Age-related outcome of facial reanimation surgery using cross face nerve graft and gracilis free functional muscle transfer-A retrospective cohort study

被引:16
作者
Weiss, Jakob B. W. [1 ]
Spuerck, Felicitas [1 ]
Kollar, Branislav [1 ]
Eisenhardt, Steffen U. [1 ]
机构
[1] Univ Freiburg, Med Fac, Univ Freiburg Med Ctr, Dept Plast & Hand Surg, Freiburg, Germany
关键词
AXONAL LOAD; MOTOR-NERVE; MASSETERIC NERVE; DONOR NERVE; PARALYSIS; TRANSPLANTATION; RECONSTRUCTION;
D O I
10.1002/micr.30896
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Free functional muscle transfer has become the criterion standard for the treatment of long-standing flaccid facial paralysis. Clinical experience suggests that a two-stage approach using a cross-face nerve graft (CFNG) as a donor nerve for free functional muscle transfers (FFMT) is less successful in older patients when compared to the pediatric population. However, clear data and scientific evidence are still rare. This study examines the age-related outcome of CFNG-driven FFMT. Methods Twenty-eight patients with a mean age of 20.73 years (ranging 5-51 years) who received two-stage facial reanimation with CFNG-driven gracilis FFMT at our institution from 1998 to 2019 were included. The ipsilateral sural nerve was used as CFNG. After 12 months, the ipsilateral gracilis muscle was used as FFMT. Patients were distributed equally into three cohorts according to their age. We assessed facial symmetry before and after facial reanimation measuring the angle between the interpupillary and the intermodiolar line (pupillo-modiolar angle). Additionally, the commissure height was measured using the Emotrics software. Results The mean follow-up of the pediatric, young adults and the middle-aged cohort was 29.5 +/- 7.3, 24.9 +/- 6.3, and 25.5 +/- 12.4 months, respectively. One patient suffered flap loss due to flap ischemia. Four patients suffered insufficient innervation of the FFMT. Otherwise no major complication occurred. The likelihood of successful innervation of the FFMT was significantly higher in patients younger than 31 years (100% vs. 50%; p = .003). Smiling facial symmetry (pupillo-modiolar angle) significantly improved in the pediatric cohort (5-16 years; 8.68 degrees +/- 0.69 degrees to 1.48 degrees +/- 0.67 degrees; p < .001) and the young adults' cohort (17-30 years; 11.55 degrees +/- 1.95 degrees to 4.62 degrees +/- 1.08 degrees; p = .005), but improved only slightly in the middle-aged cohort (31-51 years; 11.77 degrees +/- 1.16 degrees to 9.4 degrees +/- 1.8 degrees p = .27). The postoperative smiling symmetry showed a significant correlation with increasing age (r = .62, p < .001). The smiling commissure height deviation significantly improved in the pediatric cohort (5-16 years; 6.5-2.3 mm; p = .006) and the postoperative result was significantly better than the middle-aged group (31-51 years; 2.3 vs. 7.5 mm; p = .02). Conclusions The outcome of CFNG-driven gracilis FFMT is age-related. Static as well as dynamic facial symmetry after two-stage facial reanimation was best in the pediatric and young adult population. For older patients, other approaches like the nerve-to-masseter-driven FFMT should be considered.
引用
收藏
页码:557 / 567
页数:11
相关论文
共 28 条
[1]   A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve [J].
Bae, Yong-Chan ;
Zuker, Ronald M. ;
Manktelow, Ralph T. ;
Wade, Shawna .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2006, 117 (07) :2407-2413
[2]   AXONAL REGENERATION RATE THROUGH CROSS-FACE NERVE GRAFTS [J].
BRAAM, MJI ;
NICOLAI, JPA .
MICROSURGERY, 1993, 14 (09) :589-591
[3]   Analysis of the ideal muscle weight of gracilis muscle transplants for facial reanimation surgery with regard to the donor nerve and outcome [J].
Braig, David ;
Bannasch, Holger ;
Stark, G. Bjoern ;
Eisenhardt, Steffen U. .
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, 2017, 70 (04) :459-468
[4]   Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery [J].
Dusseldorp, Joseph R. ;
van Veen, Martinus M. ;
Guarin, Diego L. ;
Quatela, Olivia ;
Jowett, Nate ;
Hadlock, Tessa A. .
JAMA FACIAL PLASTIC SURGERY, 2019, 21 (06) :551-557
[5]   Comparison of Cross Face Nerve Graft with Masseteric Nerve as Donor Nerves for Free Functional Muscle Transfers in Facial Reanimation Surgery [J].
Eisenhardt, S. U. ;
Thiele, J. R. ;
Stark, G. B. ;
Bannasch, H. .
HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE, 2013, 45 (04) :223-228
[6]   Salvage Procedures After Failed Facial Reanimation Surgery Using the Masseteric Nerve as the Motor Nerve for Free Functional Gracilis Muscle Transfer [J].
Eisenhardt, Steffen U. ;
Eisenhardt, Nils A. ;
Thiele, Jan R. ;
Stark, Bjoern ;
Bannasch, Holger .
JAMA FACIAL PLASTIC SURGERY, 2014, 16 (05) :359-363
[7]   Magnetic Resonance Imaging as a Biomarker in Rodent Peripheral Nerve Injury Models Reveals an Age-Related Impairment of Nerve Regeneration [J].
Giorgetti, Elisa ;
Obrecht, Michael ;
Ronco, Marie ;
Panesar, Moh ;
Lambert, Christian ;
Accart, Nathalie ;
Doelemeyer, Arno ;
Nash, Mark ;
Bidinosti, Michael ;
Beckmann, Nicolau .
SCIENTIFIC REPORTS, 2019, 9 (1)
[8]   Treatment of Facial Paralysis: Dynamic Reanimation of Spontaneous Facial Expression-Apropos of 655 Patients [J].
Gousheh, Jamal ;
Arasteh, Ehsan .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2011, 128 (06) :693E-703E
[9]   A Machine Learning Approach for Automated Facial Measurements in Facial Palsy [J].
Guarin, Diego L. ;
Dusseldorp, Joseph ;
Hadlock, Tessa A. ;
Jowett, Nate .
JAMA FACIAL PLASTIC SURGERY, 2018, 20 (04) :335-337
[10]   Postoperative functional evaluation of different reanimation techniques for facial nerve repair [J].
Guntinas-Lichius, O ;
Streppel, M ;
Stennert, E .
AMERICAN JOURNAL OF SURGERY, 2006, 191 (01) :61-67