Catapano Joseph, Scholl David, Ho Emily, Zuker Ronald M, Borschel Gregory H
Toronto, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children; and the Department of Surgery, University of Toronto.
Plast Reconstr Surg. 2015 Sep;136(3):568-571. doi: 10.1097/PRS.0000000000001504.
Although treating facial palsy is considered debilitating for patients, trigeminal nerve palsy and sensory deficits of the face are overlooked components of disability. Complete anesthesia leaves patients susceptible to occult injury, and facial sensation is an important component of interaction and activities of daily living. Sensory reconstruction is well established in the restoration of hand sensation; however, only one previous report proposed a surgical strategy for sensory nerve reconstruction of the face with use of nerve transfers. Nerve transfers, when used alone, have limited application because of their restricted arc of rotation in the face; extending their arc by adding nerve grafts greatly expands their utility. The following cases demonstrate the early results after V2 and V3 reconstruction with cross-face nerve grafts in three patients with acquired trigeminal nerve palsy. Cross-face nerve grafts using the sural nerve permit more proximal reconstruction of the infraorbital and mental nerves, which allows reinnervation of their entire cutaneous distribution. All patients demonstrated improved sensation in the reconstructed dermatomes, and no patients reported donor-site abnormalities. Cross-face nerve grafts result in minimal donor-site morbidity and are promising as a surgical strategy to address sensory deficits of the face.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
尽管对面神经麻痹患者的治疗被认为会使其虚弱，但三叉神经麻痹和面部感觉缺陷是残疾中被忽视的部分。完全麻醉会使患者易受隐匿性损伤，而面部感觉是人际交往和日常生活活动的重要组成部分。感觉重建在手部感觉恢复方面已得到充分确立；然而，之前仅有一份报告提出了一种利用神经移位进行面部感觉神经重建的手术策略。单独使用神经移位时，由于其在面部的旋转弧受限，应用有限；通过添加神经移植物来延长其弧长可大大扩展其效用。以下病例展示了在三名获得性三叉神经麻痹患者中使用跨面神经移植物进行V2和V3重建后的早期结果。使用腓肠神经的跨面神经移植物可实现眶下神经和颏神经更接近端的重建，从而使其整个皮肤分布区域重新获得神经支配。所有患者在重建皮节中的感觉均有改善，且无患者报告供区异常。跨面神经移植物导致的供区发病率极低，作为解决面部感觉缺陷的手术策略很有前景。
临床问题/证据水平：治疗性，V级
