Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell School of Medicine, Houston, TX, United States.
J Plast Reconstr Aesthet Surg. 2024 Jan;88:196-207. doi: 10.1016/j.bjps.2023.10.124. Epub 2023 Oct 31.
The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis.
The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality.
The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P < 0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P < 0.001 in CFNG compared with MNM, P = 0.013 for CLFN compared with MNM, P < 0.001 for DI compared with MNM).
DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.
自发微笑的恢复已成为面部再 生手术的主要焦点，其主要决定因素是选择的神经化剂。我们旨在比较游离功能性肌肉转移治疗长 期面瘫时最常用的神经化方法的自发性结果。
使用 21 个关键词在 Embase、Ovid Medline 和 PubMed 数据库中进行检索。所有报告特定神经化策略（面 神经交叉吻合术 (CFNG)、对侧面神经 (CLFN)、咬肌运动神经 (MNM)和双重神经支配 (DI)）术后自发性率的过去 20 年的临床研究均包括在内。使用 Freeman-Tukey 双反正弦变换、I 统计量和基于随机效应模型的通用倒数方差进行患病率的荟萃分析。使用非随机干预研究的偏倚风险和纽卡斯尔-渥太华量表来评估偏倚和研究质量。
文献检索产生了 2613 项结果和 473 项独特的面部再 生引文。29 项研究包括 2046 名患者被纳入系统评价。对合格数据（23 项研究的 1952 个观察值）进行荟萃分析显示，组间存在统计学显著差异（CFNG：0.94；95%置信区间 [CI]，0.76-1.00，CLFN：0.91；95%CI，0.49-1.00，MNM：0.26；95%CI，0.05-0.54，DI：0.98；95%CI，0.90-1.00，P<0.001）。在两两比较中，MNM 与其他神经化策略之间存在统计学显著差异（CFNG 与 MNM 相比，P<0.001，CLFN 与 MNM 相比，P=0.013，DI 与 MNM 相比，P<0.001）。
DI 和 CLFN 驱动的策略取得了最有希望的结果，而 MNM 显示出在较低程度上引发自发微笑的潜力。我们的荟萃分析主要受到自发评估系统不一致的限制。达成标准化工具的共识将能够更有效地比较结果。
