Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Center, 79106 Freiburg, Germany.
Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Center, 79106 Freiburg, Germany.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:436-445. doi: 10.1016/j.bjps.2023.07.045. Epub 2023 Jul 26.
The free functional muscle gracilis transfer is an established approach in facial reanimation surgery; however, the significance of its neurotization and the patient's age is still inconclusive. Several donor nerves are available for facial reanimation using the free functional gracilis muscle transfer.
This retrospective cohort study investigates whether the masseteric nerve is an equally reliable donor nerve in both older and younger patients.
We included 46 patients (13-71 years, male and female) who underwent nerve-to-masseter (NTM)-driven free functional muscle transfer (FFMT) between January 2008 and December 2019. Patients were distributed into three cohorts according to their age at surgery. We assessed the facial symmetry before and after surgery using the pupillo-modiolar angle. Commissure height and excursion deviation were measured with the Emotrics software. Patient-reported outcome measurements were taken using the Facial Clinimetric Examination (FaCE) scale.
All patients had successful flap innervation, except for one patient in the middle-aged cohort (31-51 years). The postoperative facial symmetry at rest, smiling, and laughing was analyzed with the pupillo-modiolar angle and the Emotrics software and showed similar results between all cohorts. The FaCE scale showed similar scores for the middle-aged (31-51 years) cohort and the senior cohort (52-71 years). The social function score in the senior cohort was higher than in the middle-aged cohort, without statistical significance. One patient in the middle-aged (31-51 years) cohort and the senior cohort (52-71 years), respectively, underwent emergency revision due to impaired flap perfusion and could be salvaged.
NTM-driven FFMT for facial reanimation is a safe and reliable procedure across all age groups of patients.
游离股薄肌功能重建术是面部再表情手术中的一种成熟方法；然而，神经化的重要性及其与患者年龄的关系仍不明确。在游离股薄肌功能重建术中，有几种可供选择的供体神经用于面部再表情。
本回顾性队列研究旨在探讨咬肌神经在老年和年轻患者中是否都是一种可靠的供体神经。
我们纳入了 46 名（13-71 岁，男女）患者，他们在 2008 年 1 月至 2019 年 12 月期间接受了神经-咬肌（NTM）驱动的游离功能肌转移（FFMT）。根据手术时的年龄，患者被分为三个队列。我们使用瞳孔-中脑角评估手术前后的面部对称性。使用 Emotrics 软件测量口角高度和偏移。使用面部临床计量学评估量表（FaCE）量表进行患者报告的结果测量。
除了中年队列（31-51 岁）中的一名患者外，所有患者的皮瓣均成功获得神经支配。在休息、微笑和大笑时，通过瞳孔-中脑角和 Emotrics 软件分析术后的面部对称性，所有队列之间的结果相似。在中年队列（31-51 岁）和老年队列（52-71 岁）中，FaCE 量表的评分相似。老年队列的社会功能评分高于中年队列，但无统计学意义。中年队列（31-51 岁）和老年队列（52-71 岁）中的一名患者分别因皮瓣灌注受损而进行了紧急修复，并得以挽救。
NTM 驱动的 FFMT 用于面部再表情是一种安全可靠的手术，适用于所有年龄段的患者。
