Viterbo Fausto, Romão Adriana, Brock Ryane Schmidt, Joethy Janna
São Paulo State University, Julio de Mesquita Filho, UNESP, Rua Domingos Minicucci Filho, 587, Botucatu, São Paulo, 18607-030, Brazil,
Aesthetic Plast Surg. 2014 Aug;38(4):788-95. doi: 10.1007/s00266-014-0357-8. Epub 2014 Jun 19.
Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.
Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.
There was significant improvement in smile symmetry in 89.5 % of patients.
Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.
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对于面瘫6个月或更长时间且无临床或肌电图改善证据的患者，采用顺行颞肌转移联合端侧跨面神经移植已成功实现面部再运动。颞肌附着点从下颌骨冠状突松解，缝合至阔筋膜移植片，该移植片在远端固定于口角和麻痹的半侧唇部。颞肌的顺行转移克服了因颞肌中部向下翻转（吉利斯手术）所产生的颞部凹陷畸形和颧部丰满，同时产生更强的肌肉收缩和更对称的微笑。肌瓣与跨面腓肠神经移植联合，采用端侧神经缝合，将有髓运动纤维导入中面部和口周区域的面部表情麻痹肌肉。跨面神经移植为真正的自发面部运动提供了可能。我们认为，这些技术联合所产生的协同作用或许能比单独使用任何一种手术产生更对称、更同步的微笑。
19例患者接受了顺行颞肌瓣联合跨面（颊 - 颊端侧神经缝合）神经移植。为评估微笑的对称性，我们使用CorelDRAW X3软件测量了两侧半侧唇部（正常侧和患侧）的长度。在术前和术后进行测量，并比较其对称性。
89.5%的患者微笑对称性有显著改善。
顺行颞肌转移联合跨面神经移植产生协同效应，常能产生美观、对称的微笑。
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