Long Island City, N.Y.; and Norfolk, Va. From the Department of Plastic Surgery, New York University Medical Center, and the International Institute of Reconstructive Microsurgery, and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Microsurgical Research Center.
Plast Reconstr Surg. 2012 Jul;130(1):51e-66e. doi: 10.1097/PRS.0b013e318254b149.
The aim of this study was to present the authors' experience with facial reanimation in adult patients following tumor extirpation and to analyze the functional outcomes.
From 1978 to 2006, 60 adult patients underwent facial reanimation for facial paralysis following tumor extirpation. There was one patient with bilateral facial paralysis. Thus, evaluation was carried out in 61 hemifaces. Three independent assessors evaluated the preoperative and postoperative videos using the Terzis grading scale for eye closure, smile, depressor, and overall aesthetic and functional outcomes. Preoperative and postoperative electromyographic interpretations and the effect of demographic variables were also evaluated.
There was significant improvement regarding preoperative versus postoperative outcomes for overall aesthesis and function. Good and excellent results were observed in 72.14 percent of the hemifaces (n = 44). The difference between preoperative and postoperative electromyographic results was of statistical significance (p < 0.0001) for each target reinnervated. Better results were observed in younger patients (≤ 35 years) (p = 0.023) and in early cases (p = 0.019).
: The results of this present series illustrate that age and denervation time correlate with the final functional outcome. Cross-facial nerve grafts should ideally be used in patients with denervation time less than 6 months or more than 2 years combined with muscle transfers. In patients with a denervation time between 6 months and 2 years, the use of the babysitter procedure can yield a superior outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在介绍作者在成人患者肿瘤切除后进行面部再神经支配的经验，并分析其功能结果。
1978 年至 2006 年，60 例成人患者因肿瘤切除后面瘫而行面部再神经支配。有 1 例患者双侧面瘫。因此，对 61 半侧面部进行了评估。三位独立评估者使用 Terzis 分级量表对术前和术后的视频进行了眼闭合、微笑、降肌和整体美观及功能结果的评估。还评估了术前和术后肌电图的解读以及人口统计学变量的影响。
在整体美感和功能方面，术前与术后结果有显著改善。72.14%（n=44）的半侧面部获得良好和优秀结果。每个目标再神经支配的术前和术后肌电图结果差异具有统计学意义（p<0.0001）。年轻患者（≤35 岁）（p=0.023）和早期病例（p=0.019）的结果更好。
本系列研究结果表明，年龄和去神经时间与最终功能结果相关。面神经交叉吻合术应理想地用于去神经时间少于 6 个月或超过 2 年的患者，结合肌肉转移。对于去神经时间在 6 个月至 2 年之间的患者，使用保姆手术可以获得更好的结果。
临床问题/证据水平：治疗，IV。
