Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, Parma, Italy.
Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Microsurgery. 2022 Mar;42(3):231-238. doi: 10.1002/micr.30849. Epub 2022 Jan 11.
The choice of neurotization source for gracilis neuromuscular transplant is a key point in the treatment of unilateral long-standing paralysis. To combine the advantages of different donor nerves and overcome their disadvantages, mixed neurotization sources have been described with encouraging results. The authors present a preliminary report of a novel technique, the "supercharged" cross-graft, a two-step technique consisting of a double powered cross nerve graft provided by a zygomatic branch of the healthy facial nerve and the masseter nerve of the healthy side.
From January 2015 to December 2019 eight patients, aged between 19 and 61 years old (mean age at surgery 33.62) suffering unilateral established paralysis (congenital or acquired, >24 months) underwent gracilis reinnervation with the supercharged cross grafting technique. Subjects underwent a two-step surgical rehabilitation: in the first operation sural nerve was harvested and used as cross-graft cooptated by healthy side facial nerve branch and masseteric nerve. During second procedure gracilis neuromuscular transplant was performed reinnervarting the muscle with the cross-graft. Patients were evaluated using Emotrics software, which allowed for automated facial measurements on post-operative pictures taken at the last follow-up. The results of the different poses were compared to assess the contribution to smile excursion by the masseter and facial nerve, together and separately. Finally, we analyzed spontaneous smile to assess whether masseteric contribution is used in daily life.
No major or minor complications occurred. Follow-up time ranged from 12 to 41 months, with a mean of 22.75 months. A good commissure excursion (mean 33.84 mm) was obtained during smile with no teeth clenching (without masseter activation), as well as during teeth clenching without smiling (activation of gracilis only - mean 32.55). When smiling and biting simultaneously the excursion was greater than the single two components (mean 35.91). In spontaneous smile, commissure excursion was higher (mean 34.23) than that provided by only the facial nerve (smile only) in most patients.
This novel technique of mixed neurotization for gracilis transplant shows consistent results with powerful contraction and good smile coordination. It also allows us to extend the indications for mixed neurotization techniques.
股薄肌神经肌移植的神经源选择是治疗单侧长期瘫痪的关键。为了结合不同供体神经的优点并克服其缺点，已经描述了混合神经源，结果令人鼓舞。作者介绍了一种新的技术，即“增压”交叉移植术的初步报告，该技术是一种两步技术，由健康面神经的颧支和健侧面肌神经提供双重动力交叉神经移植。
2015 年 1 月至 2019 年 12 月，8 例年龄在 19 至 61 岁（平均手术年龄 33.62 岁）的患者，患有单侧已建立的瘫痪（先天性或后天性，>24 个月）接受了股薄肌神经再支配，采用增压交叉移植技术。患者接受了两步手术康复：在第一次手术中采集腓肠神经，用作健康侧面神经分支和咬肌神经共募集的交叉移植物。在第二次手术中，将股薄肌神经肌移植，通过交叉移植物重新支配肌肉。使用 Emotrics 软件对患者进行评估，该软件允许对最后一次随访时拍摄的术后照片进行自动面部测量。比较不同姿势的结果，以评估咬肌和面神经共同和单独对微笑幅度的贡献。最后，我们分析了自发性微笑，以评估在日常生活中是否使用咬肌的贡献。
无重大或轻微并发症。随访时间为 12 至 41 个月，平均 22.75 个月。在没有牙齿咬紧的微笑（无咬肌激活）期间，以及在没有微笑但牙齿咬紧的情况下（仅激活股薄肌-平均 32.55），获得了良好的口角偏移（平均 33.84 毫米）。当同时微笑和咬紧时，偏移量大于单个两个分量（平均 35.91）。在自发性微笑中，大多数患者的口角偏移高于仅由面神经提供的（仅微笑）（平均 34.23）。
这种股薄肌移植的混合神经源新技术显示出一致的结果，具有强大的收缩力和良好的微笑协调性。它还允许我们扩展混合神经源技术的适应症。
