Department of Facial Plastic Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston.
JAMA Facial Plast Surg. 2018 Mar 1;20(2):148-153. doi: 10.1001/jamafacial.2017.1425.
Creation of symmetrical nasolabial folds (NLFs) is important in the management of the paralyzed face. Established techniques use a linear incision in the NLF, and technical refinements now allow the linear incision to be omitted.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series was conducted in a tertiary care setting from February 2, 2017, to June 7, 2017. Participants were all patients (N = 21) with peripheral facial paralysis who underwent NLF modification that used the minimal nasolabial incision technique at the Massachusetts Eye and Ear Infirmary Facial Nerve Center from February 1, 2015, through August 31, 2016.
Patient-reported outcome measures using the validated, quality-of-life Facial Clinimetric Evaluation (FaCE) Scale; clinician-reported facial function outcomes using a validated electronic clinician-graded facial paralysis assessment (eFACE); layperson assessment of the overall aesthetic outcome of the NLF; and expert-clinician scar assessment of the NLF.
Of the 21 patients who underwent NLF modification that used the minimal nasolabial incision technique, 9 patients (43%) were female and 12 (57%) were male. The mean age was 41 (range, 9-90) years; 17 patients (81%) were adults (≥18 years) and 4 (19%) were children (<18 years). Overall, significant improvements were observed after NLF modification in all outcome measures as graded by both clinicians and patients. The mean (SD) scores for total eFACE were 60.7 (14.9) before the operation and 77.2 (8.9) after the operation (mean difference, 16.5 [95% CI, 8.5-24.2]; P < .001). The mean (SD) static eFACE scores were 61.4 (20.6) before the operation and 82.7 (12.4) after the operation (mean difference, 21.3 [95% CI, 10.7-31.9]; P < .001). The mean (SD) FaCE quality-of-life scores were 51.3 (20.1) before the operation and 70.3 (12.6) after the operation (mean difference, 19.0 [95% CI, 6.5-31.6]; P = .001). The layperson self-assessment of the overall aesthetic outcome of the NLF modification was higher among the group who had the minimal nasolabial incision than it was for the group who had a historical nasolabial incision (mean [SD], 68.17 [13.59] vs 56.28 [13.60]; mean difference, 11.89 [95% CI, 3.81-19.97]; P < .001). Similarly, the expert-clinician scar assessment of the NLF modification was higher for the group who had the minimal nasolabial incision than it was for the group who had a historical nasolabial incision (3.78 [0.91] vs 2.98 [0.81]; mean difference, 0.80 [95% CI, 0.29-1.32]; P = .007).
The minimal nasolabial incision technique for NLF modification is effective in rehabilitating the NLF in facial paralysis without adding a long linear scar to the central midface.
在面瘫的治疗中，创造对称的鼻唇沟（NLF）很重要。已建立的技术使用 NLF 中的线性切口，现在的技术改进允许省略线性切口。
设计、设置和参与者：这项回顾性病例系列研究是在 2017 年 2 月 2 日至 6 月 7 日在一家三级保健机构进行的。参与者均为在马萨诸塞州眼耳医院面神经中心接受 NLF 改良的周围性面瘫患者（N = 21），该改良采用最小鼻唇沟切口技术，时间为 2015 年 2 月 1 日至 2016 年 8 月 31 日。
使用经过验证的面部临床计量评定量表（FaCE）的患者报告的结果测量；使用经过验证的电子临床医生分级面瘫评估（eFACE）的临床医生报告的面部功能结果；普通人对 NLF 整体美学结果的评估；以及专家临床医生对 NLF 的疤痕评估。
在接受最小鼻唇沟切口技术的 21 例 NLF 改良患者中，9 例（43%）为女性，12 例（57%）为男性。平均年龄为 41 岁（范围为 9-90 岁）；17 例（81%）为成年人（≥18 岁），4 例（19%）为儿童（＜18 岁）。总的来说，所有患者在接受 NLF 改良后，所有临床医生和患者评分的结果测量都有显著改善。手术前的总 eFACE 平均（SD）评分为 60.7（14.9），手术后为 77.2（8.9）（平均差异，16.5 [95%置信区间，8.5-24.2]；P<0.001）。手术前静态 eFACE 的平均（SD）评分为 61.4（20.6），手术后为 82.7（12.4）（平均差异，21.3 [95%置信区间，10.7-31.9]；P<0.001）。手术前 FaCE 生活质量的平均（SD）评分为 51.3（20.1），手术后为 70.3（12.6）（平均差异，19.0 [95%置信区间，6.5-31.6]；P=0.001）。接受最小鼻唇沟切口的患者对 NLF 改良的整体美学效果的自我评估高于接受历史鼻唇沟切口的患者（平均[SD]，68.17[13.59]比 56.28[13.60]；平均差异，11.89 [95%置信区间，3.81-19.97]；P<0.001）。同样，接受最小鼻唇沟切口的患者对 NLF 改良的专家临床医生疤痕评估也高于接受历史鼻唇沟切口的患者（3.78[0.91]比 2.98[0.81]；平均差异，0.80 [95%置信区间，0.29-1.32]；P=0.007）。
NLF 改良的最小鼻唇沟切口技术有效修复面瘫中的 NLF，而不会在中面部中央增加长线性疤痕。
4 级。
