Balaji S M
Director and Consultant Maxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
Ann Maxillofac Surg. 2016 Jul-Dec;6(2):267-271. doi: 10.4103/2231-0746.200323.
Surgical rehabilitation of facial palsy is challenging as each case is unique and success rate is often unpredictable. In one technique, temporalis is elevated from origin preserving vessels, and this elevation increases the length which is tunneled into buccal tissues (pull-through technique, Group A). In the other technique, a harvested fascia lata is attached to temporalis after a coronoidectomy release and the fascia lata is attached to the modiolus (Group B). The aim of this study is to compare the two different surgical techniques.
Case records of 22 cases, 15 females, and 7 males who were operated between 2008 and 2012 for facial palsy with at least 1-year follow-up, using either of the techniques were assessed for pull of muscle, postoperative pain, recovery time, motor control, and symmetry at rest. Descriptive statistics are presented.
The Group A ( = 7) and Group B ( = 15) formed the study group. In the Group A, residual asymmetry ( = 3), poor postoperative muscle pull ( = 2) were noticed while in the modified group it was 2 and 3, respectively. The technique used in Group B had better pull of muscle, symmetry, faster recovery time, and better motor control at 1-year follow-up than the conventional technique.
The difference between the two groups is due to preservation of original muscular architecture, vascular channel supply. As the muscle is not traumatized, no fibrosis occurs aiding regaining of normal function. In addition, the facial reanimation is more successful in the Group B. The mechanism and success behind the technique used in Group B is discussed elaborately in terms of localregional anatomy and physiology.
面瘫的外科康复具有挑战性，因为每个病例都是独特的，成功率往往不可预测。在一种技术中，颞肌从起点处掀起并保留血管，这种掀起增加了穿入颊部组织的长度（牵拉技术，A组）。在另一种技术中，在冠状突切除松解后将切取的阔筋膜附着于颞肌，并且将阔筋膜附着于蜗轴（B组）。本研究的目的是比较这两种不同的外科技术。
评估2008年至2012年间因面瘫接受手术且至少随访1年的22例患者（15例女性和7例男性）的病例记录，这些患者使用了上述任何一种技术，评估指标包括肌肉牵拉、术后疼痛、恢复时间、运动控制和静息时的对称性。给出描述性统计结果。
A组（n = 7）和B组（n = 15）构成研究组。在A组中，观察到有残余不对称（n = 3）、术后肌肉牵拉不佳（n = 2），而在改良组中分别为2例和3例。在1年随访时，B组使用的技术比传统技术具有更好的肌肉牵拉、对称性、更快的恢复时间和更好的运动控制。
两组之间的差异归因于原始肌肉结构和血管通道供应的保留。由于肌肉未受创伤，不会发生纤维化，有助于恢复正常功能。此外，B组的面部重建更成功。从局部区域解剖学和生理学角度详细讨论了B组所用技术背后的机制和成功之处。
