From the Department of Surgery, Division of Plastic Surgery.
Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital.
Plast Reconstr Surg. 2023 Jun 1;151(6):1296-1305. doi: 10.1097/PRS.0000000000010102. Epub 2023 May 24.
Facial palsy patients experience an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos, and the inability to spontaneously blink are the main symptoms and, if left untreated, can compromise the cornea and vision. This article reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.
Data were collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterion was that a minimum of a 2-year follow-up was required. Patients were assessed preoperatively and postoperatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.
A total of 26 free functional platysma transfers were completed between 2011 and 2018; three patients were excluded because of inadequate follow-up. The mean age was 9.1 ± 7.1 years and there were 12 boys and 11 girls. Preoperatively, no patients had evidence of a blink reflex in comparison to 22 patients at 2-year follow-up. There was a statistically significant improvement in palpebral fissure ( P < 0.001) and full eye closure ( P < 0.001) scores at 2-year follow-up; however, there was no statistically significant difference in gentle eye closure ( P = 0.15).
This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
面瘫患者会出现一系列问题，包括功能和心理问题。就眼睛而言，流泪、眼睑闭合不全和无法自主眨眼是主要症状，如果不治疗，会损害角膜和视力。本文报告了 23 例游离功能性颈阔肌移植用于单侧面瘫患者眼肌再支配的结果。
所有接受游离功能性颈阔肌移植进行瘫痪侧眼再支配的患者的数据均进行前瞻性收集。唯一的排除标准是需要至少 2 年的随访。患者在术前和术后进行评估，并使用 eFACE 工具进行评分，重点关注眼对称性，并记录眨眼反射。
2011 年至 2018 年间共完成 26 例游离功能性颈阔肌移植；由于随访不足，有 3 例患者被排除。平均年龄为 9.1 ± 7.1 岁，其中 12 例为男性，11 例为女性。与 2 年随访时的 22 例患者相比，术前没有患者出现眨眼反射。在 2 年随访时，眼睑裂（ P < 0.001）和完全闭眼（ P < 0.001）评分有显著改善；但在轻闭眼（ P = 0.15）方面无显著差异。
这是首例关于游离功能性颈阔肌在眼再支配中长期结果的报告。结果表明，手术可以成功恢复眨眼反射，并实现完全闭眼。
临床问题/证据水平：治疗，IV。
