带蒂胸锁乳突肌移位术修复晚期面瘫

TRANSPOSITION OF PEDICLED STERNOCLEIDOMASTOID MUSCLE FOR REPAIR OF FACIAL PARALYSIS IN LATE STAGE

目的 探讨应用带蒂胸锁乳突肌移位术动态修复晚期面瘫畸形的疗效。方法 1999年 12月以来 ,采用带蒂胸锁乳突肌移位术修复 7例晚期面瘫 ,将胸锁乳突肌的胸骨头及锁骨头移位至患侧口周 ,替代瘫痪的口周肌肉 ,修复因面神经瘫痪所致的口鼻歪斜畸形及活动障碍。保留副神经的其余功能。结果 术后立即矫正静态时口鼻歪斜畸形 ,1周后已能活动患侧口角。术后 1个月 ,经训练能恢复笑容。经 10个月随访 ,所有患者口部活动恢复满意。结论 带蒂胸锁乳突肌移位术能修复晚期面瘫所致的口鼻畸形 。

Objective To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. Methods Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. Results Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. Conclusion The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.