Sun Qing, Li Xing, Zhu Zhihui, Xiang Xiting, Zhang Tao
Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China.
Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China.
J Clin Med. 2024 Aug 22;13(16):4955. doi: 10.3390/jcm13164955.
Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included "dynamic repair", "late-stage facial paralysis", "nerve and muscle transplantation", "muscle flap", and "tendon transposition". Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies.
面瘫是由先天性或后天性面神经损伤引起的，会导致明显的外貌和功能缺陷。腮腺和中面部肿瘤的手术切除可导致面瘫，因此需要有效的治疗策略。本综述探讨了晚期面瘫恢复运动和功能的挑战，重点关注涉及神经和肌肉移植的动态修复技术。该综述涵盖了晚期面瘫动态修复手术的研究，包括带蒂局部肌瓣转移、带蒂血管化神经瓣转移和多肌瓣手术等技术。使用PubMed、Web of Science和谷歌学术进行了系统的文献检索，涵盖了2000年至2024年的研究。关键词包括“动态修复”、“晚期面瘫”、“神经和肌肉移植”、“肌瓣”和“肌腱转位”。纳入的研究包括报告手术结果的临床研究、系统评价和荟萃分析。排除标准包括数据不足的研究和非同行评审的文章。涉及神经和肌肉移植的动态修复技术对于治疗晚期面瘫至关重要。每种手术方法都有其优缺点。咬肌瓣成功率高，尽管可能会导致水平张力和下颌轮廓问题。颞肌瓣对恢复笑容有效，但可能导致颞部凹陷。股薄肌瓣应用广泛，尤其是双神经支配时，自发微笑成功率高，但恢复时间较长。背阔肌瓣有效，但可能导致水肿和肩部问题。前锯肌游离瓣具有精确矢量定位的灵活性，但可能无法实现足够的唇部提升，并可能导致脸颊肿胀。联合多瓣手术可提供更自然的面部表情，但会增加手术复杂性，需要先进的显微外科技术。双神经支配有望恢复自发微笑。一期手术恢复更快，减轻经济负担。全面的患者评估对于选择最合适的手术方法至关重要。涉及神经和肌肉移植的动态修复技术为晚期面瘫恢复功能和美观提供了有效的解决方案。未来的研究应关注长期结果、患者满意度以及规范手术方案以优化治疗策略。
