From the Division of Reconstructive Microsurgery, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2018 Nov;142(5):1307-1317. doi: 10.1097/PRS.0000000000004849.
Functioning free muscle transplantation is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than on the lower lip. This study aimed to compare different lower lip reconstructive methods when performing functioning free muscle transplantation for facial reanimation.
A retrospective review of functioning free muscle transplantation for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: in group 1 (n = 15), a free plantaris tendon graft anchored to the gracilis muscle was passed into the lower lip to create a loop within; in group 2 (n = 12), an aponeurosis tail of the gracilis muscle was attached to the lower lip; and in group 3 (n = 18), no suspension of the lower lip was performed. All patients had at least 2 years of follow-up. Outcomes were assessed by photographs and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area.
A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p = 0.004 and p = 0.005, Fisher's exact test). The objective evaluation showed group 1 and 2 patients with better results compared with group 3 (horizontal component, p = 0.009; vertical component, p = 0.004; area distribution, p < 0.001, Kruskal-Wallis test).
Both plantaris tendon graft and gracilis aponeurosis achieved better improvement in subjective and objective evaluations than those who had no reconstruction of the lower lip. In particular, the plantaris tendon graft can achieve the most lower lip excursion with overall improved symmetry.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
功能性游离肌肉移植目前是面瘫重建的金标准，主要侧重于上唇的重建，而不是下唇。本研究旨在比较在行功能性游离肌肉移植对面部神经再支配时，不同的下唇重建方法。
回顾性分析 2007 年至 2015 年行功能性游离肌肉移植对面部神经再支配的病例。患者分为三组：在第 1 组（n=15）中，游离比目鱼肌腱移植体锚定于股薄肌内，穿过下唇形成一个环；在第 2 组（n=12）中，股薄肌的腱膜尾附着于下唇；在第 3 组（n=18）中，不进行下唇悬吊。所有患者均有至少 2 年的随访。结果通过照片和视频进行评估，包括对中线偏差和水平倾斜的主观评估，以及对微笑维度和面积的客观分析。
共纳入 45 例患者。主观评估结果表明第 1 组患者的改善最佳（总评分：p=0.004 和 p=0.005，Fisher 确切检验）。客观评估显示，与第 3 组相比，第 1 组和第 2 组患者的结果更好（水平分量，p=0.009；垂直分量，p=0.004；面积分布，p<0.001，Kruskal-Wallis 检验）。
比目鱼肌腱移植体和股薄肌腱膜都比没有重建下唇的患者在主观和客观评估方面有更好的改善。特别是，比目鱼肌腱移植体可以实现最大的下唇位移，整体对称性得到改善。
临床问题/证据水平：治疗性，III 级。
