Anat Cell Biol.  2011 Mar;44(1):1-7. 10.5115/acb.2011.44.1.1.

Clinical and anatomical approach using Sihler's staining technique (whole mount nerve stain)

• Won SY
• Kim DH
• Yang HM
• Park JT
• Kwak HH
• Hu KS
• Kim HJ

• KMID: 2168862
• DOI: http://doi.org/10.5115/acb.2011.44.1.1

Abstract

Sihler's staining allows visualization of the nerve distribution within soft tissues without extensive dissection and does not require slide preparation, unlike traditional approaches. This technique can be applied to the mucosa, muscle, and organs that contain myelinated nerve fibers. In particular, Sihler's technique may be considered the best tool for observing nerve distribution within skeletal muscles. The intramuscular distribution pattern of nerves is difficult to observe through manual manipulation due to the gradual tapering of nerves toward the terminal end of muscles, so it should be accompanied by histological studies to establish the finer branches therein. This method provides useful information not only for anatomists but also for physiologists and clinicians. Advanced knowledge of the nerve distribution patterns will be useful for developing guidelines for clinicians who perform operations such as muscle resection, tendon transplantation, and botulinum toxin injection. Furthermore, it is a useful technique to develop neurosurgical techniques and perform electrophysiological experiments. In this review, Sihler's staining technique is described in detail, covering its history, staining protocol, advantages, disadvantages, and possible applications. The application of this technique for determining the arterial distribution pattern is also described additionally in this study.

Keyword

Review; Sihler's staining; Whole mount nerve staining; Nerve; Artery

MeSH Terms

Anatomists
Arteries
Botulinum Toxins
Humans
Mucous Membrane
Muscle, Skeletal
Muscles
Nerve Fibers, Myelinated
Tendons
Transplants
Botulinum Toxins

Figure

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  Fig. 1 The appearance of the muscle which is changed through Sihler's staining described every stage. A: Fixed specimen, B: Macerated specimen, C: Stained specimen (intramuscular nerve distribution of the masseter muscle for botulinum toxin injection. Reproduced from J Craniofac Surg 2010;21:588-91, with permission) [13].

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  Fig. 2 For observing the exact distribution of the buccal nerve and its anatomical relationship with mental nerve and infraorbital nerve which is innervating the oral mucosa applied a Sihler's staining (Sihler's-staining study of buccal nerve distribution and its clinical implications, focusing on its relationship with adjacent sensory nerves in the angular area of the mouth. Reproduced from J Craniofac Surg Submitted, with permission).

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  Fig. 3 For observing the intramuscular distribution of masseteric nerve innervating the masseter muscle applied a Sihler's staining (intramuscular nerve distribution of the masseter muscle for botulinum toxin injection. Reproduced form J Craniofac Surg 2010;21:588-91, with permission) [13].

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  Fig. 4 For observing the intramuscular distribution of deep temporal nerve innervating the temporalis muscle which is divided into three portions as regards topographical shape applied a Sihler's staining.

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  Fig. 5 For finding the region as near as possible to the neuromuscular synapses in a forearm muscles applied a Sihler's staining (intramuscular nerve distribution of the masseter muscle for botulinum toxin injection. Reproduced from Am J Phys Med Rehabil 2010;89:644-52, with permission) [21].

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  Fig. 6 For observing the intramuscular branching pattern and arborizing area of hip adductor muscle with reference to surface landmarks of the thigh applied a Sihler's staining (This research is in the middle of writing an article. Reproduced with permission).

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  Fig. 7 For observing the intramuscular nerve distribution innervating the triceps surae muscles applied a Sihler's staining (extra- and intramuscular nerves distributions of the triceps surae muscle as a basis for muscle resection and botulinum toxin injections. Reproduced form Surg Radiol Anat 2009;31:615-21, with permission) [37].

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  Fig. 8 For observing the accurate courses of main trunk of greater palatine artery with reference to cevix of individual teeth was used only in step 2 of Sihler's staining (This research is in the middle of writing an article. Reproduced with permission).

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