咬肌神经-面神经吻合术治疗周围性面瘫的疗效

Efficacy of masseteric-facial nerve transfer in the treatment of peripheral facial paralysis

目的探讨咬肌神经-面神经吻合术(MFNT)治疗周围性面瘫的效果和安全性。方法回顾性分析2017年6月至2020年9月于四川大学华西医院神经外科接受MFNT治疗的40例周围性面瘫患者的临床资料。所有患者均在术前和随访中记录其面部表情,以及执行一系列动作时的面部运动情况。根据面部神经分级量表(FNGS)2.0和Sunnybrook面部分级系统(SFGS),以及面部不对称指数(FAI)、睑裂宽度、人中偏移以及嘴角运动的角度或位移等指标评估面部的对称性和面部运动功能,从而评价手术疗效。结果手术并发症的发生率为7.5%(3/40),包括切口感染、眼部不适和腮腺液漏各1例。40例患者的中位随访时间为13.4个月(6.6~24.7个月),术后首次出现面部肌肉收缩的中位时间为2.4个月(0.8~5.6个月)。术后85%(34/40)的患者面部对称性和运动功能明显改善。FNGS 2.0评估结果提示,术后40例患者患侧的闭眼、鼻唇沟及嘴角运动方面的得分均较术前明显降低(均P<0.001),而联带运动得分无明显增加(P>0.05);术后中位面瘫等级自术前的5.0级降至3.5级(P<0.001)。SFGS评估结果显示,术后患者的静息对称性评分下降,运动对称性评分和综合评分均增加(均P<0.001),但联带运动得分亦较术前增加(P<0.05)。与术前相比,术后40例患者静息和运动时的FAI均降低(均P<0.001);眼睑闭合能力增强,人中偏移减小(均P<0.001);患侧嘴角运动位移明显增大,双侧嘴角倾角明显减小(均P<0.001)。结论MFNT是治疗周围性面瘫的有效方法,可改善面部的对称性和运动功能,且手术相关并发症较少。

Objective To investigate the efficacy and safety of masseteric-facial nerve transfer(MFNT)technique in the treatment of peripheral facial paralysis(PFP).Methods We conducted a retrospective study on the clinical data of 40 patients with PFP who underwent MFNT at the Department of Neurosurgery,West China Hospital,Sichuan University from June 2017 to September 2020.Facial expression and facial movements as participants attempted to perform a series of facial expression tasks were documented and evaluated based on facial nerve grading scale 2.0(FNGS 2.0)and Sunnybrook facial grading system(SFGS).Moreover,facial asymmetry index(FAI),width of palpebral fissure,deviation of the philtrum and angles or excursions of the oral commissure were applied to assess the facial symmetry and motor function in order to explore the effect of MFNT.Results The occurrence of postoperative complication was 7.5%(3/40),including mild infection,discomfort in eyes and parotid leakage in 1 case each.Forty patients were followed up for 6.6-24.7 months(median:13.4 months).The median interval to first contraction of facial muscles while biting after surgery was 2.4(0.8-5.6)months in 40 patients.Out of 40 patients,34(85%)showed significantly improved facial symmetry and movements.The FNGS 2.0 results revealed that compared to those before operation,the scores of eye closure,nasolabial folds and oral commissure motion on the affected sides post operation were evidently decreased(all P<0.001),while the synkinesis score did not increase(P>0.05).After operation,the median grade of the patients was significantly reduced from 5.0 to 3.5 based on the FNGS 2.0(P<0.001).Patients experienced distinctly improved scores in resting and voluntary movement domains(both P<0.001)with slightly elevated scores in synkinesis domain(P<0.05),resulting in dramatically increased composite score(P<0.001).evaluated by the SFGS.The quantitative facial measurement indicated that both resting FAI and FAI during smiling decreased(both P<0.001).The eyelid closing capacity was notably enhanced,and the deviation of the philtrum was decreased post operation(both P<0.001).After MFNT,the oral commissure excursion on the affected side was significantly increased and the slope of bilateral oral commissure reduced significantly(both P<0.01).Conclusions The MFNT is an effective technique for facial reanimation,which could achieve satisfactory facial symmetry,and improve facial movement with few complications.The masseteric nerve should be a preferential choice for facial nerve transfer.