Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
J Craniomaxillofac Surg. 2020 Feb;48(2):162-169. doi: 10.1016/j.jcms.2020.01.001. Epub 2020 Jan 15.
Despite successfully gaining excursion after free muscle transfer for facial palsy, soft tissue asymmetry, especially around the nasolabial fold (NLF) and medial cheek, is a troublesome problem in elderly patients. An NLF reset technique that enhances midface lifts has been introduced to overcome this problem. Our study included 43 consecutive patients who underwent facial reanimation surgery with free functional muscle transfer between March 2015 and July 2017. Of these, 20 patients underwent conventional procedures and 23 underwent our NLF reset technique. Postoperative oral commissure excursion and symmetry at rest and while smiling were quantified using FACEgram (Facial Assessment by Computer Evaluation) software. To detect soft-tissue changes after surgery, three-dimensional analysis was performed using Morpheus®, a 3D, LED-based, white-structured-light scanner. The NLF group had a significantly larger postoperative mean excursion at rest (control 25.32 ± 2.80 mm vs NLF 27.42 ± 3.60 mm; p = 0.047). The mean horizontal length ratios (affected-to-healthy) revealed better symmetry in the NLF group (resting 1.05 ± 0.22, smiling 0.97 ± 0.19; p = 0.201). The three-dimensional midface volume difference was significantly lower in the NLF group. The NLF reset technique produced improved surgical outcomes. An incision made along a mirrored NLF can influence midface lifting in patients with facial palsy, with the soft tissue concentrated in the lower face mobilized superomedially.
尽管在面瘫游离肌肉移植后成功获得了外展，但软组织不对称，特别是在鼻唇沟（NLF）和内颊周围，是老年患者的一个麻烦问题。已经引入了一种 NLF 复位技术来克服这个问题，该技术可以增强中面部提升。我们的研究包括 43 例连续接受游离功能性肌肉移植面部再神经支配手术的患者，时间为 2015 年 3 月至 2017 年 7 月。其中，20 例患者接受常规手术，23 例患者接受我们的 NLF 复位技术。使用 FACEgram（计算机评估的面部评估）软件量化术后口角外展和休息时及微笑时的对称性。为了检测手术后软组织的变化，使用 Morpheus®，一种基于 3D、LED 的白色结构光扫描仪进行三维分析。NLF 组在休息时的平均术后外展量明显更大（对照组 25.32 ± 2.80 mm 与 NLF 组 27.42 ± 3.60 mm；p = 0.047）。NLF 组的平均水平长度比（患侧/健侧）显示出更好的对称性（休息时 1.05 ± 0.22，微笑时 0.97 ± 0.19；p = 0.201）。NLF 组的三维中面部体积差异明显更低。NLF 复位技术产生了更好的手术效果。沿着镜像 NLF 切口可以影响面瘫患者的中面部提升，将软组织集中在下脸并向内侧上方移动。
