Hadlock Tessa A, Malo Juan S, Cheney Mack L, Henstrom Douglas K
Facial Nerve Center, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
Arch Facial Plast Surg. 2011 May-Jun;13(3):190-4. doi: 10.1001/archfacial.2011.29.
Free muscle transfer for facial reanimation has become the standard of care in recent decades and is now the cornerstone intervention for dynamic smile reanimation. We sought to quantify smile excursion and quality-of-life (QOL) changes in our pediatric free gracilis recipients following reanimation.
We quantified gracilis muscle excursion in 17 pediatric patients undergoing 19 consecutive pediatric free gracilis transplantation operations, using our validated SMILE program, as an objective measure of functional outcome. These were compared against excursion measured the same way in a cohort of 17 adults with 19 free gracilis operations. In addition, we prospectively evaluated QOL outcomes in these children using the Facial Clinimetric Evaluation (FaCE) instrument.
The mean gracilis excursion in our pediatric free gracilis recipients was 8.8 mm ± 5.0 mm, which matched adult results, but with fewer complete failures of less than 2-mm excursion, with 2 (11%) and 4 (21%), respectively. Quality-of-life measures indicated statistically significant improvements following dynamic smile reanimation (P = .01).
Dynamic facial reanimation using free gracilis transfer in children has an acceptable success rate, yields improved commissure excursion, and improves QOL in the pediatric population. It should be considered first-line therapy for children with lack of a meaningful smile secondary to facial paralysis.
近几十年来，游离肌肉移植用于面部重建已成为标准治疗方法，目前是动态微笑重建的基石性干预措施。我们试图量化小儿游离股薄肌移植重建术后患儿的微笑幅度及生活质量（QOL）变化。
我们使用经过验证的SMILE程序，对17例接受19次连续小儿游离股薄肌移植手术的患儿的股薄肌活动幅度进行量化，作为功能结果的客观指标。将这些结果与17例接受19次游离股薄肌手术的成人队列中以相同方式测量的活动幅度进行比较。此外，我们使用面部临床测量评估（FaCE）工具对这些患儿的生活质量结果进行前瞻性评估。
我们的小儿游离股薄肌移植受者的股薄肌平均活动幅度为8.8 mm±5.0 mm，与成人结果相当，但活动幅度小于2 mm的完全失败情况较少，分别为2例（11%）和4例（21%）。生活质量测量结果表明，动态微笑重建术后有统计学意义的改善（P = 0.01）。
小儿采用游离股薄肌移植进行动态面部重建具有可接受的成功率，可改善口角活动幅度，并提高小儿群体的生活质量。对于因面瘫导致缺乏有意义微笑的儿童，应将其视为一线治疗方法。
