van Veen Martinus M, Dijkstra Pieter U, Werker Paul M N
University of Groningen, University Medical Centre Groningen, Department of Plastic Surgery, Groningen, The Netherlands.
University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Oral and Maxillofacial Surgery, Groningen, The Netherlands.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1666-1674. doi: 10.1016/j.bjps.2017.06.002. Epub 2017 Jun 10.
Nerve reconstructions are the preferred technique for short-standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve provides a strong motor signal, whereas the signal of a cross-face nerve graft is weaker but spontaneous. Spontaneity in facial expression is believed to be important for psychological wellbeing. Therefore, a combination of the two procedures incorporates the best of both: a strong motor signal and a spontaneous smile. This study aimed to objectify this expected benefit. Of the 20 patients who received a hypoglossal-facial nerve anastomosis from 1995 to 2015 in our institutions, 12 patients were included in this study, 5 with and 7 without a cross-face nerve graft. The outcomes were compared using photographs, disease-specific quality of life (Facial Clinimetric Evaluation (FaCE) scale), a self-reported synkinesis scale (Synkinesis Assessment Questionnaire) and the presence of a spontaneous smile. Significant differences were found in preoperative excursion of the affected side of the mouth and the change in excursion. Median Total FaCE scores were considerably larger (18.3 points) for patients who underwent the combined procedure. A spontaneous smile was observed both with (n = 2) and without (n = 1) a cross-face nerve graft. The addition of a cross-face nerve graft to a hypoglossal-facial nerve anastomosis resulted in a positive trend in disease-specific quality of life. This benefit could also be present with the combination of a cross-face nerve graft with another nerve transfer such as a masseteric-facial nerve anastomosis.
神经重建是短期面瘫的首选技术，最常用的是对侧面神经或同侧舌下神经。舌下神经提供强烈的运动信号，而跨面神经移植的信号较弱但具有自发性。面部表情的自发性被认为对心理健康很重要。因此，两种手术方法相结合可以兼取二者之长：强烈的运动信号和自然的微笑。本研究旨在证实这一预期益处。1995年至2015年在我们机构接受舌下神经-面神经吻合术的20例患者中，12例纳入本研究，其中5例进行了跨面神经移植，7例未进行。通过照片、疾病特异性生活质量（面部临床评估（FaCE）量表）、自我报告的联带运动量表（联带运动评估问卷）和自然微笑的情况对结果进行比较。发现患侧口角术前移动度和移动度变化存在显著差异。接受联合手术的患者FaCE总分中位数明显更高（18.3分）。在进行（n = 2）和未进行（n = 1）跨面神经移植的患者中均观察到自然微笑。在舌下神经-面神经吻合术中增加跨面神经移植可使疾病特异性生活质量呈积极趋势。跨面神经移植与其他神经转移术（如咬肌-面神经吻合术）相结合也可能有此益处。
