From the Division of Plastic and Reconstructive Surgery, Department of Surgery.
Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children.
Plast Reconstr Surg. 2024 Sep 1;154(3):618-629. doi: 10.1097/PRS.0000000000011073. Epub 2023 Sep 19.
Outcomes of pediatric facial reanimation beyond 10 years are not known. This cross-sectional study evaluated long-term surgical and patient-reported outcomes of adults who underwent smile reconstruction as children with either a cross-face nerve graft (CFNG) or masseter nerve transfer at least 10 years previously.
Commissure excursion was quantified with FACE-Gram software at 3 time points: preoperatively, early postoperatively within 2 years, and at long-term follow-up. Patient-reported outcomes were evaluated with validated questionnaires (Facial Clinimetric Evaluation Scale, FACE-Q 1.0) and thematic analysis of semistructured interviews. Results are reported as median (interquartile range [IQR]).
A total of 42 patients were included (26 women and 16 men). Median long-term follow-up was 19.3 years (IQR, 8.8 years) for CFNG and 17.6 years (IQR, 5.8 years) for masseter nerve transfer. For both groups, commissure excursion increased significantly from preoperative to early postoperative time points and remained stable at long-term follow-up (P < 0.0001). Commissure excursion at long-term follow-up between the 2 groups was not significantly different (CFNG, 5.0 mm [IQR, 9.4 mm]; masseter nerve transfer, 8.4 mm [IQR, 4.1 mm]); P > 0.05). For patient-reported outcomes, median Facial Clinimetric Evaluation Scale score was 72 of 100, and 95% of respondents agreed with the statement "I am pleased with the result" on the FACE-Q 1.0. Overall quality of life was rated at 7 of 10 or greater by 97% of participants, and all participants would recommend the surgery to other children.
Pediatric facial reanimation with CFNG or masseter nerve transfer reliably improves commissure excursion with longevity beyond 10 years. Adult patients report overall high satisfaction and social functioning.
目前尚不清楚儿童面部再 10 年以上的结果。本研究通过对至少 10 年前接受过交叉面神经移植（CFNG）或咬肌神经转移术的儿童进行微笑重建的成年人进行横断面研究，评估了长期手术和患者报告的结果。
通过 FACE-Gram 软件在 3 个时间点量化口角位移：术前、术后 2 年内早期和长期随访。使用经过验证的问卷（面部临床计量评估量表，FACE-Q 1.0）和半结构化访谈的主题分析评估患者报告的结果。结果以中位数（四分位距[IQR]）表示。
共纳入 42 例患者（26 名女性和 16 名男性）。CFNG 的中位长期随访时间为 19.3 年（IQR，8.8 年），咬肌神经转移的中位长期随访时间为 17.6 年（IQR，5.8 年）。对于两组患者，口角位移均从术前到术后早期显著增加，并在长期随访中保持稳定（P < 0.0001）。两组患者在长期随访时的口角位移差异无统计学意义（CFNG，5.0mm[IQR，9.4mm]；咬肌神经转移，8.4mm[IQR，4.1mm]）（P > 0.05）。对于患者报告的结果，面部临床计量评估量表的中位数为 100 分中的 72 分，95%的患者同意 FACE-Q 1.0 中“我对结果感到满意”的说法。97%的参与者总体生活质量评分为 10 分或更高，所有参与者都会向其他孩子推荐该手术。
CFNG 或咬肌神经转移的儿童面部再神经化可可靠地改善口角位移，并能保持 10 年以上的长期效果。成年患者报告总体满意度高，社会功能良好。
