Sakuma Hisashi, Tanaka Ichiro, Yazawa Masaki, Oh Anna
Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan.
Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
Arch Plast Surg. 2021 May;48(3):282-286. doi: 10.5999/aps.2020.01599. Epub 2021 May 15.
Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.
最近的报告描述了几例通过双肌肉转移来恢复长期面瘫患者自然、对称笑容的病例。然而，这些复杂的手术有时会因双肌肉转移导致脸颊臃肿。我们报告了一例67岁长期面瘫女性患者的病例，该患者通过腓肠神经移植，采用咬肌神经和对侧面神经支配的前锯肌两个表浅肌束进行了两阶段面部重建。每个肌束被转移到上唇和口角，且方向不同。此外，在下唇添加了一条阔筋膜移植片，以防止如下唇伸长和偏斜等畸形。术后约4个月时出现自主收缩，术后8个月时出现无需咬紧的自发微笑。术后18个月，患者展现出自发对称的微笑，下唇、上唇和口角有足够的活动度，且无脸颊臃肿。使用前锯肌两个多向量表浅肌束进行双神经支配肌肉转移对于长期面瘫可能是一个不错的选择，因为它可以实现能自主和自发进行的对称微笑。
