Park Seong Oh, Ha Jeong Hyun, Kim Il-Kug, Jin Ung Sik, Chang Hak
Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea.
Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Microsurgery. 2020 Feb;40(2):175-182. doi: 10.1002/micr.30448. Epub 2019 Apr 4.
Cross-face nerve grafting (CFNG) is an important treatment for patients with facial palsy. Currently, two-stage CFNG is frequently performed. CFNG is performed first, followed by coaptation when innervation reaches the grafted nerve ending. The present study compared single-stage CFNG with conventional two-stage CFNG.
We retrospectively reviewed data of 17 patients who underwent CFNG with zygomatic and buccal branch with hypoglossal crossover. Patients with single-stage (group 1) and two-stage (group 2) CFNG were comparatively analyzed 2 years postoperatively. There were nine and eight patients in groups 1 and 2, respectively. The patient's perioperative status was measured with imaging and animation using the Yanagihara grade, altitude, and angle differences of the oral commissure and eye closure.
Patients in group 1 could recognize their first postoperative spontaneous movement earlier than those in group 2 (268.3 ± 25.1 days vs. 327.5 ± 51.3 days, respectively, p = 0.015). The Yanagihara grade significantly improved for patients in both groups postoperatively (group 1: 12.8 ± 5.5 to 25.3 ± 6.1, p < 0.01; group 2: 12.4 ± 5.6 to 24.3 ± 5.0, p = 0.012). Height and angle difference of the oral commissure showed a significant improvement during resting and smiling in both groups. Eye closure also showed significant improvement in both groups (group 1: 4.1 ± 0.6 to 2.6 ± 0.5, p < 0.01; group 2: 4.0 ± 0.5 to 2.8 ± 0.7, p < 0.01). There was no significant difference in the postoperative improvement rate between the groups.
Single-stage CFNG shows results equivalent to those of two-stage CFNG. Single-stage CFNG is associated with a shorter treatment period and fewer operations.
跨面神经移植术（CFNG）是面瘫患者的一种重要治疗方法。目前，常采用两阶段CFNG。先进行CFNG，待神经支配到达移植神经末端时再进行神经吻合。本研究比较了单阶段CFNG与传统两阶段CFNG。
我们回顾性分析了17例行颧颊支与舌下神经交叉的CFNG患者的数据。对单阶段（第1组）和两阶段（第2组）CFNG患者术后2年进行比较分析。第1组和第2组分别有9例和8例患者。采用柳原分级、口角高度和角度差异以及闭眼情况，通过影像学和动态观察来评估患者围手术期状况。
第1组患者术后首次自发运动的识别时间早于第2组（分别为268.3±25.1天和327.5±51.3天，p = 0.015）。两组患者术后柳原分级均显著改善（第1组：12.8±5.5至25.3±6.1，p < 0.01；第2组：12.4±5.6至24.3±5.0，p = 0.012）。两组患者在静息和微笑时口角的高度和角度差异均有显著改善。两组患者的闭眼情况也有显著改善（第1组：4.1±0.6至2.6±0.5，p < 0.01；第2组：4.0±0.5至2.8±0.7，p < 0.01）。两组术后改善率无显著差异。
单阶段CFNG的效果与两阶段CFNG相当。单阶段CFNG治疗周期更短，手术次数更少。
