Markey Jeffrey D, Loyo Myriam
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Curr Opin Otolaryngol Head Neck Surg. 2017 Aug;25(4):265-272. doi: 10.1097/MOO.0000000000000376.
To provide an overview of the treatment options for nonflaccid facial paralysis including physical rehabilitation, botulinum toxin injection and surgical intervention. To also describe recent technique advances regarding facial synkinesis in each zone of facial movement.
Physical therapy and neuromodulation with botulinum toxin continues to be the main treatment strategy for facial synkinesis. Treating the orbicularis oculi, mentalis and platysma muscles with neurotoxin has been well described. A symmetric smile can also be improved with ipsilateral depressor anguli oris and the contralateral depressor labi inferioris weakening. Novel surgical techniques to selectively ablate specific facial muscles have also been recently described.
Nonflaccid facial paralysis is a spectrum of hypokinetic and hyperkinetic movement following facial nerve injury that is best treated in a patient-tailored graduated fashion. Novel techniques are evolving to maximize patient function while minimizing morbidity.
概述非弛缓性面神经麻痹的治疗选择，包括物理康复、肉毒毒素注射和手术干预。同时描述面部运动各区域面部联带运动的最新技术进展。
物理治疗和肉毒毒素神经调节仍是面部联带运动的主要治疗策略。用神经毒素治疗眼轮匝肌、颏肌和颈阔肌已有详细描述。通过同侧降口角肌和对侧降下唇肌减弱也可改善对称微笑。最近也描述了选择性切除特定面部肌肉的新型手术技术。
非弛缓性面神经麻痹是面神经损伤后一系列运动减少和运动亢进的表现，最好采用针对患者的分级方式进行治疗。正在不断发展新的技术，以在使发病率最小化的同时最大化患者功能。
