Cross-face nerve grafting followed by free functional gracilis muscle transplantation in patients with long-standing facial paralysis
10.3760/cma.j.cn114453-20220228-00051
- VernacularTitle:跨面神经-带神经血管股薄肌游离移植分期治疗晚期面瘫
- Author:
Ning MA
1
;
Yangqun LI
;
Zhe YANG
;
Weixin WANG
;
Qi WU
Author Information
1. 中国医学科学院北京协和医学院整形外科医院整形二科，北京 100144
- Keywords:
Nerve transfer;
Sural nerve;
Gracilis muscle;
Facial paralysis;
Tissue transplantation
- From:
Chinese Journal of Plastic Surgery
2023;39(1):28-34
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of stage treatment for long-standing facial paralysis with free functional gracilis transfer innervated by cross-face nerve grafting(CFNG).Methods:A retrospective study was carried out focusing on the case data of patients with long-standing facial paralysis who were treated by the free functional gracilis transfer innervated by CFNG in the Second Department of Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2014 to December 2020. CFNG was performed in the first stage approach and free functional gracilis transfer in the second stage approach. Auther utilized the modified House-Brackmann grading scale to record the patients’ lip angle movements postoperatively and measured the static and dynamic angle formed between the horizontal line of both lip corners and the vertical midline before and after surgery objectively. Paired t-test was utilized to evaluate the bilateral middle and lower facial symmetry changes, so as to estimate the surgical effect. The significance level was set at 0.05. Results:A total of 26 patients with long-standing facial paralysis were enrolled in this study, including 10 males and 16 females, aged from 16 to 28 years, with an average age of (24.8±3.5) years. The interval of staging operation was 6 to 12 months. The postoperative follow-up was 1-3 years, with an average of (34.9±11.7) months. All grafts survived well. No major complication occurred. 2 patients underwent gracilis muscle debulking due to the paralysis side facial bulking one year after the second stage operation. 1 patient underwent muscle fixation position adjustment due to the poor position of gracilis muscle fixation one year after the second stage operation. 1 patient underwent masseter nerve-CFNG end-to-side anastomosis 2 years after the second stage operation due to insufficient movement of the mouth. The facial symmetry of all patients was improved after the two-staged operations. The movement of lip corners was classified as excellent in 15 cases, good in 9 cases, and fair in 2 cases in terms of the modified House-Brackmann grading scale. According to the objective evaluation of oral angle movement, the static lip angle after surgery was higher than that before surgery (86.4°±3.3° vs. 82.3°±2.7°) and the difference was statistically significant ( t=5.27, P=0.017); the dynamic lip angle after surgery was higher than that before surgery (86.9°±2.8° vs. 80.1°±3.3°), and the difference was statistically significant ( t=7.55, P<0.001). Conclusion:Free functional gracilis transfer innervated by CFNG is an ideal technique for long-standing facial paralysis. It can effectively improve the facial dynamic of the affected side.
