Lengthening Temporalis Myoplasty Versus Hypoglossal-Facial Nerve Coaptation in the Surgical Rehabilitation of Facial Palsy: Evaluation by Medical and Nonmedical Juries and Patient-Assessed Quality of Life
Lengthening Temporalis Myoplasty Versus Hypoglossal-Facial Nerve Coaptation in the Surgical Rehabilitation of Facial Palsy: Evaluation by Medical and Nonmedical Juries and Patient-Assessed Quality of Life
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面瘫手术康复中颞肌延长术与舌下面神经接合术：医学和非医学陪审团的评估以及患者评估的生活质量
DOI：
10.1097/mao.0b013e318194f871
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发表时间：
2009
影响因子：
2.1
通讯作者：
E. Sauvaget
中科院分区：
文献类型：
--
作者：
G. Kecskés;P. Herman;R. Kania;D. Salvan;W. El Bakkouri;P. Tran Ba Huy;E. Sauvaget
背景资料：比较两种面部康复技术，延长颞肌成形术和两种类型的舌下-面部（XII-VII）接合术的结果，由医疗和非医疗团队以及患者生活质量（QOL）自我评估进行评价。材料与方法：回顾性分析1998年至2005年42例完全性面瘫手术患者的手术录像。面部康复是通过颞肌成形术（n = 10）或XII-VII接合术（n = 32），端对端（n = 16）或端对侧跳跃间置移植物（n = 16）。评价由（i）医学陪审团使用4个面神经分级系统和3个其他测量的脸在休息和自愿和情绪运动，（ii）非医学陪审团使用上述3个措施，（iii）患者自我评估的QOL问卷。结果：无论使用何种评分系统，医学陪审团都认为XII-VII接合术的面部康复优于肌成形术。两种接合类型之间的评分没有差异：端端接合的联带运动严重，端侧接合的联带运动几乎不存在。然而，端对端接合的肌张力比端对侧接合的强。非医学评审团认为，无论是哪种类型的XII-VII接合术，其结果都优于肌成形术。所有组中的患者都认为他们的生活质量通过手术得到改善，无论手术形式如何，组间无显著差异。结论：本研究显示XII-VII接合术的结果优于肌成形术。端对端接合应仅限于情绪表达强烈或长期面瘫的患者，因为它提供了强有力的肌肉张力，但有显著的联带运动。
Background: To compare the results of 2 techniques of facial rehabilitation, lengthening temporalis myoplasty and 2 types of hypoglossal-facial (XII-VII) coaptation as evaluated by medical and nonmedical teams and patient self-assessment of quality of life (QOL). Materials and Methods: Videos of 42 consecutive patients with complete facial palsy who underwent surgery from 1998 to 2005 were reviewed. Facial rehabilitation was by temporalis myoplasty (n = 10) or by XII-VII coaptation (n = 32) either end-to-end (n = 16) or end-to-side with a jump interpositional graft (n = 16). Evaluation was by (i) a medical jury using 4 facial nerve grading systems and 3 other measurements for the face at rest and during voluntary and emotional motions, (ii) a nonmedical jury using the 3 measures described above, and (iii) patient self-assessment of QOL by questionnaires. Results: Whatever the grading systems used, the medical jury rated facial rehabilitation with XII-VII coaptation better than myoplasty. Scores did not differ between the 2 types of coaptation: synkinesis was severe with end-to-end and almost absent with end-to-side coaptation. However, muscle tone was stronger in the end-to-end than end-to-side coaptation. The nonmedical jury considered that XII-VII coaptation, whatever the type, led to better results than myoplasty. Patients in all groups considered their QOL improved by surgery, whatever the format, with no significant differences between the groups. Conclusion: This study revealed XII-VII coaptation with better results than myoplasty. End-to-end coaptation should be restricted to patients with a strong emotional expression or those with a long-standing facial palsy because it provides a strong muscle tone but significant synkinesis.