Kochhar Amit, Albathi Monirah, Sharon Jeffrey D, Ishii Lisa E, Byrne Patrick, Boahene Kofi D
Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
JAMA Facial Plast Surg. 2016 Sep 1;18(5):370-8. doi: 10.1001/jamafacial.2016.0514.
The hypoglossal nerve has long been an axonal source for reinnervation of the paralyzed face. In this study, we report our experience with transposition of the intratemporal facial nerve to the hypoglossal nerve for facial reanimation.
To determine the feasibility and outcomes of the transposition of the infratemeporal facial nerve for end-to-side coaptation to the hypoglossal nerve for facial reanimation.
DESIGN, SETTINGS, AND PARTICIPANTS: A case series of 20 patients with facial paralysis who underwent mobilization and transposition of the intratemporal segment of the facial nerve for an end-to-side coaptation to the hypoglossal nerve (the VII to XII technique). Participants were treated between January 2007 and December 2014 at a tertiary care center.
Outcome measures include paralysis duration, facial tone, facial symmetry at rest, and with smile, oral commissure excursion, post-reanimation volitional smile, and synkinesis.
Demographic data, the effects of this technique on facial tone, symmetry, oral commissure excursion and smile recovery were evaluated. Preoperative and postoperative photography and videography were reviewed. Facial symmetry was assessed with a facial asymmetry index. Smile outcomes were evaluated with a visual smile recovery scale, and lip excursion was assessed with the MEEI-SMILE system.
All 20 patients had adequate length of facial nerve mobilized for direct end-to-side coaptation to the hypoglossal nerve. The median duration of facial paralysis prior to treatment was 11.4 months. Median follow-up time was 29 months. Three patients were excluded from functional analysis due to lack of follow-up. Facial symmetry at rest and during animation improved in 16 of 17 patients. The median (range) time for return of facial muscle tone was 7.3 (2.0-12.0) months. A significant reduction in facial asymmetry index occurred at rest and with movement. The MEEI FACE-gram software detected a significant increase in horizontal, vertical, overall lip excursion and smile angle. No patient developed significant tongue atrophy, impaired tongue mobility, or speech or swallow dysfunction.
Mobilization of the intratemporal segment of the facial nerve provides adequate length for direct end-to-end coaptation to the hypoglossal nerve and is effective in restoring facial tone and symmetry after facial paralysis. The resulting smile is symmetric or nearly symmetric in the majority of patients with varying degree of dental show. The additional length provided by utilizing the intratemporal segment of the facial nerve reduces the deficits associated with complete hypoglossal division/splitting, and avoids the need for interposition grafts and multiple coaptation sites.
舌下神经长期以来一直是用于修复面瘫面部的轴突来源。在本研究中，我们报告了将颞内面神经转位至舌下神经进行面部重建的经验。
确定将颞下面神经转位至舌下神经进行端侧吻合以实现面部重建的可行性和效果。
设计、地点和参与者：一项病例系列研究，纳入20例面瘫患者，他们接受了颞内段面神经的游离和转位，以与舌下神经进行端侧吻合（VII至XII技术）。参与者于2007年1月至2014年12月在一家三级医疗中心接受治疗。
结局指标包括面瘫持续时间、面部肌张力、静息时面部对称性、微笑时面部对称性、口角偏移、重建后自主微笑以及联带运动。
评估人口统计学数据，以及该技术对面部肌张力、对称性、口角偏移和微笑恢复的影响。回顾术前和术后的照片及视频。使用面部不对称指数评估面部对称性。使用视觉微笑恢复量表评估微笑效果，使用MEEI-SMILE系统评估唇部偏移。
所有20例患者的面神经游离长度均足够，可直接与舌下神经进行端侧吻合。治疗前面瘫的中位持续时间为11.4个月。中位随访时间为29个月。3例患者因缺乏随访而被排除在功能分析之外。17例患者中有16例静息和活动时的面部对称性得到改善。面部肌肉张力恢复的中位（范围）时间为7.3（2.0 - 12.0）个月。静息和活动时面部不对称指数显著降低。MEEI FACE-gram软件检测到水平、垂直、整体唇部偏移和微笑角度显著增加。没有患者出现明显的舌萎缩、舌运动障碍或言语或吞咽功能障碍。
颞内段面神经的游离可为与舌下神经直接端端吻合提供足够长度，并且在面瘫后恢复面部肌张力和对称性方面有效。在大多数有不同程度牙齿暴露的患者中，由此产生的微笑是对称或近乎对称的。利用颞内段面神经提供的额外长度减少了与舌下神经完全切断/劈开相关的缺陷，并且避免了使用移植体和多个吻合部位的需要。
4级。
