Department of Craniofacial Surgery and Plastic Surgery, Tominaga Hospital, Osaka, Japan.
Oper Neurosurg (Hagerstown). 2018 Aug 1;15(2):174-178. doi: 10.1093/ons/opx217.
Hypoglossal nerve transfer is frequently employed to reanimate the paralyzed facial muscles after irreversible proximal facial nerve injury. However, it can cause significant postoperative synkinesis because it involves the reinnervation of the whole mimetic musculature using a single motor source.
To describe our experience with differential reanimation of the midface and lower face using separate motor sources in patients with short-term facial paralysis after brain surgery.
Seven patients underwent combined nerve transfer (the masseteric nerve to the zygomatic branch and the hypoglossal nerve to the cervicofacial division of the facial nerve) and cross-facial nerve grafting with the aim of achieving a spontaneous smile. The median duration of paralysis before surgery was 7 mo and follow-up ranged from 7 to 31 mo (mean: 18 mo). For evaluation, both physical examination and video analysis were performed.
In all patients, reanimation of both the midface and the lower face was successful. A nearly symmetrical resting lip was achieved in all patients, and they were able to voluntarily elevate the corners of their mouths without visible synkinesis and to close their eyes while biting. No patient experienced impairment of masticatory function or tongue atrophy.
Differential reanimation of the midface and lower face with the masseteric and hypoglossal nerves is an alternative method that helps to minimize synkinetic mass movement and morbidity at the donor site.
在不可逆的面神经近端损伤后，舌下神经转移术常用于重新支配瘫痪的面肌。然而，由于它涉及使用单一运动源对面部所有表情肌进行再神经支配，因此会导致明显的术后联带运动。
描述我们在脑外科手术后发生短期面瘫的患者中，使用不同的运动源对面中部和下部进行差异再支配的经验。
7 例患者接受了联合神经转移（咬肌神经至颧支和舌下神经至面神经颈支）和跨面神经移植术，目的是实现自然微笑。术前瘫痪的中位持续时间为 7 个月，随访时间为 7 至 31 个月（平均 18 个月）。评估包括体格检查和视频分析。
所有患者的面中部和下部的再支配均成功。所有患者的唇均呈现近乎对称的静止状态，他们能够在没有可见联带运动的情况下自愿提起口角，并在咬牙时闭眼。没有患者出现咀嚼功能受损或舌萎缩。
使用咬肌神经和舌下神经对面中部和下部进行差异再支配是一种替代方法，可以帮助最小化供体部位的联带运动和发病率。
