半侧颜面萎缩合并面瘫的整形外科治疗

Plastic Surgery for Facial Hemiatrophy with Facial Paralysis

目的 探讨半侧颜面萎缩合并面瘫患者的整形外科治疗方法。方法 2006年3月至2012年3月北京协和医院整形外科收治半侧颜面萎缩合并面瘫患者共12例。其中男3例,女9例。年龄16~49岁,半侧颜面萎缩平均发病时间6.9年（5~30年）,面瘫平均发病时间4.5年（2~18年）。手术治疗针对患者的具体畸形情况设计相应的手术方案重建患侧外形与功能,多种方法综合应用,4例采取真皮脂肪充填、2例腹股沟真皮脂肪瓣游离移植及6例小肌肉拇、趾短伸肌游离移植充填并悬吊治疗半侧颜面萎缩畸形合并面瘫,为获得更好的对称效果还将鼻唇沟进行悬吊和对移植物边缘凹陷区域进行脂肪颗粒注射。结果 本组12例患者术后脂肪筋膜瓣全部成活,供区切口愈合良好,无脂肪液化及其他并发症发生。随访0.5~6年,所有患者均取得满意效果,轮廓修正理想。结论 半侧颜面萎缩合并面瘫患者通过真皮脂肪游离移植结合小肌肉游离移植的方法治疗,能获得较好的对称性效果。

Objective To explore the plastic surgery to treat facial hemiatrophy combined with facial paralysis. Methods From March 2006 to March 2012 , 12 patients of facial hemiatrophy with facial paralysis were treated in Department of Plastic Surgery of Peking Union Medical College Hospital, including 3 males and 9 females. Their ages ranged from 16 to 49 years. The average duration of facial hemiatrophy was 6. 9 years （5-30 years） , and the average duration of facial paralysis was 4. 5 years （2-18 years） . Several reconstructive procedures were applied for reconstruction of appearance and function, taking into consideration of the individu-al conditions of each case. For correction of facial hemiatrophy with facial paralysis, dermis-fat grafts were used in 4 patients, groin dermis-fat free flaps in 2 , and extensor pollicis brevis and extensor digitorum brevis free flaps combined with suspension in 6 . To achieve the satisfied symmetrical results, nasolabial fold suspension and additional fat injection at the depression edge of the graft were performed. Results The adipofascial flaps survived in all the 12 patients. The incisions all healed without fat liquefaction or other complications. In the fol-low-up of 0. 5-6 years, all the patients were satisfied with the results. The facial contour of all the patients were well corrected. Conclusion Dermis-fat free grafts combined with free small muscle free grafts could achieve＆amp;nbsp;satisfied symmetrical effect for patients of facial hemiatrophy with facial paralysis.