Chuang D C, Wei F C, Noordhoff M S
Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taiwan, Republic of China.
Ann Plast Surg. 1989 Jul;23(1):56-65. doi: 10.1097/00000637-198907000-00010.
Reanimation of the face following facial nerve paralysis, especially the socially important smile, presents a complex surgical challenge requiring an individualized approach. Both neural and non-neural operative procedures have been used in an attempt to achieve the goal of a symmetrical synchronous smiling expression. A retrospective review of the results of both neural and nonneural methods was made to determine the relative efficacy of various methods. Of the neural techniques, early direct nerve repair primarily consistently achieved the best functional recovery. Double nerve grafts were found to be superior to a single nerve graft in nerve severance with a nerve gap at the facial nerve trunk bifurcation in delayed cases. In long-standing cases, ipsilateral or cross-face nerve grafting followed by functioning muscle transfer gives the most acceptable synchronous smile. Although cross-face nerve graft only, hypoglossal facial transfer, or non-neural techniques such as temporal muscle transfer achieved restoration of the smile, their inconsistent results and asynchronous action still limited the patient's confidence in social interactions.
面神经麻痹后面部的重建，尤其是具有重要社交意义的微笑，是一项复杂的外科挑战，需要个体化的方法。神经和非神经手术方法都曾被用于尝试实现对称同步微笑表情的目标。对神经和非神经方法的结果进行了回顾性分析，以确定各种方法的相对疗效。在神经技术中，早期直接神经修复主要始终能实现最佳功能恢复。在延迟病例中，当面神经干分叉处存在神经间隙且神经离断时，发现双神经移植优于单神经移植。在长期病例中，同侧或跨面神经移植后进行功能性肌肉转移可带来最可接受的同步微笑。虽然仅进行跨面神经移植、舌下-面神经转移或颞肌转移等非神经技术也能实现微笑的恢复，但其结果不一致且动作不同步，仍然限制了患者在社交互动中的信心。
