Horta Ricardo, Correia-Sá Inês, Nascimento Ricardo, Silva Alvaro, Amarante José
Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar de São João, Faculty of Medicine-Porto University, Alameda Professor Hernâni Monteiro, Porto, Portugal.
J Craniofac Surg. 2016 Nov;27(8):2143-2145. doi: 10.1097/SCS.0000000000002970.
Free muscle flap transfer is currently the procedure of choice for longstanding facial paralysis to restore symmetry both at rest and when smiling. However, movements obtained are generally localized, unidirectional, and philtrum centralization and lower lip movement is not proportionally achieved. The stability of free flap insertion at the lips also interferes with the results, as gradual disinsertion and shifting of the nasolabial fold can be caused by repetitive movements. Asymmetry of smile can also be caused by lip depressor inactivity due to marginal mandibular paralysis, and both dynamic and static procedures are often required after dynamic reanimation. Here, the authors report a technical refinement that can be used even years after facial reanimation, using concealed scars and with minimal morbidity for correction of static and dynamic labial deviations from the midline. Placement of a transfixed tendon graft in C-fashion tendon graft between the gracilis free flap and the orbicularis oris of the upper and lower lip on the nonparalyzed side allows the forces from muscle contraction to be transferred to the philtrum and lower lip. It allows correction of static and dynamic labial deviations from the midline, reducing rates of inadequate fixation and partial or total disinsertion of the muscle flap in the buccal region.
目前，游离肌瓣转移术是治疗长期面瘫以恢复静息和微笑时面部对称性的首选方法。然而，所获得的运动通常是局部的、单向的，人中集中和下唇运动无法按比例实现。游离瓣在唇部植入的稳定性也会影响手术效果，因为重复运动会导致鼻唇沟逐渐脱离植入部位并移位。由于下颌缘支麻痹导致降唇肌活动不足，也会引起微笑不对称，动态重建后通常需要同时进行动态和静态手术。在此，作者报告了一种技术改进方法，即使在面部重建多年后也可使用，通过隐蔽的瘢痕，且矫正静态和动态唇部中线偏差的发病率最低。在健侧股薄肌游离瓣与上下唇口轮匝肌之间呈C形放置贯穿固定的肌腱移植片，可使肌肉收缩产生的力量传递至人中及下唇。它能够矫正静态和动态唇部中线偏差，降低颊部区域肌瓣固定不充分及部分或完全脱离植入部位的发生率。
