Özücer Berke, Çam Osman Halit
Department of Otorhinolaryngology, Başkent University School of Medicine, İstanbul, Turkey.
Turk Arch Otorhinolaryngol. 2020 Dec;58(4):249-253. doi: 10.5152/tao.2020.5823. Epub 2020 Dec 1.
Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion.
Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side.
Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0±10.2 months. The average interval between facial denervation and nerve repair was 14.0±4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5±20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5±17.4% to postoperative 93.4±6.9%. Vertical excursion changed from preoperative 38.4±24.6% to postoperative 89.3±11.8%. Overall excursion changed from preoperative 68.4±19.6% to postoperative 92.9±10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p<0.05).
Facial paralysis patients with an asymmetric smile benefit from distal masseter-to-facial nerve transfer and it improves smile excursion dramatically. This effect was especially prominent in the vertical component of the smiling vector.
远端咬肌-面神经吻合术是一种在不切断面神经干并确保面神经连续性的情况下，改善面瘫患者早期微笑幅度的方法。本研究旨在探讨远端咬肌-面神经吻合术对微笑幅度的影响。
回顾性分析8例患者的病历。从术前视频中截取显示最佳可能微笑的截图。从术后视频中截取截图，显示健康侧自然微笑与患侧咬牙微笑的最佳组合。使用Emotrics和Photoshop软件从面部标志点计算垂直、水平和整体偏移。评估唇部偏移和唇角改善的比例测量值。通过将健康侧视为100%来评估对称性，患侧计算为健康侧的百分比。
5例患者为完全性面瘫，3例为面部轻瘫。术后平均随访期为15.0±10.2个月。面部去神经支配与神经修复之间的平均间隔为14.0±4.1个月（范围11-23个月）。所有神经吻合均采用端端吻合至颧支或颊支，未使用移植体。术后平均初始运动发生在95.5±20.5天（范围72-138天）。患侧与健康侧的水平偏移从术前的72.5±17.4%变为术后的93.4±6.9%。垂直偏移从术前的38.4±24.6%变为术后的89.3±11.8%。整体偏移从术前的68.4±19.6%变为术后的92.9±10.4%。患侧与健康侧的平均唇角从术前的64.7%变为术后的95.2%。所有变化均具有统计学意义（p<0.05）。
微笑不对称的面瘫患者受益于远端咬肌-面神经转移术，且该手术能显著改善微笑幅度。这种效果在微笑向量的垂直分量中尤为突出。
