Koshima I, Umeda N, Handa T, Moriguchi T, Orita Y
Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Okayama, Japan.
J Reconstr Microsurg. 1997 Apr;13(3):157-62. doi: 10.1055/s-2007-1000242.
There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.
不露牙齿（平常的微笑）和露出牙齿（方形微笑）。前者主要通过颧大肌发挥作用，而后者则是由颧大肌和降下唇肌共同作用产生。在面瘫重建中，降下唇肌的作用不可忽视。本文描述了一种使用股直肌分束进行双肌肉转移，一期重建颧大肌和降下唇肌的方法。该患者因源于面神经的颅外神经鞘瘤导致面瘫。肿瘤切除后，将股直肌分束转移以重建颧大肌和降下唇肌。肌肉的蒂血管与受区面部血管吻合后，近端分束肌肉的长运动神经进行交叉，并直接与对侧准备好的颊支神经吻合。远端肌段的短运动神经则缝合至同侧咬肌神经。股直肌分束转移的优点包括：（1）可重建独立的肌肉收缩；（2）由于使用咬肌神经作为下唇降肌的运动源，不会出现舌肌或斜方肌萎缩；（3）肌肉移植仅牺牲一块肌肉；（4）是一期重建。
