title: Concepts in Neural Coaptation: Using the Facial Nerve as a Paradigm in Understanding Principles Surrounding Nerve Injury and Repair.
abstract: OBJECTIVE
  Individuals with nerve transection face unpredictable outcomes, and microsurgical interventions have variable success. The facial nerve in particular is prone to traumatic transection and leads to debilitating sequelae. Surgeons have used multiple modalities of enhancing nerve regeneration and restoring premorbid functionality. The success of nerve regeneration is predicated on multiple physiologic factors. This article sought to collate the literature on factors influencing nerve damage and repair, using the facial nerve as a paradigm. As such, facial reanimation will also be briefly discussed as it relates to the central theme.
  
  
  METHODS
  A PubMed search was conducted to find articles published on nerve physiology and anatomy, as well as repair. Articles from 1947 to 2013 were studied; however, the preponderance of articles in the study was from the past 15 years to include recent advances.
  
  
  RESULTS
  The type and severity of nerve injury, as well as timing of intervention, influence the anatomical and functional outcomes of nerve repair. As there is no uniform solution for all reconstructive challenges, multiple factors must be considered when planning an intervention. Future advances suggest a potential role for engineered nerve conduits in providing a tool for nerve regrowth.
  
  
  CONCLUSIONS
  Our review has detailed mechanisms of nerve injury, physiology, interventions in nerve repair, and future direction of this expanding field. This review provides a guide for the microsurgeon in factors involved in restorative success.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary-Mount Sinai Health System, New York, NY †Department of Neuroscience, University of Maryland School of Medicine, Baltimore, MD ‡Department of Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, New York, NY.
authors.forename: Sameep
authors.initials: S
authors.lastname: Kadakia
authors.forename: Samuel
authors.initials: S
authors.lastname: Helman
authors.forename: Masoud
authors.initials: M
authors.lastname: Saman
authors.forename: Nisha
authors.initials: N
authors.lastname: Cooch
authors.forename: Donald
authors.initials: D
authors.lastname: Wood-Smith
mesh_terms: D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009416:Nerve Regeneration / Q000502:physiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020196:Trauma, Nervous System / Q000601:surgery