Biglioli F, Bayoudh W, Colombo V, Pedrazzoli M, Rabbiosi D
Maxillo-Facial Surgical Unit, San Paolo Hospital, University of Milan, via A. di Rudini 8, 20142 Milano, Italie.
Ann Chir Plast Esthet. 2013 Apr;58(2):89-95. doi: 10.1016/j.anplas.2012.12.001. Epub 2013 Jan 11.
The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers.
In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients.
No failure was observed. The average delay of a voluntary contraction was 3.8months, and 7.2months for a spontaneous one. Three of the six patients had "excellent" results according to the Terzis and Noah classification, two were classified as "good" and one "average".
A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand.
This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.
面瘫是一种并不罕见的病症，会对功能、形态及心理造成严重的致残性影响。目前面部重建的金标准是带血管神经蒂的肌肉移植。
在本文中，我们报告了一种新方法的结果，该方法是在6例患者中通过单阶段手术，采用股薄肌瓣经腓肠神经移植，同时与咬肌运动神经和对侧面神经进行双神经支配。
未观察到失败病例。自主收缩的平均延迟时间为3.8个月，自发收缩为7.2个月。根据特尔齐斯（Terzis）和诺亚（Noah）分类，6例患者中有3例结果“优秀”，2例为“良好”，1例为“中等”。
在提倡自然自发动态性（对侧面神经刺激）的方法和注重收缩质量与数量（同侧三叉神经刺激）的方法之间需要做出选择。在这项新技术中，我们将两种方法结合起来：一方面是通过腓肠神经移植对健康的对侧面神经进行双神经支配的游离股薄肌移植，另一方面是在同侧咬肌神经上进行二次吻合。
根据我们的结果，这种新提出的方法似乎是一种可靠的技术，能够恢复自主收缩和情感性微笑。
