From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children; School of Medicine, Queen's University; and Department of Occupational Science and Occupational Therapy, University of Toronto.
Plast Reconstr Surg. 2022 Apr 1;149(4):919-929. doi: 10.1097/PRS.0000000000008927.
Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of facial paralysis in patients with craniofacial microsomia and outcomes after free functioning muscle transfer for dynamic smile reconstruction.
A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software.
This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent) affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent smile reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in lip symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes.
The authors' institution's incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
颅面短小症与下颌骨和上颌骨发育不全、小耳畸形、软组织缺乏以及颅神经功能障碍的严重程度不同有关，最常见的是面神经。本研究评估了颅面短小症患者中面瘫的发生率以及游离功能性肌肉移植进行动态微笑重建后的结果。
本研究为单中心回顾性横断面研究，1985 年至 2018 年期间，共纳入 186 例颅面短小症患儿，这些患儿均接受游离功能性肌肉移植进行动态微笑重建，并伴有严重的面神经功能障碍。使用摄影面部分析软件测量术前和术后最大微笑时的面部对称性和口角最大偏移。
本研究共纳入 186 例颅面短小症患儿，41 例（21 例男性，20 例女性）患儿存在明确的面神经功能障碍（22%），影响所有分支（51%）或仅影响下颌支（24%）。8 例严重面瘫患者（n=8）接受游离功能性肌肉移植进行微笑重建，其中 7 例采用面神经交叉吻合，1 例采用同侧咬肌神经。所有患者均获得随意肌收缩，唇对称性和口角最大偏移改善（中位数为 8mm；四分位距为 3 至 10mm）。正畸正颌手术和面瘫重建的时机是优化患者预后的重要考虑因素。
本机构儿童颅面短小症患者的面神经功能障碍发生率为 22%。游离功能性肌肉移植是治疗颅面短小症儿童微笑重建的可靠选择。为了优化结果，提出了一种新的治疗算法，用于可能需要同时进行正畸正颌手术和面瘫重建的颅面短小症患者。
临床问题/证据水平：治疗，IV。
