膈神经为受区神经源的背阔肌游离移植治疗面瘫

Latissimus dorsi muscle transplantation for the treatment of facial paralysis with phrenic nerve as a recipient motor nerve source

目的 探讨以膈神经为受区神经源的肌肉移植治疗面瘫的临床疗效。 方法 用带神经及血管的背阔肌移植治疗面瘫 3例。术中以同侧膈神经作为受区神经源 ,以同侧面动、静脉为受区血管。肌肉起点固定于颧弓 ,止点固定于鼻唇沟及口角处。 结果 3例于术后 12～ 16周逐渐恢复肌肉运动功能 ,面部动态和静态表情得到明显改善。 2例肌肉移植后术侧较饱满 ,其中 1例作二期手术修薄肌肉和皮下脂肪后得到改善。 结论 与现有的肌肉移植治疗面瘫的术式相比 ,该术式可以 1次完成。手术不需要在健侧面部寻找面神经颊支 ,不会造成健侧创伤和留下瘢痕 ;另外 ,受区的膈神经较长且易分离 ,移植肌肉上仅保留很短的神经就足够吻合 ,使神经再生距离短 ,肌肉恢复功能较快。

Objective To evaluate the effect of microneurovascular muscle transplantation for long standing facial paralysis by employing phrenic nerve as recipient motor nerve source Method Three cases with long standing facial palsy were treated using this operative method The latissimus dorsi with thoracodorsal vessels and thoracordorsal nerve was used as donor The ipsilateral phrenic nerve was used as a recipient motor nerve source and the facial artery and vein as recipient vessels The transferred muscle was fixated on the zygomatic arch,the nasalabial fold and commissure of orbicular oris Results All of cases obtained function restoration of the transferred muscle during 12～16 weeks postoperatively Both static and dynamic facial appearance improved Among them,two cases showed a little over bulk in the operative side,among them,one case was improved by removing a part of subcutaneous fat and outer layer of transferred muscle in another operation Conclusion Comparing with the previous operative method,this new operation method could be completed in one stage,which had not to explore the buccal branch of facial nerve in the health side of face,therefore,there is no scar left in the health side In addition,phrenic nerve was easy to explore and longer enough for anastomosis to the nerve attached to the muscle,so the short length of nerve in the transferred muscle is more easy to regeneration after anastomosis to the recipient nerve All these suggests that the transplanted muscle with phrenic nerve as recipient motor source is a simple,short time consumption, less scar left and good effect operation method for facial paralysis