Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Department of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
J Plast Reconstr Aesthet Surg. 2023 Jul;82:31-47. doi: 10.1016/j.bjps.2023.04.014. Epub 2023 Apr 18.
One of the critical factors in facial reanimation is selecting the donor nerve. The most favored neurotizers are the contralateral facial nerve with a cross-face nerve graft (CFNG) and motor nerve to the masseter (MNM). A relatively new dual innervation (DI) method has shown successful results. This study aimed to compare the clinical outcomes of different neurotization strategies for free gracilis muscle transfer (FGMT).
The Scopus and WoS databases were queried with 21 keywords. Three-stage article selection was performed for the systematic review. Articles presenting quantitative data for commissure excursion and facial symmetry were included in meta-analysis, using random-effects model. ROBINS-I tool and Newcastle-Ottawa scale were used to assess bias and study quality.
One hundred forty-seven articles containing FGMT were systematically reviewed. Most studies indicated CFNG as the first choice. MNM was primarily indicated in bilateral palsy and in elderly. Clinical outcomes of DI studies were promising. 13 studies including 435 observations (179 CFNG, 182 MNM, 74 DI) were eligible for meta-analysis. The mean change in commissure excursion was 7.15 mm (95% CI: 4.57-9.72) for CFNG, 8.46 mm (95% CI: 6.86-10.06) for MNM, and 5.18 mm (95% CI: 4.01-6.34) for DI. In pairwise comparisons, a significant difference was found between MNM and DI (p = 0.0011), despite the superior outcomes described in DI studies. No statistically significant difference was found in resting and smile symmetry (p = 0.625, p = 0.780).
CFNG is the most preferred neurotizer, and MNM is a reliable second option. Outcomes of DI studies are promising, but more comparison studies are needed to draw conclusions. Our meta-analysis was limited by incompatibility of the assessment scales. Consensus on a standardized assessment system would add value to future studies.
面部再运动的关键因素之一是选择供体神经。最受欢迎的神经化剂是对侧面神经加面横神经移植（CFNG）和咬肌运动神经（MNM）。一种相对较新的双重神经支配（DI）方法已显示出成功的结果。本研究旨在比较不同神经化策略对游离股薄肌移植（FGMT）的临床效果。
使用 21 个关键词在 Scopus 和 WoS 数据库中进行检索。对系统综述进行了三阶段文章选择。纳入了定量报告口角位移和面部对称性数据的 Meta 分析，使用随机效应模型。使用 ROBINS-I 工具和纽卡斯尔-渥太华量表评估偏倚和研究质量。
系统综述共纳入 147 篇含有 FGMT 的文章。大多数研究表明 CFNG 是首选。MNM 主要用于双侧麻痹和老年患者。DI 研究的临床结果很有希望。13 项研究（包括 435 例观察）符合 Meta 分析条件，其中 179 例 CFNG、182 例 MNM 和 74 例 DI。CFNG 的口角位移平均变化为 7.15mm（95%CI：4.57-9.72），MNM 为 8.46mm（95%CI：6.86-10.06），DI 为 5.18mm（95%CI：4.01-6.34）。在两两比较中，MNM 和 DI 之间存在显著差异（p=0.0011），尽管 DI 研究中描述了更好的结果。在静止和微笑对称性方面，差异无统计学意义（p=0.625，p=0.780）。
CFNG 是最受欢迎的神经化剂，MNM 是可靠的第二选择。DI 研究的结果很有希望，但需要更多的比较研究来得出结论。我们的 Meta 分析受到评估量表不兼容的限制。达成标准化评估系统的共识将为未来的研究增添价值。
