Pavese Chiara, Cecini Miriam, Lozza Alessandro, Biglioli Federico, Lisi Claudio, Bejor Maurizio, Dalla Toffola Elena
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy -
Eur J Phys Rehabil Med. 2016 Jun;52(3):379-88. Epub 2015 Apr 15.
After masseteric-facial nerve (V-VII) anastomosis, a new neurological circuit oversees the facial muscles and patients should learn to activate the facial movements using the masseteric function.
To monitor the rehabilitative protocol of facial muscles activation through teeth clenching and to assess the clinical evolution after V-VII anastomosis in terms of facial symmetry and functional recovery.
Case series.
Outpatients clinic.
Eleven patients undergone V-VII anastomosis for complete unilateral facial palsy.
After surgery, patients underwent a needle electromyography (EMG) and a rehabilitative training with mirror feedback to learn how to reach the symmetry at rest and during facial movements through teeth clenching. The rehabilitative protocol at the first clinical evaluation has been monitored through the Italian version of Sunnybrook Facial Grading System (SFGS) and the Software Facial Assessment by Computer Evaluation (FACE). Functional limitations and quality of life have been evaluated using the Italian version of Facial Disability Index (FDI). The clinical evolution at 18 months was evaluated with EMG, SFGS, biting evaluation and FDI.
At the first clinical evaluation after reinnervation, through teeth clenching patients displayed an improvement of symmetry at rest, symmetry of voluntary movement, symmetry of smile and composite score of SFGS. Objective measurement of facial structures with FACE system demonstrated an improvement of symmetry at rest and during smile through teeth clenching. At 18 months patients displayed a good reinnervation with a further improvement of SFGS scores and reduction of functional disability. No biting deficit has been observed.
After V-VII anastomosis, at the first rehabilitative visit, patients learn to activate the reinnervated facial muscles through teeth clenching. Eighteen months after the anastomosis, patients display a further improvement of voluntary control on facial symmetry and smile and a reduction of disability.
Our study illustrates the rehabilitative protocol after V-VII anastomosis and analyzes the clinical evolution after this intervention in terms of recovery of facial symmetry and reduction of disability. This will be instrumental to standardize the rehabilitative protocol among different centers and to choose the best patient-tailored surgical approach for subjects affected by complete facial palsy.
在咬肌-面神经（V-VII）吻合术后，一个新的神经回路负责支配面部肌肉，患者应学会利用咬肌功能来激活面部运动。
通过咬紧牙关来监测面部肌肉激活的康复方案，并从面部对称性和功能恢复方面评估V-VII吻合术后的临床进展。
病例系列。
门诊诊所。
11例因完全性单侧面瘫接受V-VII吻合术的患者。
术后，患者接受针极肌电图（EMG）检查，并进行有镜像反馈的康复训练，以学习如何通过咬紧牙关在静息状态和面部运动时达到对称性。首次临床评估时的康复方案通过意大利版的桑尼布鲁克面部分级系统（SFGS）和计算机评估面部软件（FACE）进行监测。使用意大利版面部残疾指数（FDI）评估功能受限情况和生活质量。18个月时的临床进展通过EMG、SFGS、咬合力评估和FDI进行评估。
在神经再支配后的首次临床评估中，通过咬紧牙关，患者在静息状态下的对称性、自主运动对称性、微笑对称性以及SFGS综合评分均有改善。使用FACE系统对面部结构进行客观测量显示，通过咬紧牙关，静息状态和微笑时的对称性均有改善。18个月时，患者神经再支配情况良好，SFGS评分进一步提高，功能残疾减轻。未观察到咬合力缺陷。
V-VII吻合术后，在首次康复就诊时，患者学会通过咬紧牙关来激活重新获得神经支配的面部肌肉。吻合术后18个月，患者对面部对称性和微笑的自主控制进一步改善，残疾程度减轻。
我们的研究阐述了V-VII吻合术后的康复方案，并从面部对称性恢复和残疾程度减轻方面分析了该干预后的临床进展。这将有助于规范不同中心之间的康复方案，并为完全性面瘫患者选择最佳的个体化手术方法。
