Biglio Andrea, Rossetti Giulia, Gibelli Daniele Maria, Dolci Claudia, Cappella Annalisa, Allevi Fabiana, Vaira Luigi Angelo, De Riu Giacomo, Sforza Chiarella, Biglioli Federico
Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy; Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy.
J Craniomaxillofac Surg. 2023 Dec;51(12):766-771. doi: 10.1016/j.jcms.2023.09.011. Epub 2023 Oct 7.
Facial palsy can severely compromise quality of life, significantly altering the harmony and symmetry of the face, which can be restored by surgical rehabilitation. The aim of the study was the quantification of facial symmetry following facial reanimation. Fifteen consecutive adult patients were surgically treated through triple innervation for reanimation of flaccid unilateral facial paralysis (contralateral facial nerve, masseteric nerve, and hypoglossal nerve) and fascia lata graft for definition of the nasolabial sulcus. In the preoperative stage and at least 11 months after the surgical treatment, three-dimensional facial images were recorded through stereophotogrammetry in a neutral (rest) position, and with Mona Lisa and full-denture (maximum) smiles. Labial commissure inclination relative to the interpupillary axis, and a surface assessment of local facial asymmetry at rest and while smiling were obtained for the upper, middle, and lower facial thirds. The angle between the interpupillary axis and the labial commissure significantly improved in post-surgical acquisitions, regaining symmetry at rest (t-test; p < 0.001). Facial symmetry increased significantly when passing from pre-to postsurgical facial scans, from the lower to the upper facial third, and from the full smile to the rest position (ANOVA; p < 0.001). After treatment, the full smile recovered more symmetry than the other two expressions. In summary, surgical treatment significantly reduced facial asymmetry, but this reduction differed significantly among the various animations and facial thirds. The results of this study confirmed clinical findings of significant static and dynamic improvements in facial symmetry after triple innervation reanimation surgery.
面瘫会严重影响生活质量，显著改变面部的和谐与对称，而手术康复可以恢复这种状态。本研究的目的是对面部重建后的面部对称性进行量化。连续15例成年患者接受了三联神经支配手术治疗弛缓性单侧面瘫（对侧面神经、咬肌神经和舌下神经），并采用阔筋膜移植来确定鼻唇沟。在术前阶段以及手术治疗后至少11个月，通过立体摄影测量法记录三维面部图像，包括中立（休息）位、蒙娜丽莎微笑位和全口义齿（最大）微笑位。获取相对于瞳孔间轴的口角倾斜度，以及上、中、下三分之一面部在休息和微笑时局部面部不对称的表面评估。术后采集时，瞳孔间轴与口角之间的角度显著改善，在休息时恢复了对称性（t检验；p < 0.001）。从术前到术后面部扫描、从下三分之一面部到上三分之一面部、从全口义齿微笑位到休息位，面部对称性显著增加（方差分析；p < 0.001）。治疗后，全口义齿微笑位比其他两种表情恢复了更多的对称性。总之，手术治疗显著降低了面部不对称性，但这种降低在不同表情和面部三分之一区域之间存在显著差异。本研究结果证实了三联神经支配重建手术后面部对称性在静态和动态方面有显著改善的临床发现。
