Five-Year Experience with Fifth-to-Seventh Nerve Transfer for Smile

被引:37
作者
Banks, Caroline A. [1 ]
Jowett, Nate [1 ]
Iacolucci, Carlo [1 ]
Heiser, Alyssa [1 ]
Hadlock, Tessa A. [1 ]
机构
[1] Harvard Med Sch, Div Facial Plast & Reconstruct Surg, Dept Otolaryngol Head & Neck Surg, Massachusetts Eye & Ear Infirm, Boston, MA 02115 USA
关键词
FACIAL-NERVE; MASSETERIC NERVE; HEMIHYPOGLOSSAL NERVE; MOTOR-NERVE; PARALYSIS; MUSCLE; ANASTOMOSIS; REANIMATION; VALIDATION;
D O I
10.1097/PRS.0000000000005591
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Masseteric- or deep temporal-to-facial nerve transfer (five-to-seven nerve transfer) is increasingly used in facial reanimation; however, the indications and clinical variables affecting outcomes for five-to-seven nerve transfer have not been defined. The authors describe their early experience with five-to-seven nerve transfer, reporting function and patient-reported outcomes, to identify potential parameters that are predictive of outcome. Methods: The authors conducted a retrospective chart review of all patients who underwent five-to-seven nerve transfer for smile reanimation from 2012 to 2017. Age, sex, cause of facial paralysis, onset and duration of paralysis, history of adjuvant chemotherapy and/or radiation therapy, donor nerve used, adjunctive procedures, and final excursion were recorded. Standard photographs and videos, and data regarding clinical facial nerve function and patient-reported quality of life, were obtained preoperatively and postoperatively. Results: Sixty patients were identified. Forty-seven had flaccid facial paralysis and 13 had postparalysis facial palsy. Among flaccid facial paralysis patients, masseteric nerve transfer was successful in 30 patients (88 percent) and deep temporal nerve transfer was successful in three cases (60 percent). Among postparalysis facial palsy patients, five-to-seven nerve transfer was successful in two patients (20 percent). Average quality-of-life scores improved significantly from preoperatively (46) to postoperatively (59) among flaccid facial paralysis patients with successful five-to-seven nerve transfer. Conclusions: Five-to-seven nerve transfer is a viable option in facial reanimation. Shorter denervation times and preoperative flaccidity are favorable predictors of outcome. Five-to-seven nerve transfer as an adjunct to primary repair appears highly effective for enhancing smile function. Five-to-seven nerve transfer results are not reliable in patients with postparalysis facial palsy.
引用
收藏
页码:1060E / 1071E
页数:12
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