Koshima Isao, Narushima Mitsunaga, Mihara Makoto, Uchida Gentaro, Nakagawa Masahiro
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ann Plast Surg. 2009 Dec;63(6):621-3. doi: 10.1097/SAP.0b013e3181955cc7.
Reconstruction for trigeminal nerve II palsy is challenging. Cross-face nerve transfer from the contralateral trigeminal nerve facilitates this reconstruction. However, the microanatomy and techniques required for nerve sutures cause problems for many surgeons. Following the recent development of supramicrosurgical techniques appropriate for the microanatomy of peripheral nerves, a new method of intraoral "cross-face nerve transfer" was successfully used for repairing trigeminal nerve II palsy. Two cases of trigeminal nerve II palsy were repaired with contralateral trigeminal nerve transfer without any nerve graft. Affected upper labial sensory recovery was 1.65 to 2.44 (Semmes-Weinstein values) and 15 to 30 mm (moving 2-point discriminations) at 1 to 1 1/2 years after surgery. The advantages of this method are excellent nerve regeneration and the lack of donor site morbidity. It is a brief and simple operation in comparison to free nerve grafts. The disadvantage is a need for a supramicrosurgical technique, using a needle less than 80 microm wide.
三叉神经Ⅱ支麻痹的重建颇具挑战性。来自对侧三叉神经的跨面神经移植有助于这种重建。然而，神经缝合所需的显微解剖结构和技术给许多外科医生带来了问题。随着适合周围神经显微解剖的超显微外科技术的最新发展，一种新的口内“跨面神经移植”方法成功用于修复三叉神经Ⅱ支麻痹。两例三叉神经Ⅱ支麻痹患者通过对侧三叉神经移植进行修复，未使用任何神经移植片。术后1至1年半时，患侧上唇感觉恢复情况为Semmes-Weinstein值1.65至2.44，两点移动辨别距离为15至30毫米。该方法的优点是神经再生良好且无供区并发症。与游离神经移植相比，这是一种简短且简单的手术。缺点是需要超显微外科技术，使用宽度小于80微米的针。
