患者因素和手术因素对面部再支配手术结局的影响
Impact of Patient and Surgical Factors on Outcomes of Facial Re-innervation Procedures.
文献信息
| PMID | 42732622 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Thomas Stubley |
| 作者单位 | Department of Anatomy, University of Birmingham, Birmingham, England. |
| 期刊 | The journal of international advanced otology |
| SCI 分区 | Q3 |
| IF | 1.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 在手术治疗过程中面神经被切除或切断的患者，可通过直接吻合术、间置移植术进行修复，或者可原发或最迟2年后接受面部肌肉的再支配，在大多数情况下使用咬肌神经或舌下神经。本研究的目的是比较接受直接吻合术、神经移植术或咬肌神经转位术的患者的面部再支配手术结局。
方法： 对就诊于面瘫门诊的患者进行回顾性病历审查。排除了手术并非所提供治疗一部分的患者、翻修病例、病理复发的患者或数据集不完整的患者。记录了患者因素、病因、术中发现以及术前和术后的Sunnybrook面部分级。为了考虑到恢复时间的差异，术后评分被视为改善已进入平台期时记录的评分。
结果： 30例（16例女性，14例男性）患者因面瘫接受了初次手术。中位年龄为44岁。16例患者接受了“神经转位术”，10例接受了“神经移植术”，4例接受了“端对端吻合术”。三个亚组之间的术前Sunnybrook面部分级量表无差异。神经转位术患者的平均术后评分为58.1，神经移植术为51.4，端对端吻合术为68.8（Chi2=2.196，P=.33）。
结论： 在可行的情况下，端对端吻合术似乎能最大程度地改善面神经功能。在不可行的情况下，在患者特定背景下考虑时，移植术和神经转位术应被给予同等权重。
英文摘要
BACKGROUND: Patients in whom the facial nerve has been resected or divided during surgical treatment may have it repaired by direct anastomosis, interposition graft, or may either primarily or up to 2 years later undergo reinnervation of the facial musculature, in most cases using the masseteric or hypoglossal nerve. The aim of this study is to compare outcomes of facial reanimation procedures for those who have undergone either direct anastomosis, nerve grafting, or masseteric nerve transfer.
METHODS: Retrospective case note review of patients attending the Facial Palsy Clinics. Patients in whom surgery was not part of the treatment provided, revision cases, patients with recurrence of pathology, or incomplete datasets were excluded. Patient factors, etiology, operative findings, and pre- and post-operative Sunnybrook Facial Grading were recorded. In order to allow for differences in recovery time, the post-operative score was considered as the score recorded when improvement had plateaued.
RESULTS: Thirty (16 female, 14 male) patients underwent primary surgery for facial palsy. Median age was 44 years. Sixteen patients underwent "Nerve Transfer," 10 "Nerve Grafting," and 4 "End-to-End." Pre-operative Sunnybrook Facial Grading Scale did not differ between the three subgroups. Nerve transfer patients had a mean post-operative score of 58.1, nerve graft 51.4, and end-to-end 68.8 (Chi2=2.196, P=.33).
CONCLUSION: End-to-end anastomosis, where viable, appears to give the greatest improvement in facial nerve function. Where this is not viable, both grafting and nerve transfer should be given equal weighting when considered in a patient specific context.