Factors Affecting Outcomes of Cross Face Nerve Graft-Innervated Functioning Free Muscle Transplantation in Smile Reanimation in Patients with Facial Paralysis

對側臉神經移植支配功能性肌肉瓣治療顏面神經麻痺病人預後的影響因子

Jerry Tsung-Kai Lin(林琮凱)；David Chwei-Chin Chuang(莊垂慶)；Tommy Nai-Jen Chang(張乃仁)；Johnny Chuieng-Yi Lu(呂炯毅)

facial paralysis ； smile reanimation ； cross face nerve graft ； functioning free muscle transplantation

臺灣整形外科醫學會雜誌

33卷3期（2024 / 09 / 01）

274 - 282

英文;繁體中文

Background: Cross face nerve graft (CFNG)-innervated functioning free muscle transplantation (FFMT) is often regarded as the primary option for smile restoration in facial paralysis. CFNG has a privilege of creating a more nature smile compared to other neurotizers. However, CFNG traditionally restores smile slower than the other neurotizers (masseter nerve, spinal accessory nerve) and can present with unfavorable outcomes. Patient related factors can be instrumental in predicting outcomes that can guide the decision making process preoperatively. Aims and Objectives: This study aims to investigate patients who underwent CFNG-innervated FFMT and to analyze the factors that had significant effects on the functional outcomes of the transplanted muscle. Material and Methods: 68 patients with CFNG-innervated FFMT were collected from 2002 to 2020. Patients were evaluated by SMILE evaluation (Hadlock, 2010). The improvement of smile excursion of the paralyzed side after the surgery was measured using adobe photoshop (version 25.0) and was used to derive the final functional outcome. The independent variables in the study included age, sex, side of paralysis, time since paralysis, cause of paralysis and time between the two stages of surgery. Independent t tests and multiple regression model were used for analysis of SMILE evaluation. Results: At an average follow up period of 34.06 months, there was significant improvement of smile excursion postoperatively. Younger patients (younger than 42.5 years old) with a shorter denervation period (shorter than 15.5 months) are more likely to achieve better functional outcomes. Patients experiencing idiopathic facial paralysis exhibit a less favorable outcome. Sex and time between two stages of surgery have no significant impact on the functional outcome. Conclusion: The outcome of smile reanimation using CFNG-innervated FFMT can be individualized based on predictive factors that lead to positive outcomes. Surgeons should take note of such factors to achieve satisfactory outcomes.

背景：由對側臉神經移植（CFNG）支配的功能性肌肉瓣（FFMT）常被視為顏面神經麻痺中重建微笑的首選方法。CFNG相對於其他用以支配功能性肌肉瓣的神經重建出的微笑較為自然。然而由CFNG支配的功能性肌肉瓣重建的笑容恢復的速度相較其他用以支配功能性肌肉瓣的神經（如咀嚼肌神經、副神經）慢。研究目標：本研究旨在調查接受以對側臉神經移植（CFNG）支配功能性肌肉瓣（FFMT）移植重建微笑的患者，並分析對移植肌肉功能結果產生顯著影響的因素。材料與方法：從2002年至2020年，共收集了68名接受對側臉神經移植支配功能性肌肉瓣移植重建微笑的患者。微笑結果的評估方法使用SMILE評估（Hadlock, 2010）：使用Adobe Photoshop（版本25.0）測量麻痹側笑容幅度在手術後的改善。研究中的自變數包括年齡、性別、麻痹側、麻痹時間、麻痹原因以及兩階段手術相隔的時間。統計分析包含獨立樣本t檢驗和多元回歸模型。結果：在平均34.06個月的追蹤期內，手術後笑容明顯改善。年齡較輕（小於42.5歲）且麻痺時間較短（短於15.5個月）的患者更有可能得到更好的結果。患有自發性顏面神經麻痺的患者結果較差。性別和兩階段手術相隔的時間對結果沒有顯著影響。結論：使用對側臉神經移植（CFNG）支配功能性肌肉瓣（FFMT）重建微笑的結果可以根據預測性因素進行個人化。整形外科醫師應注意這些因素，以實現滿意的結果。