Jin Tingting, Chai Yongchuan, Xue Lu, Jiang Yi, Xue Na, Wang Zhaoyan
Department of Otolaryngology Head and Neck Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200011,China.
Ear Institute,Shanghai Jiao Tong University School of Medicine.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 May;38(5):385-390. doi: 10.13201/j.issn.2096-7993.2024.05.007.
To investigate the factors and efficacy of different surgical techniques used in facial nerve(FN) reconstruction. A retrospective analysis was conducted on 24 patients who underwent facial nerve reconstruction surgery in our department from January 2016 to January 2021. The duration of total facial nerve paralysis was less than 18 months. The study included 5 surgical techniques, including 6 cases of FN anastomosis(Group A), 5 cases of FN grafting(sural nerve or great auricular nerve)(Group B), 5 cases of side-to-end facial-hypoglossal nerve anastomosis(Group C), 4 cases of side-to-end FN grafting(sural nerve or great auricular nerve) hypoglossal nerve anastomosis(Group D), and 4 cases of dual nerve reanimation(Group E). The postoperative follow-up period was ≥1 year. The HB-Ⅲ level of FN function at 1 year after surgery was 83.3%(5/6) in group A, 60.0%(3/5) in group B, 40.0%(2/5) in group C, 25.0%(1/4) in group D, and 50.0%(2/4) in group E. In patients without multiple FN repair, the incidence of synkinesis was 15.0%(3/20), while no cases of synkinesis were observed in patients with dual nerve reanimation. The patients who underwent hypoglossal-facial side-to-end anastomosis showed no hypoglossal nerve dysfunction. Different FN repair techniques result in varying postoperative FN function recovery, as personalized repair should be managed. Among the various techniques, FN end-to-end anastomosis after FN transposition is recommended as to reduce the number of anastomotic stoma, while hypoglossal-facial side-to-end anastomosis is advocated as to prevent postoperative hypoglossal nerve dysfunction. Additionally, dual nerve repair can effectively improve smile symmetry and reduce synkinesis, which enhances patients' quality.
探讨面神经(FN)重建中不同手术技术的影响因素及疗效。对2016年1月至2021年1月在我科接受面神经重建手术的24例患者进行回顾性分析。全面神经麻痹持续时间小于18个月。该研究包括5种手术技术,其中FN吻合术6例(A组),FN移植术(腓肠神经或耳大神经)5例(B组),面-舌下神经端侧吻合术5例(C组),FN移植术(腓肠神经或耳大神经)与舌下神经端侧吻合术4例(D组),双神经修复术4例(E组)。术后随访时间≥1年。术后1年时,A组FN功能的HB-Ⅲ级水平为83.3%(5/6),B组为60.0%(3/5),C组为40.0%(2/5),D组为25.0%(1/4),E组为50.0%(2/4)。在未进行多次FN修复的患者中,联带运动发生率为15.0%(3/20),而在接受双神经修复的患者中未观察到联带运动病例。接受舌下-面神经端侧吻合术的患者未出现舌下神经功能障碍。不同的FN修复技术导致术后FN功能恢复情况各异,应进行个体化修复。在各种技术中,建议行FN移位后端端吻合以减少吻合口数量,同时提倡面-舌下神经端侧吻合以防止术后舌下神经功能障碍。此外,双神经修复可有效改善微笑对称性并减少联带运动,从而提高患者生活质量。