Costa Márcia Gonçalves E Silva Targino da, Maranhão-Filho Péricles de Andrade, Santos Izabella Costa, Luiz Ronir Raggio, Vincent Maurice Borges
Instituto Nacional de Câncer, Serviço de Fisioterapia, Rio de Janeiro RJ, Brasil.
Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia, Rio de Janeiro RJ, Brasil.
Arq Neuropsiquiatr. 2019 Jul 29;77(7):460-469. doi: 10.1590/0004-282X20190074.
Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch.
We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014.
The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function.
The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
面神经损伤是腮腺切除术最常见的神经并发症，主要影响下颌缘支。为了测试改良的桑尼布鲁克面部分级系统作为评估腮腺切除术后面神经功能的新工具，重点关注下颌缘支。
我们回顾了73例接受腮腺切除术后面神经保留的患者（40例女性，年龄18 - 84岁，平均年龄53.2岁）的病历，这些患者转诊至物理治疗科。所有患者均患有腮腺肿瘤或晚期皮肤癌，由第一作者在2006年至2014年期间进行随访。
下颌缘支支配的肌肉受影响最为频繁（72.6%），尤其是在接受颈部清扫术的患者中（p = 0.023）。与原始版本相比，改良系统获得的自主运动评分显著更低（p < 0.001）。良性腮腺肿瘤患者和皮肤癌患者分别观察到最佳和最差评分。需要颈部清扫术（p = 0.031）和切除其他结构（p = 0.021）的患者评分最低，这仅在改良版本中得到体现。无论桑尼布鲁克系统版本如何，恶性肿瘤患者的评级明显更差。物理治疗后分析涉及50例患者。最差的面部康复结果与下颌缘支功能有关。
改良的桑尼布鲁克面部分级系统改善了下颌缘支的评估，同时保留了对面神经其他分支的评估。
