Silvestri A, Mariani G, Vernucci R A
Department of Orthodontics, Rome 'La Sapienza' University, Italy.
Eur J Paediatr Dent. 2008 Dec;9(4):175-82.
The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency.
Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit.
Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement.
Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal.
The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.
面神经下颌缘支麻痹可能发生在半侧颜面短小畸形（HM）中；HM与麻痹并存会导致下颌体伸长。本研究探讨神经功能缺损、肌肉张力缺失与结构缺陷之间的可能相关性。
在罗马大学（萨皮恩扎）外科正畸科就诊的58例HM患者中，4例患有半侧颜面短小畸形及下颌缘支神经麻痹；这些患者接受了体格、神经、眼科和全身检查。然后对结果进行分析，以确定神经肌肉和结构缺陷之间的可能相关性。
进行神经电图和肌电图检查，以评估面神经和肌肉的受累情况。
神经电图检查显示，HM同侧的面神经运动神经纤维受损，同时伴有肌肉功能损害，而健康侧的神经肌肉功能正常。
周围神经和肌肉功能缺损会影响面部软组织功能和下颌体生长，表现为不对称，特征为下颌支发育不全（由于HM）和下颌体伸长（由于下颌缘支神经麻痹），因此颏部偏斜与HM相反。在这些病例中，有必要进行神经检查以评估HM侧的神经损伤。神经肌肉功能缺损也可能导致外科正畸治疗后出现复发倾向。
