颞肌瓣前移术——一种微创的晚期面瘫治疗方法

Orthodromic Temporalis Flap Transfer for Late Facial Palsy Reanimation:a Minimal Invasive Procedure

目的明确鼻唇沟入路的颞肌瓣前移术治疗晚期面瘫的疗效和并发症。方法11例随访患者作为回顾性研究对象,随访时间6～15个月。其中完全性面瘫5例,不完全性面瘫6例。依据Terzis微笑功能评价表,对患者手术前后面部表情的录像资料进行评价。通过对病史资料的回顾性分析,对患者的并发症情况进行研究。结果11例患者术前平均评分为1.18±0.12,术后为4.45±0.25,有显著性差异(P<0.01);在不完全性6例面瘫患者中,术后没有发生原残存面神经的继发损伤;术后早期,11例患者张口度有暂时性受限(1指),经过训练,术后2个月时张口度可以完全恢复(3指);1例(9%)患者发生移植筋膜的部分坏死;5例(45%)患者发生腮腺瘘,经过加压治疗后痊愈;1例(9%)患者发生肌腱固定松弛,需二期修整;没有患者发生严重并发症,如下颌骨骨折、下颌骨深部大血管破裂和严重血肿等。结论经鼻唇沟入路的颞肌瓣前移术作为晚期面瘫动力性修复的一种方法,具有继发创伤小、疗效可靠的优点。

Objective To investigate the clinical outcome of treating late facial palsy by using orthodromic temporalis transfer through nasolabial fold approach. Methods Eleven patients were treated and studied respectively. There were 6 cases of incomplete facial palsy and 5 cases of complete facial palsy. The results were evaluated based on Terzis＇ Scale. Results All patient＇s were followed up for 6-15 months. The patients average score increased from 1.18±0.12 to 4.45±0.25 according to Terzis＇s scoring postoperative （P〈0.01）. There was no secondary injury of residual facial nerve function in incomplete facial palsy patients; All patients obtained mouth opening one finger in width at the early postoperatively stage and 3 -finger in width after 2-months physical training; There was partial transplanted fascia necrosis in one cases （9%）. Five （45%） cases were developed parotid gland fistula and cured by compression treatment. There was loose of commissural fixation in 1 case （9%）. The results were satisfactory without serious complications such as fracture of ascending ramus of mandible, huge bleeding and hematomas. Conclusion This technique has advantages as follows： mini-wound, satisfying therapeutic effect and good functional recovery.