Maxillo-Facial Surgical Unit, Ospedale San Paolo, Dipartimento di Scienze della Salute, (Director, professor Stefano Centanni), Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy.
Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell'Apparato Stomatognatico (LAFAS), Laboratorio di Anatomia Funzionale dell'Apparato Locomotore (LAFAL), Dipartimento di Scienze Biomediche per la Salute, (Director, professor Francesco Auxilia), Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, Italy; Department of Electronics, Information and Bioengineering (DEIB), (Director, professor Stefano Tubaro), Politecnico di Milano, Milano, Italy.
J Craniomaxillofac Surg. 2018 Mar;46(3):521-526. doi: 10.1016/j.jcms.2017.12.022. Epub 2017 Dec 27.
Alterations of facial muscles may critically humper patients' quality of life. One of the worst conditions is the reduction or abolition of eye blinking. To prevent these adverse effects, surgical rehabilitation of eyelid function is the current treatment choice. In the present paper, we present a modification of the technique devised by Nassif to recover lids from long-standing paralysis. In our modification, the upper lid is rehabilitated by a platisma graft innervated by the contralateral facial nerve branches using a cross-face sural nerve graft. The lower lid is pulled upward by a fascia lata string suspension. Fourteen patients with unilateral facial paralysis were operated on consecutively. For each patient, two sets of frontal photographs with open and closed eyes were available, before and after the surgical rehabilitation. On average, eyelid lumen with closed eyes decreased by 2.6 mm (SD 2.4) after surgical rehabilitation (37% of the initial value). With open eyes, the decrement was 1.5 mm (SD 1.6, 15%). The modifications were highly significant (p < 0.01), with very large effect sizes. Reanimation of the paralyzed eye by mean of cross-face nerve graft followed by platisma neurotization can restore natural eyelid closure and blink reflex.
面部肌肉的改变可能严重影响患者的生活质量。最糟糕的情况之一是眨眼减少或消失。为了防止这些不良反应，目前的治疗选择是手术恢复眼睑功能。在本文中，我们对 Nassif 设计的用于从长期瘫痪中恢复眼睑的技术进行了改良。在我们的改良中，上眼睑通过由对侧面神经分支支配的颈阔肌移植物来恢复，下眼睑通过阔筋膜悬线向上拉动。连续对 14 名单侧面瘫患者进行了手术。对于每位患者，在手术康复前后，都有两组睁眼和闭眼的正面照片。平均而言，眼睑在闭眼时的管腔减少了 2.6 毫米（SD 2.4）（初始值的 37%）。睁眼时，减少了 1.5 毫米（SD 1.6，15%）。这些变化非常显著（p<0.01），效果非常大。通过面横神经移植对瘫痪的眼睛进行再神经化，然后进行颈阔肌神经化，可以恢复自然的眼睑闭合和眨眼反射。
