Harris Brianna N, Tollefson Travis T
Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, California, USA.
Curr Opin Otolaryngol Head Neck Surg. 2015 Oct;23(5):399-406. doi: 10.1097/MOO.0000000000000193.
The purpose of this article is to review and evaluate the surgical options for treating patients with facial paralysis, covering primary neurorrhaphy to facial reanimation, with microvascular free tissue transfer.
In recent years, free tissue transfer has been increasingly common for rehabilitating the paralyzed face, providing a more dynamic and aesthetic outcome, than has been possible prior to microvascular surgery in facial plastic and head and neck surgery.
Although primary facial nerve repair attains the best results, nerve grafting with the sural nerve and commercially available motor nerve allografts can be used alone, or in combination with masseteric nerve grafts to attain facial tone and protect eyelid function. The workhorse for reanimation is the gracilis free tissue transfer innervated by the masseteric nerve or contralateral facial nerve using a cross-face nerve graft. The orthodromic temporalis tendon transfer has minimal donor site morbidity and acceptable reported outcomes. Static procedures continue to be used alone and in combination with other paradigms for facial nerve reanimation.
本文旨在回顾和评估治疗面瘫患者的手术选择，涵盖从原发性神经缝合到面部重建以及微血管游离组织移植。
近年来，游离组织移植在面瘫修复中越来越普遍，相较于面部整形和头颈外科微血管手术之前，它能提供更具动态和美观的效果。
尽管原发性面神经修复效果最佳，但腓肠神经移植和市售运动神经异体移植可单独使用，或与咬肌神经移植联合使用以恢复面部张力并保护眼睑功能。面部重建的主力术式是使用咬肌神经或通过跨面神经移植的对侧面神经支配的股薄肌游离组织移植。顺行颞肌腱转移供区并发症最少，报道的效果也可接受。静态手术仍单独或与其他面神经重建方法联合使用。
