Effect of Forward and Reverse Suturing on Nerve Regeneration Following Facial Nerve Axotomy

When the facial nerve is severed and a nerve graft is required, motor nerves are typically connected in the forward direction, while sensory nerves are connected in the reverse direction. However, there is limited research on the effects of reversing this connection, and no studies have been conducted using the same facial nerve. This study aimed to investigate the effects of forward and reverse suturing on nerve regeneration following facial nerve axotomy.

The facial nerve trunk of male Sprague Dawley rats was incised to induce facial nerve injury, and autografts were sutured using both forward and reverse methods. Behavioral tests, including whisker reflex and eye blink tests, were conducted. Histological analyses, including toluidine blue staining and transmission electron microscopy (TEM), were performed to evaluate axon recovery.

Behavioral experiments showed signs of recovery at 3-4 weeks in both the forward and reverse suture groups, with no significant differences between the two methods (p < 0.01). Histological analysis showed partial recovery by 8 weeks in both groups. Toluidine blue staining indicated a reduction in the number of axons at 4 weeks, with partial recovery at 8 weeks (p < 0.001) in both groups. TEM analysis revealed that myelin fiber thickness was restored in both the forward and reverse suture groups, though it remained thinner compared to normal (p < 0.01).

Our results suggest that the direction of nerve suturing (forward vs. reverse) does not significantly impact nerve regeneration or functional recovery. Both suturing methods demonstrated similar recovery effects, with no significant differences in microstructural regeneration. Future studies should investigate the molecular mechanisms underlying nerve regeneration and extend the observation period to provide a more comprehensive understanding of this process.