Patient-Reported Outcomes after Aggressive Surgical Treatment for Severe Post-Paralytic Facial Synkinesis

嚴重顏面神經合併抽搐之積極性重建──病人自述結果之問卷調查

Jennifer An-Jou Lin(林安柔)；Tommy Nai-Jen Chang(張乃仁)；David Chwei-Chin Chuang(莊垂慶)；Johnny Chuieng-Yi Lu(呂炯毅)

facial paralysis ； synkinesis ； functioning free muscle transplantation ； facial reanimation

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

134 - 146

英文;繁體中文

Background: Post-paralytic facial synkinesis (PPFS) represents one of the most severe sequelae of facial palsy. However, the treatments vary and remain big challenges and one of the subjects of debate. For severe PPFS with poor smile (type III), aggressive myectomy combined with neurectomy followed by functioning free muscle transplantation was performed. This study aims to focus on patient reported outcomes of type III PPFS patients who were managed with the aforementioned methods. Aim and Objectives: The aim of the current study is to design a questionnaire to evaluate the impact of the aggressive surgical treatments and to observe the patients' quality of life and patient-reported outcomes after the treatments. Materials and Methods: A total of 100 patients who underwent aggressive surgical treatment followed by functioning free muscle transplantation for the treatment of PPFS from 1995 to 2020 (a 25-year period) were collected. Among them, 45 patients with type III PPFS were enrolled in this study to undergo questionnaire investigation with least one year follow-up after the surgery. The questionnaire assesses preoperative clinical severity and postoperative outcomes and quality of patient life. Results: A total of 29 patients completed the questionnaires. A total of 93.1% of the patients felt that their smile improved after reconstruction. A total of 86.2% of the patients felt that synkinesis improved. Before reconstruction, 75.9% of the patients concealed their facial expression in front of people. After reconstruction, the proportion of patients who hid their facial expression significantly decreased both in front of acquaintances (75.9% vs. 27.6%, p<0.001) and in front of strangers (75.9% vs. 41.4%, p=0.002). A total of 27.6% of the patients were very satisfied, 17.2% were satisfied, 37.9% felt that the results were acceptable, 13.8% were not satisfied but did not regret undergoing the procedure, and 1 patient felt unsatisfied and regretted undergoing the surgery. Conclusion: Our current surgical approach, characterized by extensive myectomy and neurectomy followed by functioning free muscle transplantation for type III PPFS, demonstrates not only promising functional and cosmetic outcomes but also substantial improvements in patients' psychosocial behaviors and overall quality of life. Contracture was one of the main reasons leading to revision surgeries and efforts are being directed to this challenge in subsequent reconstruction and rehabilitation. Further studies for the type II PPFS patients postoperatively are necessary to elicit a comprehensive treatment algorithm that offers better and available treatment to the different degree of PPFS patients.

背景：顏面神經麻痺後的合併抽搐被視為顏面麻痺最嚴重的後遺症之一。然而，目前存在許多不同的治療方法，也存在許多歧意。本院對於此類患者進行積極性的顏面肌肉，顏面神經切除合併進行功能性自由肌肉瓣移植重建微笑手術，對於重建顏面麻痺後抽搐之病人已被證實是可行且有效的，是目前本院的標準治療方法。目的及目標：本研究旨在藉由符合台灣民眾之問卷調查，評估顏面麻痺後抽搐之患者進行重建手術後，患者的生活品質和患者自述結果的影響。材料及方法：自1995年至2020年間共有100名患者接受積極性的顏面肌肉，顏面神經切除合併進行功能性自由肌肉瓣移植重建微笑手術。作者設計了顏面麻痺後抽搐經過手術後之問卷，並於手術後至少一年，發放給病人填寫。我們針對符合收案標準之45位第三類顏面麻痺合併抽搐病患進行問卷調查。該問卷包含了手術前之臨床嚴重程度和手術後之結果和生活品質調查。結果：共有29名患者完成問卷調查。93.1%的患者表示，在手術後他們的微笑有所改善。86.2%的患者表示臉部抽搐的症狀有所改善。在手術前，75.9%的患者在人前會掩飾他們的面部表情。手術後，在熟人面前掩飾面部表情的患者比例明顯減少（75.9% vs. 27.6%，p < 0.001），在陌生人面前亦同（75.9% vs. 41.4%，p = 0.002）。在滿意度方面，27.6%的患者非常滿意，17.2%的患者感到滿意，37.9%的患者認為結果可以接受，13.8%的患者不滿意但不後悔接受手術，1名患者感到不滿意並後悔接受手術。結論：經由本論文得知，本院之手術方法，亦即廣泛的肌肉切除，神經切斷手術，合併功能性自由肌肉瓣移植手術，對於第三類顏面麻痺後抽搐之病人，不僅能獲得良好的功能和外觀改善，更能在患者的心理行為和整體生活品質方面得到顯著進步。未來有待再針對第二類顏面麻痺後抽搐患者術後進行進一步研究，以得出提供治療的方針，為不同程度的顏面麻痺後抽搐患者提供更正確可用的治療方法。