咬肌神经支配股薄肌移植术在成人晚期面神经麻痹重建中的应用  

Masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults

作　　者：王成元[1] 陈剑[1] 李俊峰 Wang Chengyuan;Chen Jian;Li Junfeng(Department of Plastic Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Otorhinolaryngology,Beijing Aviation General Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院整形外科,北京100029 [2]北京航空总医院耳鼻咽喉科,北京100029

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第5期465-470,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：首都临床特色应用研究项目(Z181100001718176)。

摘　　要：目的评价咬肌神经支配股薄肌移植术治疗成人晚期面神经麻痹的疗效。方法回顾性分析中日友好医院2016—2017年37例接受股薄肌移植术的晚期面神经麻痹患者的资料。其中男11例,女26例;年龄(40.3±12.7)岁。对股薄肌移植术前、术后口角移动距离(ΔT-C)、患者自评面肌功能量表(facial clinimetric evaluation,FaCE)评分,医生使用电子化临床面神经麻痹评估量表(electronic,clinician-graded facial function scale,eFACE)评分的差异。使用SPSS 11.0软件对符合正态分布的数据进行配对t检验。结果术后随访1年,手术前后患侧口角移动距离[ΔT-C_(术前)为(-1.2±3.1)mm,ΔT-C_(术后)为(6.1±3.5)mm]差异有统计学意义(t=-31.1,P<0.01);手术前后FaCE分别为(29.4±14.1)分、(57.6±23.4)分,差异有统计学意义(t=-38.1,P<0.01);手术前后微笑总分、静态评分、动态评分、中面部评分4种状态下eFACE评分差异均有统计学意义(t值分别为-35.8、-29.1、-41.3、-43.9,P值均<0.01)。结论咬肌神经支配股薄肌移植是成人晚期面神经麻痹治疗的有效手段。Objective To investigate the outcomes of masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults and to explore surgical indications.Methods A retrospective chart review of 37 patients(11 males,26 females,with(40.3±12.7)years old)who underwent masseter nerve-innervated free gracilis muscle transfer for smile reanimation between 2016 and 2017 was performed.Patient-reported quality of life(facial clinimetric evaluation,FaCE),physician-reported facial function(eFACE facial grading scale),and oral commissure excursion were compared preoperatively and postoperatively.SPSS 11.0 software was used to analyze the data.Results Thirty-seven patients were followed up in one year after surgery.Significant postoperative improvements were demonstrated for commissure excursion with smile(preoperatively:(-1.2±3.1)mm,postoperatively:(6.1±3.5)mm,t=-31.1,P<0.01),ipsilateral FaCE(preoperatively:(29.4±14.1),postoperatively:(57.6±23.4),t=-38.1,P<0.01),eFACE score(Composite score t=-35.8,Static score t=-29.1,Dynamic score t=-41.3,Midface score t=-43.9,all P<0.01),respectively.Conclusion Masseter nerve-innervated free gracilis muscle transfer is an good option for dynamic smile reanimation in adult patients who have undergone treatment for long-standing facial paralysis.

关 键 词：面神经麻痹 修复外科手术 生活质量 股薄肌 咬肌神经 

分 类 号：R651.3[医药卫生—外科学]