Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2023 Jun;93(6):1674-1681. doi: 10.1111/ans.18336. Epub 2023 Mar 28.
The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis.
A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems.
Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81° (SD 2.90) respectively.
Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.
本研究旨在评估我们针对肿瘤相关面瘫患者采用多神经束、分区再支配方法的治疗效果。
回顾性分析了连续接受多种供体神经移植的面瘫患者。在每种情况下，供体神经的选择基于供体神经的可用性和受影响侧运动终板的活力。所利用的神经输入源包括残余面神经残端、咬肌神经、部分舌下神经和对侧面神经分支。临床结果由专家评分者进行评分。评分采用改良 House-Brackmann、eFACE 和 MEEI FACEgram 评分系统进行。
2017 年至 2020 年间，共有 12 例患者纳入研究（平均年龄 60 岁；范围 26-81 岁）。8 例患者（67%）在改良 House-Brackmann 分级量表上达到 III 级结果。平均 eFACE 静态和动态评分分别为 76 和 57，反映了静止时高度对称和动态运动的中度恢复。平均运动时间为 5.4 个月（SD 1.9）。客观的 FACE-gram 测量证实了中面部运动的恢复，平均微笑幅度和口角幅度分别改善了 3.19mm（SD 3.18）和 4.81°（SD 2.90）。
采用多神经束移植对面部功能和对称性的改善是有效的。
