Postoperative effect analysis of different surgical techniques used in facial nerve reconstruction
-
摘要: 目的 探讨不同面神经重建方案的影响因素及其疗效, 为面神经功能重建策略提供参考。方法 回顾性分析2016年1月至2021年1月因面神经不可逆损伤, 行面神经功能重建手术的24例患者, 面神经全瘫时程均 < 18个月。面神经中枢端可利用的患者中, 根据面神经缺失长度, 行面神经吻合术6例(A组), 行面神经移植术(腓肠神经或耳大神经)5例(B组); 面神经中枢端无法利用时, 行面神经-舌下神经桥接术(端-侧吻合)5例(C组), 面神经移植术(腓肠神经或耳大神经)-舌下神经桥接术(端-侧吻合)4例(D组); 联合修复术(面神经-咬肌神经桥接术联合上述方式之一)4例(E组)。术后随访时程≥1年。结果 24例患者中, 术后1年面神经功能HB-Ⅲ级的百分比分别是: A组83.3%(5/6), B组60.0%(3/5), C组40.0%(2/5), D组25.0%(1/4), E组50.0%(2/4)。非多重面神经修复患者, 口眼联动发生率为15.0%(3/20), 而进行面神经-咬肌神经桥接的多重面神经修复患者中无一例发生口眼联动, 且微笑时口角偏斜不明显。所有面神经-舌下神经端侧吻合的患者, 伸舌无偏斜, 舌肌无萎缩。结论 周围性面瘫的面神经功能重建方案多样, 需根据中枢端能否利用及面神经缺损长度制定个性化修复方案。在单一修复方案中, 为增加术后面神经功能疗效, 应尽量减少神经的吻合口, 提倡面神经转位吻合, 同时为避免术后舌下神经功能障碍, 提倡面神经-舌下神经端侧吻合。另外, 多重面神经修复能够有效提高微笑时口角活动对称性, 并降低口眼联动的发生率, 对患者术后生活质量的提高具有较重要的意义。Abstract: Objective To investigate the factors and efficacy of different surgical techniques used in facial nerve(FN) reconstruction.Methods A retrospective analysis was conducted on 24 patients who underwent facial nerve reconstruction surgery in our department from January 2016 to January 2021. The duration of total facial nerve paralysis was less than 18 months. The study included 5 surgical techniques, including 6 cases of FN anastomosis(Group A), 5 cases of FN grafting(sural nerve or great auricular nerve)(Group B), 5 cases of side-to-end facial-hypoglossal nerve anastomosis(Group C), 4 cases of side-to-end FN grafting(sural nerve or great auricular nerve) hypoglossal nerve anastomosis(Group D), and 4 cases of dual nerve reanimation(Group E). The postoperative follow-up period was ≥1 year.Results The HB-Ⅲ level of FN function at 1 year after surgery was 83.3%(5/6) in group A, 60.0%(3/5) in group B, 40.0%(2/5) in group C, 25.0%(1/4) in group D, and 50.0%(2/4) in group E. In patients without multiple FN repair, the incidence of synkinesis was 15.0%(3/20), while no cases of synkinesis were observed in patients with dual nerve reanimation. The patients who underwent hypoglossal-facial side-to-end anastomosis showed no hypoglossal nerve dysfunction.Conclusion Different FN repair techniques result in varying postoperative FN function recovery, as personalized repair should be managed. Among the various techniques, FN end-to-end anastomosis after FN transposition is recommended as to reduce the number of anastomotic stoma, while hypoglossal-facial side-to-end anastomosis is advocated as to prevent postoperative hypoglossal nerve dysfunction. Additionally, dual nerve repair can effectively improve smile symmetry and reduce synkinesis, which enhances patients' quality.
-
-
表 1 术前各组基本资料比较
项目 A组 B组 C组 D组 E组 总计 P 人数/例 6 5 5 4 4 24 性别/例 0.844 男 3 2 2 3 2 12 女 3 3 3 1 2 12 年龄/岁 38.17±7.00 40.00±11.81 43.00±10.61 44.50±6.45 38.25±14.15 40.63±9.62 0.856 病变侧别/例 0.663 左侧 3 3 1 3 1 11 右侧 3 2 4 1 3 13 面瘫时程/月 4.17±3.97 7.20±5.45 6.00±6.16 6.00±5.48 6.25±4.65 5.83±4.81 0.884 
下载: 导出CSV
-
[1] Soloperto D, Di Maro F, Le Pera B, et al. Surgical anatomy of the facial nerve: from middle cranial fossa approach to endoscopic approach. A pictorial review[J]. Eur Arch Otorhinolaryngol, 2020, 277(5): 1315-1326. doi: 10.1007/s00405-020-05841-y
[2] Jandali D, Revenaugh PC. Facial reanimation: an update on nerve transfers in facial paralysis[J]. Curr Opin Otolaryngol Head Neck Surg, 2019, 27(4): 231-236. doi: 10.1097/MOO.0000000000000543
[3] Markey JD, Loyo M. Latest advances in the management of facial synkinesis[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(4): 265-272. doi: 10.1097/MOO.0000000000000376
[4] Robinson MW, Baiungo J. Facial Rehabilitation: Evaluation and Treatment Strategies for the Patient with Facial Palsy[J]. Otolaryngol Clin North Am, 2018, 51(6): 1151-1167. doi: 10.1016/j.otc.2018.07.011
[5] Malik TH, Kelly G, Ahmed A, et al. A comparison of surgical techniques used in dynamic reanimation of the paralyzed face[J]. Otol Neurotol, 2005, 26(2): 284-291. doi: 10.1097/00129492-200503000-00028
[6] Salmerón-González E, Simón-Sanz E, García-Vilariño E, et al. Masseter-to-facial nerve transfer: Technique and outcomes utilizing a fibrin sealant for coaptation[J]. J Plast Reconstr Aesthet Surg, 2018, 71(8): 1216-1230.
[7] Mohamed A, Omi E, Honda K, et al. Outcome of different facial nerve reconstruction techniques[J]. Braz J Otorhinolaryngol, 2016, 82(6): 702-709. doi: 10.1016/j.bjorl.2015.12.010
[8] Slattery WH 3rd, Cassis AM, Wilkinson EP, et al. Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve[J]. Otol Neurotol, 2014, 35(3): 509-513. doi: 10.1097/MAO.0b013e3182936bcf
[9] Kunert P, Podgórska A, Bartoszewicz R, et al. Hemihypoglossal-facial nerve anastomosis for facial nerve palsy[J]. Neurol Neurochir Pol, 2011, 45(5): 452-460. doi: 10.1016/S0028-3843(14)60313-3
[10] Yang SF, Kim JC. Reinnervation with Selective Nerve Grafting from Multiple Donor Nerves[J]. Facial Plast Surg Clin North Am, 2021, 29(3): 389-396. doi: 10.1016/j.fsc.2021.03.003
[11] Hetzler L, MacDowell S, Trahan J, et al. Facial Nerve Translocation for Low Tension Neurorrhaphy to Masseteric Nerve[J]. Otol Neurotol, 2019, 40(5): e562-e565. doi: 10.1097/MAO.0000000000002195
[12] Bayrak SB, Kriet JD, Humphrey CD. Masseteric to buccal branch nerve transfer[J]. Curr Opin Otolaryngol Head Neck Surg, 2017, 25(4): 280-285. doi: 10.1097/MOO.0000000000000380
[13] 孔德弟, 戴春富. 颞下窝A型径路中面神经无张前移位的手术技巧[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(7): 549-552. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.07.014
[14] Boahene K. Reanimating the paralyzed face[J]. F1000Prime Rep, 2013, 5: 49.
[15] Tayebi Meybodi A, Moreira LB, Zhao X, et al. Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study[J]. Oper Neurosurg(Hagerstown), 2020, 19(4): 436-443. doi: 10.1093/ons/opz408
[16] Samii M, Alimohamadi M, Khouzani RK, et al. Comparison of Direct Side-to-End and End-to-End Hypoglossal-Facial Anastomosis for Facial Nerve Repair[J]. World Neurosurg, 2015, 84(2): 368-375. doi: 10.1016/j.wneu.2015.03.029
[17] Socolovsky M, Martins RS, di Masi G, et al. Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer[J]. ActaNeurochir(Wien), 2016, 158(5): 945-957.
[18] Kuta V, Taylor SM. Supercharging the Smile: A Novel Dual Nerve Transfer for Facial Reanimation[J]. Plast Reconstr Surg Glob Open, 2022, 10(2): e4124. doi: 10.1097/GOX.0000000000004124
[19] Okland TS, Pepper JP. Dual Nerve Transfer for Facial Reanimation[J]. Facial Plast Surg Clin North Am, 2021, 29(3): 397-403. doi: 10.1016/j.fsc.2021.03.004
[20] Yoshioka N. Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report[J]. Oper Neurosurg(Hagerstown), 2020, 19(3): E230-E235. doi: 10.1093/ons/opaa128
[21] Kim J. Neural Reanimation Advances and New Technologies[J]. Facial Plast Surg Clin North Am, 2016, 24(1): 71-84. doi: 10.1016/j.fsc.2015.09.006
[22] Rozen SM. Discussion: Symmetry Restoration at Rest after Masseter-to-Facial Nerve Transfer: Is It as Efficient as Smile Reanimation?[J]. Plast Reconstr Surg, 2017, 140(4): 802-804. doi: 10.1097/PRS.0000000000003736
[23] Wang WJ, Zhu WD, Tremp M, et al. Facial reanimation with interposition nerve graft or masseter nerve transfer: a comparative retrospective study[J]. Neural Regen Res, 2022, 17(5): 1125-1130. doi: 10.4103/1673-5374.324862
-
计量
- 文章访问数: 196
- 施引文献: 0