Dützmann S, Marquardt G, Seifert V, Krishnan K G
Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang von Goethe Universität, Schleusenweg 2-16, 60528 Frankfurt am Main, Deutschland.
Nervenarzt. 2011 Oct;82(10):1296-301. doi: 10.1007/s00115-011-3300-0.
The aim of the study was to retrospectively analyze the functional outcomes of microneurovascular facial reanimation using the masseteric innervation.
Seventeen patients with irreparable facial paralyses resulting from benign lesions involving the facial nuclei (n=14) or Möbius syndrome (n=3) were treated with free muscle flaps for oral commissural reanimation using ipsilateral masseteric innervation and using temporalis muscle transfer for eyelid reanimation. The results were analyzed by a commissural excursion (CE) index and a patient self-evaluation score. The presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean 26.4 months).
Normalization of the CE index could be observed in 8 out of 17 patients (47%), an improvement in 7 out of 17 (41%) and failure in 2 out of 17 (12%). A natural smiling response was observed in 10 out of 17 (59%) patients. Patient self-evaluation scores were a level higher than objective indices.
Innervation of free muscle flaps with the masseteric nerve for oral commissure reanimation might play an important role in patients with long-standing facial palsy (as in Möbius syndrome). Synkinesis persists for long periods after surgery. However, most of the patients had learned to express their emotions by overcoming this phenomenon. Despite hypercorrection or inadequate correction, patients evaluate themselves favorably.
本研究旨在回顾性分析采用咬肌神经支配的微血管面部重建术的功能结果。
17例因涉及面神经核的良性病变（n = 14）或莫比乌斯综合征（n = 3）导致的不可修复性面瘫患者，采用同侧咬肌神经支配的游离肌瓣进行口角重建，并采用颞肌转移进行眼睑重建。通过口角偏移（CE）指数和患者自我评估评分对结果进行分析。记录联带运动的存在情况。随访时间为8至48个月（平均26.4个月）。
17例患者中有8例（47%）的CE指数恢复正常，7例（41%）有所改善，2例（12%）失败。17例患者中有10例（59%）观察到自然微笑反应。患者自我评估评分高于客观指标。
采用咬肌神经支配游离肌瓣进行口角重建，可能对长期面瘫患者（如莫比乌斯综合征患者）发挥重要作用。联带运动在术后长期持续存在。然而，大多数患者已学会通过克服这一现象来表达情感。尽管存在矫正过度或矫正不足的情况，但患者对自己的评价良好。
