Leonetti John P, Zender Chad A, Vandevender Daryl, Marzo Sam J
Department of Otolaryngology-Head and Neck Surgery, Loyola Center for Cranial Base Surgery, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
Ear Nose Throat J. 2008 Apr;87(4):226-9, 233.
We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve-sural nerve graft, and lower facial movement was achieved through proximal facial nerve-long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper- and lower-division reanimation.
我们在我们的三级医疗学术医学中心进行了一项回顾性病例审查，以评估3例患者接受微血管游离组织移植实现面部再运动的长期结果。这些患者接受了广泛的腮腺切除术并切除了面神经。通过近端面神经-腓肠神经移植实现了上半面部再运动，通过近端面神经-胸长神经（锯肌）吻合实现了下半面部运动。根据House-Brackmann系统对面神经功能进行术后分级来确定结果。所有3例患者都能够独立于下半面部运动闭上眼睛，并且所有3例患者都达到了House-Brackmann III级功能。我们得出结论，微血管游离组织移植使瘫痪面部恢复运动，在广泛的腮腺切除术后提供了解剖覆盖和模仿功能。通过分离上下分支再运动可减少联带运动。
