吻合血管的小肌肉游离移植动态修复晚期面瘫

目的探讨应用吻合血管的小肌肉游离移植动态修复晚期面瘫的疗效。方法自2003年3月至2005年3月,采用吻合血管去神经的拇、趾短伸肌游离移植修复晚期面瘫患者共26例,将肌肉的肌腱端悬吊于患侧的鼻翼、鼻唇沟中点、口角及颏窝上,肌腹放置于咬肌的支配神经周围,并进行跗外侧动、静脉与颞浅动、静脉的吻合,修复由面瘫引起的口角畸形及运动障碍。结果术后即刻可矫正面部静态外观;1个月后可活动患侧口角;3个月后经训练可恢复微笑;6个月后口部活动恢复正常者23例占88%,较正常者2例占8%,略有改善者1例占4%。结论吻合血管的去神经小肌肉游离移植动态修复晚期面瘫,其肌肉无液化、萎缩少、成活可靠、神经再生确实,是重建面部表情及恢复口角功能的较成熟的修复方法。

Free micro-vascular mini-muscle transplantation for the treatment of long-standing facial paralysis

Objective To explore the effect of denervated mini-muscle free micro-vascular transplantation for the dynamic treatment of long-standing facial paralysis. Methods We treated 26 cases of facial paralysis using denervated extensor digitorum brevis and extensor hallusis brevis from March 2003 to March 2005. In order to correct the nasal and oral deformity, we fixed the tendon end at ala nasi, middle point of nasal labial fold, oral commissure, chin, the muscle belly were put around the masseter nerve, microsurgery was applied to anastomoses the tarsus lateral vessels to the superficial temporalis vessels. Results The patients got satisfied static facial appearance at once postoperatively, they could move their oral commisure at 1 month postoperatively and got smile recovered after training at 3 months postoperatively, 88% caeses got perfect results, 8% caeses got satisfied results, 4% caeses got improvement. Conclusion The denervated mini-muscle free vascular transplantation for the treatment of long-standing facial paralysis has less atrophy and liquefaction, nerve and muscle regenerration is reliable. It is a matural method to reconstruct the oral appearance.