From the Departments of Plastic Surgery.
Population and Data Sciences, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2024 Sep 1;154(3):633-648. doi: 10.1097/PRS.0000000000011005. Epub 2023 Aug 18.
The purpose of this study was to compare long-term tone and excursion in single- versus dual-innervated free functional muscle transfer (FFMT) in patients with longstanding facial paralysis.
Patients with longstanding facial palsy treated with an FFMT innervated either by a nerve-to-masseter graft (single-innervation group) or nerve-to-masseter and cross-facial-nerve grafts (dual-innervation group) were included. One-year minimum follow-up was required. Outcome measures, based on standardized photographs, included excursion, smile angle, teeth exposure, commissure height deviation, and upper lip height deviation in repose and in closed and open-teeth smile preoperatively and at 3 months, 1 year, and 3 years postoperatively. Emotrics software and ImageJ software were used to take measurements. Between-group and within-group longitudinal comparisons were analyzed.
At 3 years (single, n = 24; dual, n = 13), significance was found between groups in commissure position (single, 26.42 mm versus dual, 31.51 mm; P < 0.0001) and excursion with open-mouth smile (single, 31.32 mm versus dual, 26.59 mm; P < 0.001). Single-innervation FFMT within-group analysis lacked significant improvement in commissure height deviation and upper lip height deviation at 3 years in repose, whereas the dual-innervation group revealed significant improvements (3.67 mm [ P < 0.001], 3.17 mm [ P < 0.001], respectively). Teeth exposure revealed an increase in the dual-innervation group (single, 35.753 mm 2 versus dual, 64.177 mm 2 ), but significance was not observed.
Dual-innervated FFMT revealed improvements in resting tone and teeth exposure with minimal decrease in smile excursion compared with single-innervated FFMT.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在比较长期的 tone 和位移在单侧与双侧神经支配的游离功能性肌肉移植（FFMT）治疗长期面瘫患者中的效果。
本研究纳入了接受 FFMT 治疗的长期面瘫患者，这些患者的神经支配方式分别为神经-咬肌移植（单侧神经支配组）或神经-咬肌和跨面神经移植（双侧神经支配组）。需要至少 1 年的随访。根据标准化照片评估的结果包括位移、微笑角度、牙齿暴露度、口角高度偏差和休息时及闭眼和开齿微笑时的上唇高度偏差，术前和术后 3 个月、1 年和 3 年。使用 Emotrics 软件和 ImageJ 软件进行测量。分析了组间和组内的纵向比较。
在 3 年时（单侧，n = 24；双侧，n = 13），组间在口角位置（单侧，26.42mm 与双侧，31.51mm；P < 0.0001）和张口微笑时的位移（单侧，31.32mm 与双侧，26.59mm；P < 0.001）方面存在显著差异。单侧神经支配的 FFMT 组在 3 年时休息时的口角高度偏差和上唇高度偏差的组内分析没有显著改善，而双侧神经支配组则显示出显著改善（分别为 3.67mm [P < 0.001]、3.17mm [P < 0.001]）。牙齿暴露度在双侧神经支配组增加（单侧，35.753mm² 与双侧，64.177mm²），但无统计学意义。
与单侧神经支配的 FFMT 相比，双侧神经支配的 FFMT 在保持微笑位移最小减少的情况下，显示出对静止 tone 和牙齿暴露度的改善。
临床问题/证据水平：治疗性，III 级。
