From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary.
Plast Reconstr Surg. 2019 May;143(5):1060e-1071e. doi: 10.1097/PRS.0000000000005591.
Masseteric- or deep temporal-to-facial nerve transfer (five-to-seven nerve transfer) is increasingly used in facial reanimation; however, the indications and clinical variables affecting outcomes for five-to-seven nerve transfer have not been defined. The authors describe their early experience with five-to-seven nerve transfer, reporting function and patient-reported outcomes, to identify potential parameters that are predictive of outcome.
The authors conducted a retrospective chart review of all patients who underwent five-to-seven nerve transfer for smile reanimation from 2012 to 2017. Age, sex, cause of facial paralysis, onset and duration of paralysis, history of adjuvant chemotherapy and/or radiation therapy, donor nerve used, adjunctive procedures, and final excursion were recorded. Standard photographs and videos, and data regarding clinical facial nerve function and patient-reported quality of life, were obtained preoperatively and postoperatively.
Sixty patients were identified. Forty-seven had flaccid facial paralysis and 13 had postparalysis facial palsy. Among flaccid facial paralysis patients, masseteric nerve transfer was successful in 30 patients (88 percent) and deep temporal nerve transfer was successful in three cases (60 percent). Among postparalysis facial palsy patients, five-to-seven nerve transfer was successful in two patients (20 percent). Average quality-of-life scores improved significantly from preoperatively (46) to postoperatively (59) among flaccid facial paralysis patients with successful five-to-seven nerve transfer.
Five-to-seven nerve transfer is a viable option in facial reanimation. Shorter denervation times and preoperative flaccidity are favorable predictors of outcome. Five-to-seven nerve transfer as an adjunct to primary repair appears highly effective for enhancing smile function. Five-to-seven nerve transfer results are not reliable in patients with postparalysis facial palsy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
咀嚼肌或深部颞肌到面神经的转移（五到七神经转移）在面部再神经化中越来越多地使用；然而，尚未确定影响五到七神经转移结果的适应症和临床变量。作者描述了他们在五到七神经转移早期的经验，报告了功能和患者报告的结果，以确定潜在的预测结果的参数。
作者对 2012 年至 2017 年间接受五到七神经转移治疗以进行微笑再神经化的所有患者进行了回顾性图表审查。记录了年龄、性别、面瘫原因、面瘫发作和持续时间、辅助化疗和/或放疗史、供体神经使用、辅助手术以及最终活动度。术前和术后获得了标准照片和视频以及有关临床面神经功能和患者报告的生活质量的数据。
确定了 60 例患者。47 例为弛缓性面瘫，13 例为面瘫后面瘫。在弛缓性面瘫患者中，30 例（88%）成功进行了咀嚼肌神经转移，3 例（60%）成功进行了深部颞肌神经转移。在面瘫后面瘫患者中，5 到 7 神经转移在 2 例患者中成功（20%）。在成功进行五到七神经转移的弛缓性面瘫患者中，平均生活质量评分从术前（46）显著提高到术后（59）。
五到七神经转移是面部再神经化的可行选择。较短的去神经时间和术前弛缓是结果的有利预测指标。五到七神经转移作为原发性修复的辅助手段，对面部微笑功能的增强非常有效。面瘫后面瘫患者的五到七神经转移结果不可靠。
临床问题/证据水平：治疗，IV。
