Takushima Akihiko, Harii Kiyonori, Asato Hirotaka, Yamada Atsushi
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Plast Reconstr Surg. 2002 Apr 1;109(4):1219-27. doi: 10.1097/00006534-200204010-00001.
Despite the wide spectrum of hemifacial microsomia manifestations, treatment mainly focuses on mandible and ear abnormalities, rather than on facial paralysis. In fact, the surgical treatment of facial paralysis associated with hemifacial microsomia is quite underdeveloped, because the degree of paralysis is frequently incomplete or partial. Timing and type of surgery are also difficult to determine. Neurovascular free-muscle transfer is now a standard procedure for the dynamic smile reconstruction of longstanding facial paralysis. This type of strategy has considerable potential in the treatment of facial paralysis in patients with hemifacial microsomia. We present here our experience with neurovascular free-muscle transfer for smile reconstruction in eight patients with facial paralysis associated with hemifacial microsomia. The age of the patients at the time of surgery ranged from 7 to 28 years old, (average, 13.9 years). Six were male patients and two were female patients. The two-stage method combining gracilis muscle transfer with cross-face nerve grafting was performed in three patients, whereas the one-stage transfer of the latissimus dorsi muscle was performed in five. To construct a natural or near-natural smile, the muscles were transferred into the paralyzed cheek in all except one patient, in whom the latissimus dorsi muscle was transferred into the sublabial area to reconstruct a paralyzed lower lip. A dermal flap segment vascularized with perforating vessels from the latissimus dorsi muscle was simultaneously inserted into the underdeveloped cheek for soft-tissue augmentation in this patient. Muscle contraction was evident in all patients between 4 and 8 months after muscle transfer. Our present series revealed that neurovascular free-muscle transfer is a good option not only for smile reconstruction but also for restoration of the facial contours of patients with hemifacial microsomia. Compared with the two-stage method combining gracilis muscle transfer with cross-face nerve grafting, the one-stage method using the latissimus dorsi muscle has some advantages, including a one-stage operation, a shorter recovery period, and the absence of sequelae that occur after harvesting a sural nerve.
尽管半侧颜面短小畸形的表现形式多种多样，但治疗主要集中在下颌骨和耳部异常，而非面瘫。事实上，与半侧颜面短小畸形相关的面瘫的外科治疗相当不完善，因为瘫痪程度常常是不完全或部分性的。手术时机和手术类型也难以确定。神经血管游离肌肉移植目前是长期面瘫动态微笑重建的标准手术。这种策略在治疗半侧颜面短小畸形患者的面瘫方面具有相当大的潜力。我们在此介绍我们对8例与半侧颜面短小畸形相关面瘫患者进行神经血管游离肌肉移植微笑重建的经验。手术时患者年龄在7至28岁之间（平均13.9岁）。6例为男性患者，2例为女性患者。3例患者采用股薄肌移植与跨面神经移植相结合的两阶段方法，而5例患者采用背阔肌一期移植。为构建自然或接近自然的微笑，除1例患者外，所有患者的肌肉均移植到瘫痪的脸颊，该例患者的背阔肌移植到唇下区域以重建瘫痪的下唇。在该患者中，将由背阔肌穿支血管供血的皮瓣段同时插入发育不全的脸颊以进行软组织增厚。肌肉移植后4至8个月，所有患者的肌肉收缩均明显。我们目前的系列研究表明，神经血管游离肌肉移植不仅是微笑重建的良好选择，也是半侧颜面短小畸形患者面部轮廓恢复的良好选择。与股薄肌移植与跨面神经移植相结合的两阶段方法相比，使用背阔肌的一期方法具有一些优势，包括一期手术、恢复期较短以及取腓肠神经后无后遗症。
