Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milan, Italy.
Surgical Unit of Maxillo-Facial Surgery, San Paolo Hospital, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy.
J Plast Reconstr Aesthet Surg. 2014 Oct;67(10):1378-86. doi: 10.1016/j.bjps.2014.05.039. Epub 2014 Jun 2.
Facial paralysis is a severe pathological condition, negatively affecting patients' quality of life. The altered tone and mobility of the mimetic musculature provoke both functional and morphological deficits. In the present study, we longitudinally measured facial movements in 14 patients (21-69 years) affected by unilateral facial paralysis not lasting longer than 23 months. The patients were analyzed before and after surgical masseteric to facial nerve neurorrhaphy. Examinations were performed at least 3 months after they had clinically started to regain facial mimicry. The displacement of selected facial landmarks was measured using an optoelectronic three-dimensional motion analyzer during: maximum smile without clenching (pre- and postsurgery), maximum smile by clenching on their posterior teeth (only postsurgery), and spontaneous smile (recorded during the vision of a funny video in both examinations). Before facial surgery, in all smiles facial landmarks moved more in the healthy than in the paretic side; after surgery, the differences decreased for both reduction of the healthy-side motion, and increment of the paretic-side motion (motion ratio before 52%, after 87%, p < 0.05, Students' t-test). The ratio between the paretic and healthy-side total motion (asymmetry) did not modify for maximum and spontaneous smiles, but significantly increased for the maximum smiles made with teeth clenching (asymmetry before 32%, after 11%, p < 0.001). Spontaneous smiles were recorded only in a subset of patients, but their execution was modified by surgery, with more symmetrical movements of the rehabilitated-side landmarks (asymmetry before 33%, after 10%), and reduced motion of the healthy-side ones (motion ratio before 51%, after 83%). In conclusion, the significant asymmetry in the magnitude of facial movements that characterized the analyzed patients before surgery reduced after surgery, at least in those facial areas interested by the masseteric to facial nerve reanimation.
面瘫是一种严重的病理状况，会降低患者的生活质量。表情肌的张力和运动功能改变会导致功能和形态缺陷。在本研究中，我们对 14 名（21-69 岁）单侧面瘫患者进行了纵向研究，这些患者的面瘫持续时间不超过 23 个月。在接受手术治疗（咬肌-面神经吻合术）前后对患者进行分析。在他们开始临床恢复面部表情后至少 3 个月进行检查。在无咬牙最大微笑（术前和术后）、咬牙最大微笑（仅术后）和自发微笑（在两次检查中观看有趣视频时记录）期间，使用光电三维运动分析系统测量选定的面部标志点的位移。在术前所有微笑中，健康侧的面部标志点移动幅度均大于患侧；术后，健康侧运动减少，患侧运动增加，差异减小（术前运动比 52%，术后 87%，p<0.05，学生 t 检验）。最大和自发微笑时，患侧和健侧总运动的比值（不对称性）没有改变，但咬牙最大微笑时明显增加（术前不对称性 32%，术后 11%，p<0.001）。自发微笑仅在一部分患者中记录，但手术改变了它们的执行，使患侧标志点的运动更对称（术前不对称性 33%，术后 10%），健侧标志点的运动减少（术前运动比 51%，术后 83%）。总之，术前分析患者存在的面部运动幅度的显著不对称性在术后至少在咬肌-面神经再神经支配区域减小。
