Nguyen Phuong D, Faschan Kristin S, Mazzaferro Daniel M, Konieczny Tami, Jackson Oksana A, Bartlett Scott P
Division of Pediatric Plastic Surgery, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania.
J Craniofac Surg. 2020 Jan/Feb;31(1):85-90. doi: 10.1097/SCS.0000000000005885.
Lengthening temporalis myoplasty (LTM) and cross-face nerve graft with free gracilis muscle transfer (CFNG-FGMT) are the 2 most common procedures used to restore dynamic facial animation and improve facial symmetry. There has not been direct comparison or consensus. Here, the authors compare our experience with respect to muscle activity, symmetry, and excursion.
A retrospective review was performed of patients with facial palsy who had CFNG-FGMT or LTM from 2008 to 2016 at a single institution. Postoperative surface EMG was recorded at maximum open smile. Normal and paralyzed sides of the face were analyzed with Facial Assessment by Computer Evaluation software. Commissure excursion and symmetry was assessed.
Six patients with LTM and 10 with CFNG-FGMT met inclusion criteria. Muscle activity was 1st identified in LTM patients after 3 months (47.42 mV, P < 0.001) and CFNG-FGMT patients after 3 months (28.30 mV, P < 0.001) compared to immediate postoperative period. Relative to preoperative excursion, there was significant increase of 3.33 mm in commissure excursion seen at the 0 to 3 month period for LTM patients (P = 0.04). Commisure excursion for CFNG-FGMT was seen later, in the 3- to 6-month postoperative period (4.01, P = 0.024). During smile, CFNG-FGMT patients had better symmetry than unilateral LTM patients. In bilateral LTM patients, there was no significant change in symmetry.
Dynamic facial animation improved in both surgical groups. The LTM demonstrates a faster rate of muscle recruitment compared to CFNG-FGMT. After 3 months, both LTM and CFNG-FGMT groups had comparable excursions. A decision-making algorithm is presented.
延长颞肌肌成形术（LTM）和带游离股薄肌转移的跨面神经移植术（CFNG - FGMT）是用于恢复面部动态表情和改善面部对称性的两种最常见手术。目前尚无直接比较或达成共识。在此，作者比较了我们在肌肉活动、对称性和移位方面的经验。
对2008年至2016年在单一机构接受CFNG - FGMT或LTM治疗的面瘫患者进行回顾性研究。在最大程度露齿笑时记录术后表面肌电图。使用计算机评估软件对面部的正常侧和瘫痪侧进行分析。评估口角移位和对称性。
6例接受LTM手术和10例接受CFNG - FGMT手术的患者符合纳入标准。与术后即刻相比，LTM患者在3个月后首次出现肌肉活动（47.42 mV，P < 0.001），CFNG - FGMT患者在3个月后出现肌肉活动（28.30 mV，P < 0.001）。相对于术前移位，LTM患者在0至3个月期间口角移位显著增加3.33 mm（P = 0.04）。CFNG - FGMT的口角移位出现较晚，在术后3至6个月（4.01，P = 0.024）。在微笑时，CFNG - FGMT患者的对称性优于单侧LTM患者。在双侧LTM患者中，对称性无显著变化。
两个手术组的面部动态表情均有改善。与CFNG - FGMT相比，LTM显示出更快的肌肉募集速度。3个月后，LTM和CFNG - FGMT组的移位情况相当。本文提出了一种决策算法。
