Krastinova Darina, Al-Mekhlafi Ghaleb A, El-Badawy Fatma M, El-Badawy Hossein M, Germanò Demetrio
Department of Head and Neck Surgery, Cranio-Orbito-Palpebral Surgery Unit, Hôpital Foch, Suresnes, FRA.
Department of Medicine, Fakeeh College for Medical Science, Jeddah, SAU.
Cureus. 2023 Dec 30;15(12):e51348. doi: 10.7759/cureus.51348. eCollection 2023 Dec.
Background The facial nerve plays a crucial role in innervating the motor supply of facial muscles, enabling essential facial expressions that facilitate human communication. Defects or damages to this nerve can have significant consequences, leading to functional, emotional, and social difficulties caused by the immobility of facial muscles. Patients suffering from irreversible facial nerve palsy often experience functional symptoms such as eyelid closure defects, mouth deviation, and limited movement. Methods This study aims to address these challenges and offer potential solutions for patients with irreversible facial nerve palsy. In this study, 18 patients (three males and 15 females) underwent temporalis transfer with an intraoral approach in the cranio-orbito-palpebral unity. Preoperative facial reanimation planning involved evaluating the smile's appearance on the unaffected side. Photographs were captured in various positions, and facial expressions were examined. Following this, botulinum toxin was injected into the normal side of the face seven days before the procedure to address the hyperactive condition of the mimic muscles. Results Temporalis transfer with an intraoral approach for oral commissure reanimation in the context of irreversible facial nerve palsy was performed. The surgical procedure combined coronal and orbital approaches and achieved the desired outcomes. Postoperative complications observed included hematomas and ossification. Functional outcomes, assessed using the House-Brackmann grading system, indicated a mean improvement of 2.5, signifying moderate dysfunction with normal tone and facial symmetry. Conclusion This intervention represents an alternative approach to actual techniques of facial palsy reanimation, especially in selected patients who can benefit from the absence of visible scars, such as young patients and those prone to hypertrophic and keloid scarring, as well as patients with non-prominent nasolabial folds.
背景 面神经在支配面部肌肉的运动供应方面起着至关重要的作用，使基本的面部表情得以实现，从而促进人际交流。该神经的缺陷或损伤可能会产生重大后果，导致面部肌肉不动所引起的功能、情感和社交困难。患有不可逆性面神经麻痹的患者常出现眼睑闭合缺陷、口角歪斜和运动受限等功能症状。方法 本研究旨在应对这些挑战，并为不可逆性面神经麻痹患者提供潜在的解决方案。在本研究中，18例患者（3例男性和15例女性）在颅眶睑联合处采用口内入路进行颞肌转移术。术前面部重建规划包括评估未受影响侧的微笑外观。在不同位置拍摄照片，并检查面部表情。在此之后，在手术前7天向面部正常侧注射肉毒杆菌毒素，以解决表情肌过度活跃的情况。结果 在不可逆性面神经麻痹的情况下，采用口内入路进行颞肌转移以恢复口角运动。手术过程结合了冠状和眶部入路，并取得了预期效果。观察到的术后并发症包括血肿和骨化。使用House-Brackmann分级系统评估的功能结果表明，平均改善了2.5级，表明存在中度功能障碍，肌张力和面部对称性正常。结论 这种干预代表了一种替代面神经麻痹重建实际技术的方法，特别是对于那些可以从无可见疤痕中受益的特定患者，如年轻患者、易出现增生性和瘢痕疙瘩性瘢痕的患者以及鼻唇沟不明显的患者。
