Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Plastic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2317-2324. doi: 10.1016/j.bjps.2022.02.011. Epub 2022 Feb 20.
One-stage combined dynamic reanimation with static suspension has obvious advantages of improving facial symmetry. In clinical observation, patients with different levels of oral commissure drooping achieve different symmetry outcomes, despite undergoing the same surgical procedure. Patients with slight asymmetry obtain better outcomes than those with severe asymmetry. The mechanisms influencing postoperative outcomes have not been systematically explored. We retrospectively analyzed 44 patients performed with masseteric-to-facial nerve transfer combined with static suspension. Patients were divided into two groups according to the level of oral commissure drooping: slight-asymmetry group (n = 24) and severe-asymmetry group (n = 20). Static and dynamic symmetry were assessed with FACE-gram software pre and postoperatively. The symmetry of the oral commissures at rest and during smiling significantly improved postoperatively in all patients. The differences of the bilateral oral commissure positions were significantly smaller in slight-asymmetry group than that in severe-asymmetry group (p<0.001), indicating that slight-asymmetry group achieved better symmetry. Furthermore, these differences were caused by the oral commissures position on the unaffected side, both pre and postoperatively (p<0.001), but not the paralyzed side's (p>0.05). In conclusion, masseteric-to-facial nerve transfer combined with static suspension achieved dynamic and static symmetry in patients with different levels of asymmetry. Patients with slight asymmetry obtained better postoperative symmetry than those with severe asymmetry. Postoperative facial asymmetry might be influenced by the hypertonicity of facial muscles on the unaffected side.
一期联合动态再神经化与静态悬带术具有明显改善面部对称性的优势。在临床观察中，尽管接受了相同的手术程序，但不同口角下垂程度的患者会获得不同的对称效果。轻度不对称的患者比重度不对称的患者获得更好的效果。影响术后结果的机制尚未得到系统探索。我们回顾性分析了 44 例行咬肌神经-面神经吻合联合静态悬带术的患者。根据口角下垂程度将患者分为轻度不对称组（n=24）和重度不对称组（n=20）。术前和术后使用 FACE-gram 软件评估静态和动态对称性。所有患者的口角在休息和微笑时的对称性均显著改善。轻度不对称组双侧口角位置的差异明显小于重度不对称组（p<0.001），表明轻度不对称组的对称性更好。此外，这些差异是由术前和术后未受累侧口角位置引起的（p<0.001），而不是由瘫痪侧引起的（p>0.05）。总之，咬肌神经-面神经吻合联合静态悬带术可使不同程度不对称患者达到动态和静态对称性。轻度不对称的患者比重度不对称的患者获得更好的术后对称性。术后面部不对称可能受未受累侧面部肌肉张力的影响。
