Pinkiewicz Milosz, Dorobisz Karolina, Zatoński Tomasz
Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Borowska 213, 50-529 Wroclaw, Poland.
J Clin Med. 2022 May 20;11(10):2890. doi: 10.3390/jcm11102890.
To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection.
A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles.
A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.
对现有的重建技术、面神经分级量表、体格检查、麻痹的可逆性、非重建手术及药物治疗、物理治疗、面瘫的心理层面以及面神经损伤的预防进行系统综述，以阐明知识空白并探讨该领域潜在的研究目标。鉴于可用的重建方法种类繁多且影响选择的因素众多，另一个目的是提出一种简化重建策略选择的算法。
从Medline/Pubmed、Cochrane数据库及谷歌学术检索到共2439篇论文。额外的研究又补充了21篇文章。初次筛选对发表日期无限制。我们仅考虑用英文撰写的论文。排除单病例报告。筛选并去除重复项后，共得到1980篇文章。随后，由于语言和研究设计原因，我们排除了778篇文章。对1068篇文章的标题或摘要进行筛选，获得134篇未符合任何排除标准的论文。经过全文评估，因缺乏术前面神经功能及随访期信息，我们又排除了15篇论文。最终纳入119篇文章。
先进的影像学检查和肌电图检查辅助下的全面临床检查可为确定面瘫病因提供充分信息。鉴于面神经分级量表众多，显然需要明确的指南来推荐使用哪种量表以及何时进行术后评估。静态手术可恢复静息时的面部对称性，而动态重建旨在恢复面部运动。现代面瘫治疗方法包括神经化手术（神经移位和跨面神经移植）、肌肉转位和显微外科游离肌肉移植。康复治疗使患者即使在长期麻痹的情况下也有可能有效控制症状并改善面部功能。鉴于心理健康问题和重大社会障碍，应更加关注心理干预的作用。鉴于每种技术都有其优缺点，治疗方法的选择应针对每位患者进行个体化。
