Kleijwegt M C, Wever C, Hensen E F, Jansen J C, Koot R W, Malessy M J A
ENT Department, Leiden University Medical Center, Leiden, The Netherlands.
Neurosurgery Department, Leiden University Medical Center, Leiden, The Netherlands.
J Neurol Surg B Skull Base. 2023 Aug 11;85(5):546-552. doi: 10.1055/a-2128-5191. eCollection 2024 Oct.
The aim of this study was to assess the ability to smile following a hypoglossal-facial nerve transfer (N12-N7). This is a retrospective chart review. National tertiary referral center for skull base pathology. Seventeen patients. The ability to smile following an N12-N7 transfer was assessed by five medical doctors on photographs of the whole face and frontal, orbital, and oral segments. The (segmented) photographs were scored for the symmetry, asymmetry, and correct or incorrect assessment of the affected side. Seventeen patients were analyzed by 5 assessors providing 85 assessments. The whole face at rest was judged symmetrical in 26% of the cases and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20, and 35%, respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15, and 6%, respectively. The affected side of the frontal, orbital, and buccal facial segments during smiling was correctly identified in 89, 89, and 96%, respectively. Interobserver variability with Fleiss' kappa analysis showed that the strength of the agreement during smile of the total face was good (0.771) Following an N12-N7 transfer, a good facial symmetry at rest can be achieved. During smiling, almost all patients showed asymmetry of the face, which was predominantly determined by the orbital and oral segments. To improve the ability to smile after an N12-N7 transfer, additional procedures are needed.
本研究的目的是评估舌下-面神经吻合术（N12-N7）后微笑的能力。 这是一项回顾性病历审查。 国家颅底病理三级转诊中心。 17名患者。 5名医生通过全脸、正面、眼眶和口腔部分的照片评估N12-N7吻合术后的微笑能力。对（分段的）照片的患侧对称性、不对称性以及正确或错误评估进行评分。 17名患者由5名评估者进行分析，共提供了85次评估。静止时全脸被判定为对称的病例占26%，轻度不对称的占56%。正面、眼眶和口腔部分的对称率分别为63%、20%和35%。患侧被正确识别的比例为76%。微笑时，全脸对称的占6%，轻度不对称的占59%。患侧被正确识别的比例为94%。微笑时正面、眼眶和口腔部分的对称率分别为67%、15%和6%。微笑时正面、眼眶和颊面部部分的患侧被正确识别的比例分别为89%、89%和96%。Fleiss卡方分析显示观察者间的一致性表明全脸微笑时的一致性强度良好（0.771） N12-N7吻合术后，静止时可实现良好的面部对称性。微笑时，几乎所有患者都表现出面部不对称，这主要由眼眶和口腔部分决定。为了提高N12-N7吻合术后的微笑能力，需要额外的手术。
