St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom.
St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2664-2673. doi: 10.1016/j.bjps.2021.03.007. Epub 2021 Mar 22.
This study describes a different approach with a 2-stage facial reanimation in patients with long-standing unilateral facial paralysis using free gracilis muscle transfer, innervated by both cross-facial nerve graft and masseteric nerve. The authors present their rationale, surgical technique, and long-term outcomes.
Between August 2012 and March 2016, 11 patients (6 female and 5 male patients) underwent a 2-staged dually innervated gracilis muscle transfer. Patients were evaluated with physical examination and needle electromyography. A standardized assessment of preoperative and postoperative photographs and videos was performed using Terzis' smile functional grading system at 48 months following surgery and the Emotrics software to assess improvement in symmetry over a 36-month postoperative period.
Voluntary contraction of the gracilis muscle was observed in all patients at a mean of 4 months and 4 days following muscle transfer. A spontaneous smile produced without teeth clenching was developed in all patients by 18 months postoperatively. Six patients achieved excellent and 5 good results. The difference between the averaged pre- and postoperative scores was statistically significant. With Emotrics, there were significant improvements in the smile angle, upper lip elevation, commissural excursion, and commissural height, with continuous improvement over 36 months. The postoperative electromyography (EMG) confirmed dual innervation of the gracilis muscle by the facial and masseteric donor motor neural sources. We present our results at minimum 48 months postoperatively.
Dual innervated two-stage gracilis transfer is an effective method for reanimation in long-standing unilateral facial paralysis, providing both rapid reinnervation of the transferred muscle, together with a powerful, synchronous smile.
本研究描述了一种不同的方法，即通过使用游离股薄肌转位术，由面神经和咬肌神经双重神经支配，对长期单侧面瘫患者进行 2 期面部再神经化。作者介绍了其基本原理、手术技术和长期结果。
2012 年 8 月至 2016 年 3 月，11 例患者（6 名女性和 5 名男性）接受了 2 期双重神经支配的股薄肌转位术。患者通过体格检查和针极肌电图进行评估。使用 Terzis 微笑功能分级系统对术前和术后 48 个月的照片和视频进行标准化评估，并使用 Emotrics 软件评估术后 36 个月内对称性的改善情况。
所有患者在肌肉转移后平均 4 个月零 4 天观察到股薄肌的自愿收缩。所有患者在术后 18 个月都能自发地微笑，而无需咬牙。6 例患者获得了优秀结果，5 例患者获得了良好结果。平均术前和术后评分的差异具有统计学意义。使用 Emotrics，微笑角度、上唇抬高、口角偏移和口角高度均有显著改善，且在 36 个月内持续改善。术后肌电图（EMG）证实股薄肌由面神经和咬肌供体运动神经源双重支配。我们报告了术后至少 48 个月的结果。
双重神经支配的两期股薄肌转位术是一种治疗长期单侧面瘫的有效方法，可快速实现移植肌肉的再神经化，并产生有力、同步的微笑。
