Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico; Plastic Surgery Department, Hospital Angeles Pedregal, Mexico City, Mexico.
Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico.
J Plast Surg Hand Surg. 2023 Aug 9;58:62-66. doi: 10.2340/jphs.v58.6527.
Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or 'supercharging', seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients.
A retrospective cohort including all patients with early unilateral facial palsy (<12 months evolution) who underwent triple nerve transfer between 2019 and 2021 was conducted. We performed single-stage procedure including zygomatic-to-zygomatic and buccal-to-buccal cross-face grafts, a nerve-to-masseter to bucozygomatic trunk transfer, and a mini-hypoglossal to marginal branch transfer. Results were evaluated using the clinician-graded facial function scale (eFACE).
Fifteen patients were included (eight females, seven males), mean age at the time of surgery was 48.9 ± 13.3 years. Palsy was right-sided in eight cases. The mean time from palsy onset to surgery was 5.5 ± 2.8 months. Patients showed improvement in static (70.8 ± 21.9 vs. 84.15 ± 6.68, p = 0.002) and dynamic scores (20 ± 16.32 vs. 74.23 ± 7.46, p < 0.001), as well as periocular (57.33 ± 15.23 vs. 74 ± 7.18, p = 0.007), smile (54.73 ± 11.93 vs. 85.62 ± 3.86, p < 0.001), mid-face (46.33 ± 18.04 vs. 95 ± 7.21, p < 0.001) and lower face scores (67.4 ± 1.55 vs. 90.31 ± 7.54, p < 0.001).
The triple nerve transfer technique using cross-face nerve grafts, the nerve-to-masseter, and the hypoglossal nerve, is an effective and reproducible technique to obtain middle and lower face reanimation in cases of early facial palsy.
早期面瘫通常采用跨面神经移植术进行治疗，然而，到达靶肌肉的轴突数量较少可能导致肌无力或失败。多源神经支配，又称“充电”，旨在结合不同供体神经的优势，同时最大限度地减少其弱点。我们建议在我们的患者中结合跨面神经移植术和局部面外神经转移术，以实现更早的面部再神经支配。
对 2019 年至 2021 年期间接受三叉神经移植术的 15 例早期单侧面瘫（<12 个月病程）患者进行回顾性队列研究。我们进行了一期手术，包括颧-颧和颊-颊跨面移植、神经-咬肌至颊-颧干转移，以及舌下神经-下颌缘支转移。结果采用临床医生分级面部功能量表（eFACE）进行评估。
共纳入 15 例患者（女性 8 例，男性 7 例），手术时平均年龄为 48.9 ± 13.3 岁。8 例为右侧面瘫。从面瘫发病到手术的平均时间为 5.5 ± 2.8 个月。患者静态评分（70.8 ± 21.9 比 84.15 ± 6.68，p = 0.002）和动态评分（20 ± 16.32 比 74.23 ± 7.46，p < 0.001）、眶周（57.33 ± 15.23 比 74 ± 7.18，p = 0.007）、微笑（54.73 ± 11.93 比 85.62 ± 3.86，p < 0.001）、中面部（46.33 ± 18.04 比 95 ± 7.21，p < 0.001）和下部面部评分（67.4 ± 1.55 比 90.31 ± 7.54，p < 0.001）均有改善。
使用跨面神经移植术、神经-咬肌和舌下神经的三叉神经移植技术是一种有效且可重复的技术，可在早期面瘫时获得中下部面部的再神经支配。
