Comparative Efficacy of Masseteric-to-Facial Nerve Transfer with and without Fascia Lata Grafts in Reanimating Facial Paralysis.

IF 3.2 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2025-06-01 Epub Date: 2024-11-11 DOI:10.1097/PRS.0000000000011871

Yu-Lu Zhou, Gang Chen, Wen-Jin Wang, Hao Ma, Hui-Cai Wen, Wei Wang

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引用次数: 0

Abstract

Background: Masseteric-to-facial nerve transfer excels in dynamic reanimation but is lacking in restoring baseline resting tone. Combining it with fascia lata grafts is expected to more fully enhance facial symmetry. Comprehensive comparison of the results of masseteric-to-facial nerve transfer versus combined static suspension may provide valuable insights into the most appropriate treatment for patients with subacute facial paralysis.

Methods: In this retrospective study, 104 patients with facial paralysis were categorized by surgical procedure: 39 received masseteric-to-facial nerve transfer (group A), and 65 underwent transfer combined with a fascia lata graft (group B). The groups were further divided by oral commissure drooping, with severity graded as slight (A1, B1) or severe (A2, B2) asymmetry.

Results: Patients in group B2 exhibited significantly better static symmetry than those in group A2, with improvements of 87.87% versus 40%, respectively (P < 0.001). No significant difference was observed between groups A1 and B1 in slight asymmetry. The Terzis Smile Function Grading System showed no dynamic symmetry differences (P > 0.05). On objective evaluation, postoperative outcomes indicated better static symmetry in both B groups, and improved dynamic symmetry in group A1, with no statistical difference between groups A2 and B2.

Conclusions: Masseteric-to-facial nerve transfer combined with fascia lata grafts significantly enhanced both static and dynamic symmetry for patients with varying degrees of asymmetry, particularly benefitting those with severe asymmetry. Patients with slight asymmetry who underwent the combined procedure achieved satisfactory static symmetry, although with a minor compromise of approximately 1 mm in dynamic symmetry compared with those who underwent masseteric-to-facial nerve transfer alone.

Clinical question/level of evidence: Therapeutic, III.

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有与无阔筋膜面神经移植治疗面瘫的疗效比较。

背景：按摩-面神经转移在动态复苏方面表现优异，但在恢复基线静息张力方面缺乏。结合阔筋膜移植有望更充分地增强面部对称性。综合比较按摩-面神经移植与联合静态悬浮的结果可能为亚急性面瘫患者的最合适治疗提供有价值的见解。方法：对104例面瘫患者进行回顾性研究，按手术方式分类：A组39例行按摩-面神经移植，B组65例行阔筋膜移植术。根据口腔连合下垂程度分为轻度（A1, B1）和重度（A2, B2）。结果：B2组患者的静态对称性明显优于A2组，分别提高了87.87%和40% （P < 0.001）。A1组和B1组在轻微不对称上无显著差异。Terzis微笑功能分级系统无动态对称性差异（P < 0.05）。客观评价，术后B组静态对称性改善，A1组动态对称性改善，A2组与B2组无统计学差异。结论：咬面神经移植联合阔筋膜移植可显著增强不同程度不对称患者的静态和动态对称性，尤其对严重不对称患者更为有利。轻微不对称的患者接受联合手术获得了满意的静态对称性，尽管与单独接受按摩神经到面神经移植的患者相比，动态对称性有大约1毫米的轻微损害。临床问题/证据水平：治疗性，III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

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