Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Craniofac Surg. 2021;32(8):e822-e826. doi: 10.1097/SCS.0000000000007979.
Synkinesis is a common sequelae after incomplete recovery from Bell palsy. Current first-line treatments include botulinum toxin injection and physical therapy. However, patients unresponsive to these treatments may require further surgery. Various surgical treatments have been reported, but no consensus has been reached for the optimal surgery. In a guinea pig model of synkinesis, the facial nerve trunk (FNT) was observed using a scanning electron microscope. Based on the results of scanning electron microscope and clinical ultrasonography, the authors chose FNT as the therapeutic target.
The authors performed epineurectomy of FNT for 11 patients with refractory oral-ocular and oculo-oral synkinesis under abnormal muscle response and facial electromyography monitoring. The postoperative assessments at 1 year were conducted using Sunnybrook Facial Grading System and Facial Disability Index scale. Furthermore, the epineurium excised during the operation was collected as the specimen and submitted for histopathological examination; the cadaveric FNT served as the control group.
The follow-up results showed significant relief from synkinesis (4.91 ± 0.37 versus 10.18 ± 0.64, P < 0.01), improvement of physical (84.55 ± 1.96 versus 73.18 ± 3.65, P < 0.01) and social functions (77.09 ± 3.24 versus 61.82 ± 6.28, P < 0.01), with no worsening of facial paralysis in the patients. The histopathological examination revealed many nerve fibers in the epineurium, suggesting that FNT was the area of aberrant axon regeneration.
Epineurectomy of FNT is a safe and effective surgical remedy. It can be considered as a surgical option for patients with refractory oral-ocular and oculo-oral synkinesis following Bell palsy.
联带运动是贝尔麻痹不完全恢复后的常见后遗症。目前的一线治疗包括肉毒杆菌毒素注射和物理疗法。然而，对这些治疗方法无反应的患者可能需要进一步手术。已经报道了各种手术治疗方法，但对于最佳手术方法尚未达成共识。在豚鼠联带运动模型中，使用扫描电子显微镜观察面神经干（FNT）。基于扫描电子显微镜和临床超声检查的结果，作者选择 FNT 作为治疗靶点。
作者在异常肌肉反应和面部肌电图监测下，对 11 例难治性口眼和眼口联带运动患者进行 FNT 神经外膜切除术。术后 1 年采用桑尼布鲁克面部分级系统和面部残疾指数量表进行评估。此外，从手术中切除的神经外膜作为标本进行组织病理学检查；尸体 FNT 作为对照组。
随访结果显示，联带运动明显缓解（4.91 ± 0.37 与 10.18 ± 0.64，P < 0.01），身体功能（84.55 ± 1.96 与 73.18 ± 3.65，P < 0.01）和社会功能（77.09 ± 3.24 与 61.82 ± 6.28，P < 0.01）均得到改善，患者面瘫无恶化。组织病理学检查发现神经外膜中有许多神经纤维，表明 FNT 是异常轴突再生的区域。
FNT 神经外膜切除术是一种安全有效的手术治疗方法。对于贝尔麻痹后难治性口眼和眼口联带运动患者，可考虑作为一种手术选择。
