Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgical Program, Microsurgical Research Center, Eastern Virginia Medical School.
Plast Reconstr Surg. 2009 Dec;124(6):1891-1904. doi: 10.1097/PRS.0b013e3181bf81f6.
Most reconstructions for lower lip palsy focus on paralyzing the contralateral normal lip or providing static support on the affected side. The authors' unit has reported dynamic strategies for lower lip reanimation and use of 40 percent of the hypoglossal nerve (mini-hypoglossal) in facial reanimation. They report their experience with mini-hypoglossal nerve transfer for lower lip palsy.
Between 1987 and 2005, 29 patients with unilateral facial palsy had lower lip reanimation with the mini-hypoglossal as the motor donor. Twenty patients had transfer of the mini-hypoglossal to the cervicofacial branch of the facial nerve and nine had direct depressor muscle neurotization. Five patients had a mean denervation time of 14.60 +/- 4.50 months (<2 years), and the rest had a mean denervation time of 10.63 +/- 9.23 years. In late cases, the facial nerve was in-continuity, and preoperative needle electromyographs of depressors showed at least fibrillations. Standardized videos taken preoperatively and at 2 years postoperatively were available for 27 patients and assessed by three independent reviewers. Needle electromyographic results were analyzed.
Thirteen patients (48.15 percent) achieved excellent and good results, nine (33.33 percent) had moderate results, and five (18.52 percent) obtained fair results. The difference between the averaged preoperative and postoperative scores was statistically significant, as was the difference in electromyographic outcomes (p < 0.0001, Wilcoxon signed rank test). The nerve transfer and direct neurotization groups had no statistically significant difference in clinical and electromyographic outcomes. Four patients required muscle transfer for further outcome upgrading.
Use of the mini-hypoglossal either for nerve transfer or for direct muscle neurotization of lower lip depressors can provide reinnervation and satisfactory clinical function, even for muscles with prolonged partial denervation.
大多数下唇瘫痪的重建都集中在麻痹对侧正常唇或在患侧提供静态支撑上。作者所在单位报道了用于下唇再运动的动态策略，并在面部再运动中使用舌下神经的 40%（迷你舌下神经）。他们报告了使用迷你舌下神经转移术治疗下唇瘫痪的经验。
1987 年至 2005 年间，29 例单侧面瘫患者接受了迷你舌下神经作为运动供体的下唇再运动。20 例患者接受了迷你舌下神经向面神经颈支的转移，9 例患者接受了直接降肌神经化。5 例患者的平均失神经时间为 14.60±4.50 个月（<2 年），其余患者的平均失神经时间为 10.63±9.23 年。在晚期病例中，面神经连续存在，术前降肌针肌电图显示至少有纤颤。27 例患者术前和术后 2 年的标准化视频可用，并由 3 位独立评审员进行评估。分析了针肌电图的结果。
13 例（48.15%）患者获得了优秀和良好的结果，9 例（33.33%）患者获得了中等结果，5 例（18.52%）患者获得了尚可的结果。术前和术后平均评分的差异具有统计学意义，肌电图结果的差异也具有统计学意义（p<0.0001，Wilcoxon 符号秩检验）。神经转移组和直接神经化组在临床和肌电图结果方面无统计学差异。4 例患者需要进行肌肉转移以进一步改善结果。
使用迷你舌下神经进行神经转移或直接神经化下唇降肌，可以提供再神经支配和满意的临床功能，即使是在肌肉长时间部分失神经的情况下也是如此。
