Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgery Program, Eastern Virginia Medical School.
Plast Reconstr Surg. 2009 Nov;124(5):1486-1498. doi: 10.1097/PRS.0b013e3181b98924.
Multistage reconstructive procedures are often required to try to restore the emotional potential of human expression in cases of facial paralysis. In this study, the senior author's (J.K.T.) experience with the technique of direct nerve to muscle neurotization as a part of multistage facial reanimation procedures is presented. Age, denervation time, etiology of the lesion, previous reconstructive procedures, and types of muscles responsible for animation were analyzed to make evidence-based recommendations on the indications of the technique as well as its role and effectiveness in facial reanimation.
Retrospective review of 37 pediatric patients who underwent direct muscle neurotization took place. The patients were divided into three groups, depending on the region that direct neurotization was aiming to augment. Group A involved 28 patients for eye closure and blink, group B included 15 patients for smile, and group C included 19 patients for depressor augmentation.
Twenty patients were female and 17 male. Patient age ranged from 1 to 16 years, with a mean age (+/-SD) of 9 +/- 2.8 years. Denervation time ranged from 3 months to 15.25 years, and the mean denervation time was 6.72 years. Electromyographic scoring of the neurotized muscles showed an overall mean improvement of 36 percent for eye closure, 34.25 percent for blink, 37 percent for smile augmentation, and 30 percent for depressor function restoration.
Direct muscle neurotization has a valid role in pediatric facial reanimation procedures, as it augments and promotes expressivity.
在面瘫病例中，通常需要进行多阶段的重建手术，以尝试恢复人类表情的情感潜力。在这项研究中，作者（J.K.T.）介绍了其在多阶段面部再运动程序中使用直接神经肌肉神经再支配技术的经验。分析了年龄、去神经时间、病变病因、以前的重建程序以及负责运动的肌肉类型，以便就该技术的适应证以及在面部再运动中的作用和有效性提出循证建议。
回顾性分析了 37 名接受直接肌肉神经再支配的儿科患者。根据直接神经再支配旨在增强的区域，将患者分为三组。A 组 28 例用于闭眼和眨眼，B 组 15 例用于微笑，C 组 19 例用于降肌增强。
20 名女性和 17 名男性。患者年龄 1 至 16 岁，平均年龄（+/-SD）为 9+/-2.8 岁。去神经时间从 3 个月到 15.25 年不等，平均去神经时间为 6.72 年。神经支配肌肉的肌电图评分显示，闭眼的总体平均改善为 36%，眨眼为 34.25%，微笑增强为 37%，降肌功能恢复为 30%。
直接肌肉神经再支配在小儿面部再运动程序中具有有效的作用，因为它可以增强和促进表达力。
