Hontanilla Bernardo, Cabello Alvaro
Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008 Pamplona, Spain.
J Craniomaxillofac Surg. 2016 Sep;44(9):1305-9. doi: 10.1016/j.jcms.2016.06.031. Epub 2016 Jul 9.
The current focus in dynamic reanimation of facial paralysis lies not only in restoring movement but also regaining smile spontaneity. It has been argued that a spontaneous smile can only be achieved using the contralateral facial nerve as donor via cross-face nerve grafting. Techniques based on the motor nerve to the masseter, however, have shown good rates of spontaneity as well.
Patients with complete facial paralysis reanimated using free gracilis to masseteric nerve or masseteric-to-facial nerve transfer were included. Patients were grouped according to gender comparing the rates of spontaneous smile.
Thirty-six patients (17 women and 19 men) underwent gracilis innervated by the masseteric nerve whereas masseteric-to-facial nerve transfer was performed in 30 cases (14 women and 16 men). For both techniques, women showed significantly higher rates of spontaneity. Additionally, women recovered spontaneity earlier than men.
Along with providing a strong and reliable commissural pull, the motor nerve to the masseter is able to restore spontaneity as well. Women seem more prone to achieving it. Brain plasticity and the close relationship between the cortical areas of the masseteric and facial nerves are most likely the mechanisms underlying smile spontaneity.
目前面部瘫痪动态重建的重点不仅在于恢复运动，还在于重新获得微笑的自然度。有人认为，只有通过跨面神经移植，使用对侧面神经作为供体才能实现自然微笑。然而，基于咬肌运动神经的技术也显示出了较高的自然度。
纳入使用游离股薄肌至咬肌神经或咬肌至面神经转移进行面部完全瘫痪重建的患者。根据性别对患者进行分组，比较自然微笑的发生率。
36例患者（17例女性和19例男性）接受了咬肌神经支配的股薄肌移植，30例患者（14例女性和16例男性）进行了咬肌至面神经转移。对于这两种技术，女性的自然微笑发生率显著更高。此外，女性比男性更早恢复自然微笑。
除了提供强大而可靠的口角牵拉外，咬肌运动神经也能够恢复自然度。女性似乎更容易实现这一点。大脑可塑性以及咬肌神经和面部神经皮质区域之间的密切关系很可能是微笑自然度的潜在机制。
