Medical College of Georgia, Augusta, Georgia, USA.
Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida, USA.
Microsurgery. 2020 Nov;40(8):868-873. doi: 10.1002/micr.30674. Epub 2020 Oct 21.
Facial paralysis has a profound impact on quality of life in affected individuals, primarily through loss of verbal and nonverbal communication. Common facial nerve reanimation techniques include coaptation to the masseteric or hypoglossal nerve. Most techniques require nerve grafts to achieve a tension-free neurorrhaphy. Our report aims to show a surgical adaption to current facial reanimation procedures using a partial parotidoplasty approach in order to avoid challenges caused by interpositional nerve grafts through primary neurorrhaphy.
The modified surgical approach was performed on four patients, aged 30-67. Length of paralysis ranged from 6 to 13 months. Cause of paralysis included one patient with Bell's palsy in one patient, prior surgery in two patients, and traumatic fracture in the remaining patient. A modified Blair approach is used to expose the parotid capsule. The facial nerve is dissected proximally toward the stylomastoid foramen and distally toward the masseter. The parotid gland substance is sectioned overlying each branch of the facial nerve using ultrasonic dissection or hemostatic scalpel, allowing mobilization of the proximal segment and upper and lower divisions of the facial nerve. The superficial lobe of the parotid is preserved in most cases. The House-Brackmann (H-B) functional scale was used to assess facial nerve function pre- and post-operatively.
All patients showed H-B score V or greater prior to reanimation. Follow-up was conducted at 3-, 6-, and 12-months in all patients with resultant improvement of H-B scores of I in three patients and II in the remaining patient. Only one complication was noted, with one patient developing a right postauricular hematoma that was adequately managed without sequelae. All remaining patients experienced an uncomplicated post-operative course.
Our modified approach to facial nerve reanimation works well with a planned parotidoplasty allowing for successful reanimation outcomes without the need for interpositional grafting. This technique may be considered in masseteric and hemi-hypoglossal nerve transfers for the reinnervation of facial muscles.
面瘫会严重影响患者的生活质量，主要表现为言语和非言语交流的丧失。常见的面神经再支配技术包括与咬肌或舌下神经吻合。大多数技术需要神经移植来实现无张力神经吻合。我们的报告旨在展示一种使用腮腺部分切除术的面神经再支配手术方法，以避免通过直接神经吻合进行神经移植带来的挑战。
该改良手术方法应用于 4 名年龄在 30-67 岁的患者。麻痹时间为 6-13 个月。导致面瘫的原因包括 1 例贝尔麻痹、2 例既往手术和 1 例创伤性骨折。改良 Blair 入路暴露腮腺包膜。面神经近端向茎乳孔方向解剖，远端向咬肌方向解剖。使用超声刀或止血刀片在面神经各分支上方切开腮腺实质，允许面神经近端和上、下分支的移动。在大多数情况下，保留腮腺浅叶。使用 House-Brackmann（H-B）功能量表评估面神经功能术前和术后。
所有患者在再支配前均表现为 H-B 评分 V 或更高。所有患者均在 3、6 和 12 个月时进行随访，其中 3 例患者的 H-B 评分提高至 I 级，1 例患者提高至 II 级。仅 1 例患者发生并发症，即 1 例患者出现右侧耳后血肿，经适当处理后无后遗症。所有其余患者均经历了无并发症的术后过程。
我们对面神经再支配的改良方法与计划中的腮腺切除术相结合，在不需要神经移植的情况下取得了成功的再支配效果。该技术可考虑用于咬肌和半舌下神经转移，以实现面神经肌肉的再支配。
