Wong Zhen Yu, de Jongh Frank W, Ingels Koen J A O, van Heerbeek Niels, Pouwels Sjaak
Department of General Surgery, Nottingham City Hospital, Nottingham, United Kingdom.
Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands.
JPRAS Open. 2024 Nov 1;43:105-121. doi: 10.1016/j.jpra.2024.10.015. eCollection 2025 Mar.
Despite the encouraging findings of temporalis muscle-based facial reanimation surgery without the need for nerve grafting, there is a need for comprehensive evaluation of the impact of temporalis-based facial reanimation surgery on key outcome measures.
Comprehensive search in Medline and Embase databases were carried out up to 25 February 2023. The articles that examined facial reanimation surgery using the temporalis muscle were included in this study. Postoperative changes in smile excursion and the angle of the mouth while smiling were pooled using the DerSimonian and Laird random-effects model. Narrative synthesis was conducted for other outcomes including assessments of spontaneous smile, subjective evaluation of facial symmetry using validated rating tools, functional outcomes, aesthetic outcomes and patient-reported outcomes owing to heterogeneity in reporting of the outcomes.
Twenty-four studies were included in the analysis. Conflicting evidence was demonstrated regarding emotional smile outcomes and its definition. The pooled changes in smile excursion postsurgery were 7.06 mm (95% CI: 3.73-10.40, P < 0.001; I = 0%) and the angle of the mouth were 11.76° (95% CI: 8.80-14.71, P < 0.001; I = 0%). Significant improvement was reported across the validated rating scales of symmetry, functional outcomes, aesthetic outcomes and patient-reported outcomes whereas the superiority compared to other procedures remained inconclusive.
Overall, temporalis-based facial reanimation surgery is a promising option for addressing the negative effects of facial nerve paralysis on the patients' quality of life. This study highlights the uncertainty surrounding the technique and need for further studies.
尽管基于颞肌的面部重建手术无需神经移植，其结果令人鼓舞，但仍需全面评估基于颞肌的面部重建手术对关键结局指标的影响。
截至2023年2月25日，对Medline和Embase数据库进行了全面检索。本研究纳入了使用颞肌进行面部重建手术的文章。采用DerSimonian和Laird随机效应模型汇总术后微笑幅度和微笑时口角角度的变化。由于结局报告存在异质性，对其他结局进行了叙述性综合分析，包括自发微笑评估、使用经过验证的评分工具对面部对称性的主观评估、功能结局、美学结局和患者报告的结局。
分析纳入了24项研究。关于情感性微笑结局及其定义，存在相互矛盾的证据。术后微笑幅度的汇总变化为7.06毫米（95%CI：3.73 - 10.40，P < 0.001；I = 0%），口角角度为11.76°（95%CI：8.80 - 14.71，P < 0.001；I = 0%）。在对称性、功能结局、美学结局和患者报告结局的经过验证的评分量表中均报告了显著改善，而与其他手术相比的优势仍无定论。
总体而言，基于颞肌的面部重建手术是解决面神经麻痹对患者生活质量负面影响的一个有前景的选择。本研究突出了该技术存在的不确定性以及进一步研究的必要性。
