神经退行性病

    Facial reanimation with interposition nerve graft or masseter nerve transfer: a comparative retrospective study
  • Figure 1|Facial expressions after reanimation with masseter nerve transfer or interposition nerve graft. 

    The oral commissure excursion improved in both groups. The mean ratio of oral commissure excursion versus the contralateral unaffected side was 97% in the reanimated side of the masseter nerve group, which was similar to the contralateral healthy side. This ratio was significantly higher than that of the affected side of the interposition nerve graft group (82%, P < 0.01) in the long-term follow-up. The oral commissure excursion in the reanimated side of the interposition nerve graft group was significantly lower than that of the contralateral unaffected side in all cases (P < 0.01). A relatively strong smile was observed in most patients in the interposition nerve graft group, although smiles remained asymmetrical (Figure 1). 

    Figure 2|Mirrored smile by FaceGram.

    Figure 3|Patients with no evident synkinesis also displayed weak muscle function. 

    Slight or no synkinesis was observed in the patients reanimated by masseter nerve transfer. Moreover, synkinetic contracture was confined to the orbicularis oculi only. This was not reported as disturbing by the patients, because the orbicularis oculi naturally contracts in a smile, so the patients were able to deliver pleasant and meaningful smiles (Figure 1). However, in the interposition nerve graft group, severe hemiface synkinesis was observed in some of the patients with relatively strong to moderate smiles. Synkinetic frowning, eye closure, oral commissure depression, and mentalis contraction were activated simultaneously while smiling, resulting in awkward and confusing expressions (Figures 1 and 2). This became even more obvious when a mirrored full face was generated from each hemiface (Figure 2). In patients with no or slight synkinesis, facial movements (including the oral commissure excursion in the affected side) were also generally weak, and patients displayed a frozen face (Figure 3). Spontaneous smiles developed in all patients in the interposition nerve graft groups, but in no patients in the masseter-to-facial nerve transfer group.


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  • 发布日期: 2021-12-09  浏览: 506
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