Frey M, Michaelidou M, Tzou C-H J, Hold A, Pona I, Placheta E
Medizinische Universität Wien, Klinische Abteilung für Plastische und Rekonstruktive Chirurgie, Währinger Gürtel 18-20, Vienna, Austria.
Handchir Mikrochir Plast Chir. 2010 Apr;42(2):81-9. doi: 10.1055/s-0029-1239590. Epub 2010 Feb 22.
This overview on the currently most effective reconstructive techniques for reanimation of the unilaterally or bilaterally paralysed face includes all important techniques of neuromuscular reconstruction as well as of supplementary static procedures, which contribute significantly to the efficiency and quality of the functional overall result. Attention is paid to the best indications at the best time since onset of the facial palsy, depending on the age of the patient, the cause of the lesion, and the compliance of the patient for a long-lasting and complex rehabilitation programme. Immediate neuromuscular reconstruction of mimic function is favourable by nerve suture or nerve grafting of the facial nerve, or by using the contralateral healthy facial nerve via cross-face nerve grafting as long as the time since onset of the irreversible palsy is short enough that the paralysed mimic muscles can still be reinnervated. For the most frequent indication, the unilateral irreversible and complete palsy, a three-stage concept is described including cross-face nerve grafting, free functional gracilis muscle transplantation, and several supplementary procedures. In patients with limited life expectancy, transposition of the masseteric muscles is favoured. Bilateral facial palsy is treated by bilateral free gracilis muscle transplantation with the masseteric nerve branches for motor reinnervation. Functional upgrading in incomplete lesions is achieved by cross-face nerve grafting with distal end-to-side neurorrhaphy or by functional muscle transplantation with ipsilateral facial nerve supply.
这篇关于目前用于单侧或双侧面瘫面部重建最有效技术的综述，涵盖了神经肌肉重建以及辅助静态手术的所有重要技术，这些技术对整体功能效果的效率和质量有显著贡献。根据患者年龄、病变原因以及患者对长期复杂康复计划的依从性，关注面瘫发病后最佳时机的最佳适应症。只要不可逆性面瘫发病后的时间足够短，以至于瘫痪的表情肌仍可重新获得神经支配，通过面神经缝合或神经移植，或通过跨面神经移植使用对侧健康面神经，对面部表情功能进行即刻神经肌肉重建是有利的。对于最常见的适应症，即单侧不可逆性完全性面瘫，描述了一个三阶段概念，包括跨面神经移植、游离功能性股薄肌移植以及一些辅助手术。对于预期寿命有限的患者，咬肌转位是首选。双侧面瘫通过双侧游离股薄肌移植并带有咬肌神经分支进行运动再支配来治疗。不完全性病变的功能提升可通过跨面神经移植并采用远端端侧神经缝合，或通过同侧面神经供应的功能性肌肉移植来实现。
