Boahene Kofi
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland.
Facial Plast Surg. 2015 Apr;31(2):103-9. doi: 10.1055/s-0035-1549043. Epub 2015 May 8.
Facial paralysis following acoustic neuroma (AN) resection can be devastating, but timely and strategic intervention can minimize the resulting facial morbidity. A central strategy in reanimating the paralyzed face after AN resection is to restore function of the native facial muscles using available facial nerves or repurposed cranial nerves, mainly the hypoglossal or masseter nerves. The timing of reinnervation is the single most influential factor that determines outcomes in facial reanimation surgery. The rate of recovery of facial function in the first 6 months following AN resection may be used to predict ultimate facial function. Patients who show no signs of recovery in the first 6 months, even when their facial nerves are intact, recover poorly and are candidates for early facial reinnervation. With delay, facial muscles become irreversibly paralyzed. Reanimation in irreversible paralysis requires the transfer of functional muscle units such as the gracilis or the temporalis muscle tendon unit.
听神经瘤（AN）切除术后的面瘫可能是毁灭性的，但及时且策略性的干预可将由此导致的面部功能障碍降至最低。听神经瘤切除术后恢复面瘫功能的核心策略是利用可用的面神经或重新利用颅神经（主要是舌下神经或咬肌神经）来恢复面部肌肉的功能。神经再支配的时机是决定面部功能重建手术结果的最具影响力的单一因素。听神经瘤切除术后头6个月内面部功能的恢复速度可用于预测最终的面部功能。即使面神经完好无损，但在头6个月内没有恢复迹象的患者，恢复情况较差，是早期面部神经再支配的候选对象。随着时间延迟，面部肌肉会发生不可逆的麻痹。对于不可逆性麻痹的功能重建需要转移功能性肌肉单元，如股薄肌或颞肌肌腱单元。
