Cooper T M, McMahon B, Lex C, Lenert J J, Johnson P C
Facial Nerve Center, University of Pittsburgh, Pennsylvania 15261, USA.
J Reconstr Microsurg. 1996 Feb;12(2):99-103. doi: 10.1055/s-2007-1006461.
Reinnervation of the paralyzed hemiface with a cross-facial nerve graft (CFNG) required division of facial nerve branches on the normal hemiface to serve as axon donors. There is therefore concern about whether any impairment of normal hemiface motion occurs in the postoperative period. To minimize the likelihood of donor-side impairment, donor branches are chosen from the bucco-zygomatic region which was extensive cross branching, as opposed to be the single temporal or marginal mandibular branches. This study chose to determine quantitatively if this practice does, in fact, adversely affect the normal side hemiface motion governed by these branches, viz., eye closure, pucker, and smile. Since surgical procedures near the facial nerve (such as superficial parotidectomy) may leave the patient with transient facial weakness, even in the absence of nerve transection, the hypothesis was that hemiface motion would be impaired on the donor side during the early postoperative period (first month) secondary to edema and/or neuropraxia. However, based on the clinical observation that donor-side facial motion is not demonstrably impaired late after surgery, a further hypothesis was that any early facial motion is not demonstrably impaired late after surgery, a further hypothesis was that any early facial motion impairment would return to normal by 3 months postoperatively. Seven patients underwent sural CFNG as a primary or secondary component of their facial animation procedure. Their facial motion was quantified preoperatively and in serial postoperative examinations using the Maximal Static Response Assay (MSRA) of facial motion. Careful selection of redundant bucco-zygomatic branches of the facial nerve on the normal side for CFNG did not ultimately ( > or = 3 months postoperative) impair the important motions of eye closure, smile, or pucker. Early postoperative ( < or = 1 month) weakness of the smile was seen on both X and Y axes, indicating that both the risorius and zygomatic muscles were transiently weakened. The ability to elevate the lower eyelid was unaffected at any postoperative time point. Movement of the normal hemiface did not appear to be permanently affected by CFNG when a careful choice of redundant bucco-zygomatic donor branches was made.
采用跨面神经移植（CFNG）对瘫痪半侧面部进行神经再支配时，需要切断正常半侧面部的面神经分支作为轴突供体。因此，人们担心术后正常半侧面部运动是否会出现任何损伤。为了将供体侧损伤的可能性降至最低，供体分支选自颊颧区域，该区域有广泛的交叉分支，而不是单一的颞支或下颌缘支。本研究旨在定量确定这种做法是否实际上会对由这些分支支配的正常侧半侧面部运动，即闭眼、撅嘴和微笑产生不利影响。由于面神经附近的外科手术（如腮腺浅叶切除术）可能会使患者出现短暂的面部无力，即使在没有神经横断的情况下也是如此，因此假设是术后早期（第一个月）供体侧半侧面部运动会因水肿和/或神经失用而受损。然而，基于临床观察，即术后晚期供体侧面部运动没有明显受损，进一步的假设是任何早期面部运动损伤在术后3个月会恢复正常。7例患者接受了腓肠神经CFNG，作为其面部动态手术的主要或次要组成部分。术前以及术后连续检查时，使用面部运动的最大静态反应测定法（MSRA）对他们的面部运动进行定量分析。仔细选择正常侧面部神经多余的颊颧分支用于CFNG，最终（术后≥3个月）并未损害闭眼、微笑或撅嘴等重要运动。术后早期（≤1个月），X轴和Y轴上均出现微笑无力，表明笑肌和颧肌均出现短暂性减弱。术后任何时间点下睑上抬能力均未受影响。当仔细选择多余颊颧供体分支时，正常半侧面部的运动似乎不会受到CFNG的永久性影响。
