Tzafetta Kallirroi, Ruston Julia C, Pinto-Lopes Rui, Mabvuure Nigel Tapiwa
St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom.
Plast Reconstr Surg Glob Open. 2021 Mar 15;9(3):e3461. doi: 10.1097/GOX.0000000000003461. eCollection 2021 Mar.
Lower lip depression was historically regarded a neglected area of facial paralysis, but, with refinement of techniques, has gained increasing attention. We present the first detailed description and evaluation of a 2-stage technique, using first cross facial nerve graft and then the anterior belly of digastric muscle (ABDM), innervated by the cross facial nerve graft, to restore dynamic and spontaneous lower lip depression.
Retrospective analysis of 2-stage lower lip reanimations between 2010 and 2018 was performed. Demographics, etiology, and operative details were recorded. Videos were graded pre/postoperatively using a 5-point Likert scale by 21 independent observers. Objective changes of symmetry were analyzed using Photogrammetry (Emotrics).
Twenty-seven patients were identified (median age 34.9 years, range 6-64). The mean duration between the 2 stages was 15.1 months. Follow-up ranged from 18-72 months. There were minor complications in 4 patients, and 1 case was abandoned due to insufficient length of anterior belly of digastric muscle. Average peer-reviewed scores improved from 2.1 to 3.2 ( 0.05). Emotrics did not show improvement in static symmetry ( 0.05). However, during open-lip smiling, lower lip height improved significantly ( 0.05) whilst dental show improvements approached significance ( 0.08). Lower lip symmetry was also improved during lower lip depression, as shown by improvements in lower lip height ( 0.05), smile angle, and dental show (both 0.05).
These results show the safety and efficacy of 2-stage lower lip reanimation using anterior belly of digastric muscle transposition. This procedure is our choice for longstanding lower lip paralysis and provides coordinated spontaneous lower lip depression, thus enhancing the overall perioral animation and smile.
下唇凹陷在历史上一直被视为面瘫的一个被忽视的区域，但随着技术的改进，已越来越受到关注。我们首次详细描述并评估了一种两阶段技术，该技术首先使用跨面神经移植，然后使用由跨面神经移植支配的二腹肌前腹（ABDM）来恢复动态和自发性下唇凹陷。
对2010年至2018年间进行的两阶段下唇重建进行回顾性分析。记录人口统计学、病因和手术细节。21名独立观察者使用5点李克特量表对术前/术后视频进行评分。使用摄影测量法（Emotrics）分析对称性的客观变化。
共纳入27例患者（中位年龄34.9岁，范围6 - 64岁）。两阶段之间的平均间隔时间为15.1个月。随访时间为18 - 72个月。4例患者出现轻微并发症，1例因二腹肌前腹长度不足而放弃手术。平均同行评审评分从2.1提高到3.2（P < 0.05）。Emotrics未显示静态对称性有改善（P > 0.05）。然而，在露齿微笑时，下唇高度显著改善（P < 0.05），而牙齿露出改善接近显著水平（P = 0.08）。在下唇凹陷时，下唇对称性也得到改善，如下唇高度改善（P < 0.05）、微笑角度和牙齿露出（均P < 其结果显示了使用二腹肌前腹移位进行两阶段下唇重建的安全性和有效性。该手术是我们治疗长期下唇麻痹的选择，可提供协调性的自发性下唇凹陷，从而增强整体口周活动和微笑。 0.05）。
这些结果显示了使用二腹肌前腹移位进行两阶段下唇重建的安全性和有效性。该手术是我们治疗长期下唇麻痹的选择，可提供协调性的自发性下唇凹陷，从而增强整体口周活动和微笑。
