RESUMO
BACKGROUND: Outcomes of pediatric facial reanimation beyond 10 years are not known. This cross-sectional study evaluated long-term surgical and patient-reported outcomes of adults who underwent smile reconstruction as children with either a cross-face nerve graft (CFNG) or masseter nerve transfer at least 10 years previously. METHODS: Commissure excursion was quantified with FACE-Gram software at 3 time points: preoperatively, early postoperatively within 2 years, and at long-term follow-up. Patient-reported outcomes were evaluated with validated questionnaires (Facial Clinimetric Evaluation Scale, FACE-Q 1.0) and thematic analysis of semistructured interviews. Results are reported as median (interquartile range [IQR]). RESULTS: A total of 42 patients were included (26 women and 16 men). Median long-term follow-up was 19.3 years (IQR, 8.8 years) for CFNG and 17.6 years (IQR, 5.8 years) for masseter nerve transfer. For both groups, commissure excursion increased significantly from preoperative to early postoperative time points and remained stable at long-term follow-up (P < 0.0001). Commissure excursion at long-term follow-up between the 2 groups was not significantly different (CFNG, 5.0 mm [IQR, 9.4 mm]; masseter nerve transfer, 8.4 mm [IQR, 4.1 mm]); P > 0.05). For patient-reported outcomes, median Facial Clinimetric Evaluation Scale score was 72 of 100, and 95% of respondents agreed with the statement "I am pleased with the result" on the FACE-Q 1.0. Overall quality of life was rated at 7 of 10 or greater by 97% of participants, and all participants would recommend the surgery to other children. CONCLUSIONS: Pediatric facial reanimation with CFNG or masseter nerve transfer reliably improves commissure excursion with longevity beyond 10 years. Adult patients report overall high satisfaction and social functioning.
Assuntos
Paralisia Facial , Transferência de Nervo , Medidas de Resultados Relatados pelo Paciente , Sorriso , Humanos , Feminino , Masculino , Paralisia Facial/cirurgia , Estudos Transversais , Transferência de Nervo/métodos , Sorriso/fisiologia , Adulto , Criança , Seguimentos , Adolescente , Resultado do Tratamento , Procedimentos de Cirurgia Plástica/métodos , Músculo Masseter/inervação , Nervo Facial/cirurgia , Adulto Jovem , Fatores de Tempo , Satisfação do Paciente/estatística & dados numéricosRESUMO
BACKGROUND: The masseteric nerve (MN) is often used as a donor nerve for facial reanimation. In addition to already established techniques, MN transfer is rapidly gaining importance, mainly due to the single-stage approach of the procedure and its reconstructive potential. This anatomical study and the associated questionnaire study aimed to evaluate the established methods for identification of the MN and its suitability for direct nerve transfer as well as to assess the importance of MN transfer in the daily clinical routine. MATERIAL AND METHODOLOGY: Bilateral dissection of 25 fresh-frozen head specimens (n=50; 13 female, 12 male) was performed with accompanying measurement of the MN. In a questionnaire study conducted at established centres for facial surgery in German-speaking countries, clinical experience data of MN transfer was collected using the SurveyMonkey software. The data obtained was statistically analysed using Microsoft Excel and presented in numerical tables and boxplots. RESULTS: Using anatomical landmarks such as the zygomatic arch and the mandibular notch for orientation, the MN was found in 100% of cases. Its average length from the emerging point below the zygomatic arch towards its entry into the masseter muscle was measured to be 22 mm and was the length available for nerve transposition. Tension-free coaptation of the MN with the zygomatic branch was possible in 94% of cases. The questionnaire showed that the MN is considered an important donor nerve for motor nerve transfers and that MN transfer is now largely established as a standard procedure. DISCUSSION: In accordance with previously published studies, the MN was reliably found at the height of the mandibular notch and, in the vast majority of cases, was suitable for tension-free coaptation with the zygomatic branch. Differences to the existing literature, however, can be seen in the length of the nerve available for nerve transposition and the frequency of its division into several branches before entering the masseter muscle. In German-speaking countries, Cross-Face Nerve Grafting (CFNG) is still the preferred method for facial reanimation surgery. However, MN transfer is also well established by now, both as an alternative and a supplement to other techniques, possibly due to its low donor site morbidity and short time to regeneration.
Assuntos
Cadáver , Paralisia Facial , Músculo Masseter , Transferência de Nervo , Humanos , Transferência de Nervo/métodos , Feminino , Masculino , Músculo Masseter/inervação , Paralisia Facial/cirurgia , Idoso , Zigoma/cirurgia , Zigoma/inervação , Pessoa de Meia-Idade , Pontos de Referência Anatômicos , Inquéritos e Questionários , Microcirurgia/métodosRESUMO
BACKGROUND: The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis. METHODS: The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I2 statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS: The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P < 0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P < 0.001 in CFNG compared with MNM, P = 0.013 for CLFN compared with MNM, P < 0.001 for DI compared with MNM). CONCLUSIONS: DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.
Assuntos
Paralisia Facial , Transferência de Nervo , Humanos , Sorriso/fisiologia , Expressão Facial , Paralisia Facial/cirurgia , Nervo Facial/cirurgia , Músculo Masseter/inervação , Transferência de Nervo/métodosRESUMO
Background: The objective outcomes of masseteric nerve transfer in the setting of parotid malignancy are unclear. Objective: To measure objective facial reanimation outcomes of masseteric nerve transfer in patients with parotid malignancy who underwent parotidectomy with facial nerve resection. Materials and Methods: Retrospective review of patients who underwent masseteric nerve transfer for facial paralysis secondary to parotid malignancy was carried out at a tertiary referral hospital from August 2017 to November 2021. Objective facial reanimation outcomes were analyzed using Emotrics. Minimal follow-up of 6 months was required for inclusion. Results: Eight patients (five males) with a median age of 75.5 years (range 53-91) met inclusion criteria. Fifty percent had metastatic squamous cell carcinoma, and 50% had primary parotid malignancy. Five patients underwent concomitant cancer resection with facial nerve reconstruction. Seven patients received postoperative adjuvant radiotherapy. After reinnervation, patients had improved oral commissure excursion (from 1.51 mm ±1.27 to 3.77 mm ±1.81; p < 0.01) and facial symmetry during smile. Conclusion: In this study, masseteric nerve transfer enhanced oral commissure excursion and facial symmetry during smile in patients with parotid malignancy and facial nerve resection.
Assuntos
Paralisia Facial , Transferência de Nervo , Neoplasias Parotídeas , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Estudos Retrospectivos , Neoplasias Parotídeas/complicações , Neoplasias Parotídeas/cirurgia , Músculo Masseter/inervação , Nervo MandibularRESUMO
Myogenous temporomandibular disorders is associated with an increased responsiveness of nerves innervating the masseter (MM), temporal (TM), and lateral pterygoid muscles (LPM). This study aimed to examine sensory nerve types innervating MM, TM and LPM of adult non-human primate-common marmosets. Sensory nerves were localized in specific regions of these muscles. Pgp9.5, marker for all nerves, and NFH, a marker for A-fibers, showed that masticatory muscles were primarily innervated with A-fibers. The proportion of C- to A-fibers was highest in LPM, and lowest in MM. All C-fibers (pgp9.5+/NFH-) observed in masticatory muscles were peptidergic (CGRP+) and lacked mrgprD and CHRNA3, a silent nociceptive marker. TrpV1 was register in 17% of LPM nerves. All fibers in masticatory muscles were labeled with GFAP+, a myelin sheath marker. There were substantially more peptidergic A-fibers (CGRP+/NFH+) in TM and LPM compared to MM. MM, TM and LPM NFH+ fibers contained different percentages of trkC+ and parvalbumin+, but not trkB+ fibers. Tyrosine hydroxylase antibodies, which did not label TG, highlighted sympathetic fibers around blood vessels of the masticatory muscles. Overall, masticatory muscle types of marmosets have similarities and differences in innervation patterns.
Assuntos
Callithrix , Músculos Pterigoides , Animais , Músculos Pterigoides/inervação , Peptídeo Relacionado com Gene de Calcitonina , Músculos da Mastigação , Músculo Masseter/inervaçãoRESUMO
Masticatory muscle hypertrophy is a benign clinical anomaly which leads to facial asymmetry or a squared face appearance. We report a case of masticatory muscle hypertrophy, particularly on the right side, that was successfully treated by neurectomy of the right masseteric nerve through an extra-oral approach. Clinical examination showed significant aesthetic improvement of the facial symmetry with complete paralysis and atrophy of the right masseter muscle. The impaired postoperative function of the frontal branch of the right facial nerve was fully restored 10 weeks postoperatively. The patient no longer experiences headaches or discomfort with eating or sleeping on her right side.
Assuntos
Paralisia Facial , Transferência de Nervo , Humanos , Feminino , Músculo Masseter/cirurgia , Músculo Masseter/inervação , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Estética Dentária , Nervo Facial/cirurgia , Nervo Mandibular , Hipertrofia/cirurgia , DenervaçãoRESUMO
PURPOSE: Irreversible facial paralysis results in significant functional impairment. The motor nerve to the masseter is a reconstructive option, but despite its clinical importance, there are few parametric anatomic studies of the masseteric nerve. The purpose of this study was to investigate the extra- and intramuscular innervation of the masseter in 3D to determine the relationship of the nerve to the muscle heads and identify landmarks to aid identification. MATERIALS AND METHODS: The nerve was dissected throughout its entire course in eight formalin-embalmed cadaveric specimens (mean age 84.9 ± 12.2 years). The nerve was digitized at 1-2 mm intervals using a MicroScribe™ digitizer and modeled in 3D in Autodesk® Maya®. RESULTS: Two or three extramuscular nerves were found to enter the deep head (DH) of the masseter: one main "primary" nerve (n = 8) and one (n = 4) or two (n = 4) smaller primary nerve(s). The main primary nerve supplied both the deep and superficial heads, whereas the smaller primary nerve(s) only supplied the DH. Surgical landmarks for masseter nerve localization were quantified. CONCLUSIONS: Comprehensive mapping of the innervation of the masseter muscle throughout its volume revealed neural partitioning that could provide a basis for safety planning for muscle flaps and donor nerve identification and explain why masseter functional loss is not incurred by donor nerve sacrifice. Quantified landmarks correlate to previous studies and support the constant anatomy of this nerve. Our results provide a basis to optimize surgical approaches for donor nerve and muscle flap surgery.
Assuntos
Paralisia Facial , Transferência de Nervo , Procedimentos de Cirurgia Plástica , Humanos , Idoso , Idoso de 80 Anos ou mais , Músculo Masseter/inervação , Retalhos Cirúrgicos/cirurgia , Paralisia Facial/cirurgia , Nervo Mandibular/cirurgia , Transferência de Nervo/métodos , Nervo Facial/cirurgiaRESUMO
PURPOSE OF REVIEW: To highlight the recent literature on reinnervation options in the management of facial nerve paralysis using nerve conduits, and nerve and muscle transfers. RECENT FINDINGS: Engineering of natural and synthetic nerve conduits has progressed and many of these products are now available on the market. The use of the masseter nerve has become more popular recently as a choice in nerve transfer procedures due to various unique advantages. Various authors have recently described mimetic muscle reinnervation using more than one nerve transfer, as well as dual and triple innervation of free muscle transfer. SUMMARY: The ideal nerve conduit continues to be elusive, however significant progress has been made with many natural and synthetic materials and designs tested and introduced on the market. Many authors have modified the classic approaches in motor nerve transfer, as well as local and free muscle transfer, and described new ones, that aim to combine their advantages, particularly the simplification to a single stage and use of multiple reinnervation to the mimetic muscles. These advances are valuable to the reconstructive surgeon as powerful tools that can be tailored to the unique challenges of patients with facial nerve palsy looking for dynamic reanimation options.
Assuntos
Paralisia de Bell , Paralisia Facial , Transferência de Nervo , Humanos , Transferência de Nervo/métodos , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Músculos Faciais/cirurgia , Paralisia de Bell/cirurgia , Músculo Masseter/inervação , SorrisoRESUMO
PURPOSE: In this study, facial symmetry was compared between the masseter-innervated and dual-innervated free multivector serratus anterior muscle transfer (FMSAMT) methods. METHODS: Eighteen patients with unilateral complete facial paralysis underwent facial reanimation surgery between April 2006 and July 2019. The masseter-innervated FMSAMT group (Group M, n = 8) underwent end-to-end coaptation with the ipsilateral masseter nerve in one stage. The dual-innervated FMSAMT group (Group D, n = 10) underwent end-to-end coaptation with the masseter nerve and end-to-side coaptation with the contralateral facial nerve via cross-face nerve graft. They were further divided into the one-stage (Group D1, n = 5) and two-stage (Group D2, n = 5) subgroups. The durations of periods until the first visible muscle contraction with clenching, first spontaneous smile, and the completion of resting tone were evaluated. The possibility of a spontaneous smile and symmetry of the midline and horizontal deviation at rest and during voluntary smiling were compared between each group. RESULTS: Groups M and D differed significantly in the possibility of a spontaneous smile and improvement rate of midline deviation and horizontal deviation at rest (p < 0.001, p < 0.001, and p = 0.001, respectively) but not in the improvement rate of midline and horizontal deviation during voluntary smiling. The duration of the period until the completion of resting tone was significantly shorter in Group D1 than in Group D2 (p = 0.048); however, the possibility of a spontaneous smile and the improvement rate of midline and horizontal deviation were not significantly different. CONCLUSIONS: Dual-innervated FMSAMT was effective in guaranteeing a symmetrical resting tone, voluntary smiling, and reproducing a spontaneous smile.
Assuntos
Paralisia Facial , Humanos , Paralisia Facial/cirurgia , Músculo Esquelético/transplante , Músculo Masseter/inervação , Sorriso/fisiologia , Expressão FacialRESUMO
BACKGROUND: The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis. METHODS: A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems. RESULTS: Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81° (SD 2.90) respectively. CONCLUSION: Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.
Assuntos
Paralisia Facial , Neoplasias de Cabeça e Pescoço , Transferência de Nervo , Humanos , Pessoa de Meia-Idade , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Nervo Facial/cirurgia , Estudos Retrospectivos , Músculo Masseter/inervação , Neoplasias de Cabeça e Pescoço/cirurgiaRESUMO
This paper introduces my personal perspective on anatomic structures for reduction malarplasty, mandibular contouring surgery, and masseter muscle resection. The zygomaticofacial nerve innervates a rectangular area, and each side measures 18.8±4 and 15.8±3.4 mm. The center of the rectangle is located laterally, at 17.3±5.5 mm from the lateral canthus, and then inferiorly, at 18.1±3.1 mm. The point of the zygomaticotemporal nerve appears at the margin of the zygomatic bone, 11.29±2.65 mm below the zygomaticofrontal suture and 21.76±2.76 mm from the superior border of the zygomatic arch. The inferior alveolar nerve in the mandibular canal runs above the lower one-third of the mandibular body. The terminal mandibular canal is located at an average of 4.5 mm under the mental foramen, advances 5.0 mm anteriorly, loops, and ends at the foramen. The facial nerve trunk is located 11 to 14 mm medial to the posterior border of the mandible. The trunk emerges out of the stylomastoid foramen and runs anteroinferiorly at an angle of 45°. The deep branch of the middle masseteric artery travels deep in the muscle, close to the periosteum of the mandible in 94% of cases. The average diameter is 1.23±0.26 mm. The masseteric nerve runs anteriorly and inferiorly between the deep and the middle layers of the masseter. It is observed at 33±5.6 mm from the inferior border of the muscle on the anterior third vertical line of the masseter muscle and at 47±5.5 mm in the posterior third.
Assuntos
Face , Procedimentos de Cirurgia Plástica , Humanos , Face/cirurgia , Mandíbula/anatomia & histologia , Osso Temporal/cirurgia , Músculo Masseter/cirurgia , Músculo Masseter/inervação , Nervo Facial/cirurgia , Nervo Facial/anatomia & histologiaRESUMO
Trigeminal motoneurons (MNs) innervating the jaw-closing and jaw-opening muscles receive numerous inhibitory synaptic inputs from GABAergic and glycinergic neurons, which are essential for oromotor functions, such as the orofacial reflex, suckling, and mastication. The properties of the GABAergic and glycinergic inputs of these MNs undergo developmental alterations during the period in which their feeding behavior proceeds from suckling to mastication; however, the detailed characteristics of the developmental patterns of GABAergic and glycinergic transmission in these neurons remain to be elucidated. This study was conducted to investigate developmental changes in miniature inhibitory postsynaptic currents (mIPSCs) in masseter (jaw-closing) and digastric (jaw-opening) MNs using brainstem slice preparations obtained from Wistar rats on postnatal day (P)2-5, P9-12, and P14-17. The frequency and amplitude of glycinergic mIPSCs substantially increased with age in both the masseter and digastric MNs. The rise time and decay time of glycinergic mIPSCs in both MNs decreased during development. In contrast, the frequency of GABAergic components in masseter MNs was higher at P2-5 than at P14-17, whereas that in the digastric MNs remained unchanged throughout the postnatal period. The proportion of currents mediated by GABA-glycine co-transmission was higher at P2-5, and then it decreased with age in both MNs. These results suggest that characteristics related to the development of inhibitory synaptic inputs differ between jaw-closing and jaw-opening MNs and between GABAergic and glycinergic currents. These distinct developmental characteristics may contribute to the development of feeding behaviors.
Assuntos
Músculo Masseter/inervação , Neurônios Motores/fisiologia , Receptores de GABA-A/metabolismo , Receptores de Glicina/metabolismo , Transmissão Sináptica/fisiologia , Animais , Tronco Encefálico/fisiologia , Comportamento Alimentar , Potenciais Pós-Sinápticos Inibidores , Masculino , Fenômenos Fisiológicos do Sistema Nervoso , Técnicas de Patch-Clamp , Ratos , Ratos Wistar , Nervo Trigêmeo/fisiologiaRESUMO
BACKGROUND: Masseter hypertrophy is the main cause of an asymmetrical and squared lower facial contour in the Asian community. Botulinum toxin injection technique is crucial to treat this condition. OBJECTIVE: To improve injection techniques for masseter hypertrophy by elucidating the distribution of the injections within the masseter. METHODS: Thirty masseter muscles were divided into 6 groups of 5 muscles each. Each group received one 0.2- or 0.3-mL injection at Point A, B, or C according to a three-point technique. Muscle dimensions and dye of the primary and secondary dye spreading were measured. RESULTS: The average muscle length, width, and thickness were 69.87, 33.50, and 11.23 mm, respectively. The average primary longitudinal and horizontal spreading was 36.56 and 15.60 mm, respectively. No statistically significant difference was found between 0.2- and 0.3-mL injections at each point. CONCLUSION: The three-point technique best fits in the safe zone and should be the standard injection technique for masseter hypertrophy. Injection at Points B and C may create secondary spreading that affect the risorius muscle and the parotid gland which are the cause of asymmetrical smiling and xerostomia, respectively. The dosage should be adjusted according to the muscle volume and not only the thickness.
Assuntos
Toxinas Botulínicas/administração & dosagem , Hipertrofia/tratamento farmacológico , Músculo Masseter/anormalidades , Povo Asiático , Cadáver , Corantes/administração & dosagem , Feminino , Humanos , Hipertrofia/patologia , Injeções Intramusculares/métodos , Masculino , Músculo Masseter/inervação , Músculo Masseter/patologiaRESUMO
Premotor circuits in the brainstem project to pools of orofacial motoneurons to execute essential motor action such as licking, chewing, breathing, and in rodent, whisking. Previous transsynaptic tracing studies only mapped orofacial premotor circuits in neonatal mice, but the adult circuits remain unknown as a consequence of technical difficulties. Here, we developed a three-step monosynaptic transsynaptic tracing strategy to identify premotor neurons controlling vibrissa, tongue protrusion, and jaw-closing muscles in the adult mouse. We registered these different groups of premotor neurons onto the Allen mouse brain common coordinate framework (CCF) and consequently generated a combined 3D orofacial premotor atlas, revealing unique spatial organizations of distinct premotor circuits. We further uncovered premotor neurons that simultaneously innervate multiple motor nuclei and, consequently, are likely to coordinate different muscles involved in the same orofacial motor actions. Our method for tracing adult premotor circuits and registering to Allen CCF is generally applicable and should facilitate the investigations of motor controls of diverse behaviors.
Assuntos
Arcada Osseodentária/inervação , Neurônios Motores/fisiologia , Boca/inervação , Animais , Atlas como Assunto , Feminino , Masculino , Músculo Masseter/inervação , Camundongos , Camundongos Endogâmicos C57BL , Córtex Motor/anatomia & histologia , Língua/inervação , Vibrissas/inervaçãoRESUMO
In the present report, we discussed the case of a 57-year-old man with unilateral masticatory muscle weakness, nystagmus, skew deviation and facial hypesthesia due to pontine tegmental infarction. Trigeminal motor neuropathy attributed to brain infarction is very rare. Brain magnetic resonance imaging revealed a small dot-like infarction lesion in the pontine tegmentum. Masticatory muscle weakness was confirmed by an electrophysiological study performed on the day after admission in which there was an incomplete interference pattern without spontaneous denervation activity, suggesting that the patient's masseter muscle weakness was caused by an infarction of the trigeminal motor nucleus proper or trigeminal motor nerve fascicles rather than Wallerian degeneration of the trigeminal nerve or the progression of masseter muscle degeneration.
Assuntos
Infartos do Tronco Encefálico/complicações , Paralisia Facial/etiologia , Músculo Masseter/inervação , Debilidade Muscular/etiologia , Núcleo Motor do Nervo Trigêmeo/irrigação sanguínea , Doenças do Nervo Trigêmeo/etiologia , Doença Aguda , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/fisiopatologiaRESUMO
Objective: To quantify the degree of oral commissure resting tone improvement in patients undergoing masseter to facial nerve transfer. Methods: A retrospective cohort study was completed in a tertiary academic medical practice. Consecutive cases of masseter nerve transfer patients within a patient database were evaluated from 6/2012 to 9/2017. Inclusion criteria were patients >18 years of age, with complete unilateral paralysis, receiving a masseter to facial nerve transfer, with at least 12 months of recovery, and possessing complete pre- and postoperative data. Patients were excluded if a simultaneous adjunctive procedure was performed so that tone could not be attributed to masseter transfer alone. The main outcome measure was the facial asymmetry index (FAI): the measured difference in distance between the medial canthus and oral commissure of the healthy and paralyzed sides. Results: Twenty-nine patients met inclusion and exclusion criteria and were further analyzed for this study. The oral commissure symmetry improved from 4.7 ± 2.8 mm preoperatively to 2.2 ± 2.3 mm postoperatively. In multivariate analysis, the preoperative FAI was the only significant predictive factor for improvement in commissure symmetry at rest (r = 0.589). This suggests that for each 1.0 mm of worse preoperatively oral commissure asymmetry, the improvement postoperatively was 0.6 mm. Age, gender, body mass index, side of paralysis, duration of paralysis, and recipient branch of facial nerve were not significant predictors in a multivariate analysis. Conclusion: Masseter to facial nerve transfer yields an estimated 60% correction in the oral commissure asymmetry. This estimation may be helpful in determining if adjunctive procedures should be utilized.
Assuntos
Regras de Decisão Clínica , Assimetria Facial/cirurgia , Paralisia Facial/cirurgia , Músculo Masseter/inervação , Tono Muscular , Transferência de Nervo/métodos , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Assimetria Facial/diagnóstico , Assimetria Facial/etiologia , Assimetria Facial/fisiopatologia , Paralisia Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Músculo Masseter/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Results of a single stage technique combining cross facial nerve graft(s) (CFNG) with an ipsilateral end to side nerve to masseter transfer (NTM) in incomplete facial paralysis are assessed in a retrospective cohort study. The hypothesis is that the technique can safely improve the quality of smile in these patients. End to side coaptations for the recipient facial nerve minimise the risk of iatrogenic function loss, contrasting with the end to end neurorrhaphies used in conventional babysitting procedures. METHODS: A series of 27 patients was studied through case note review and standardised assessments. Surgical technique involves extensive exposure of the facial nerve and the NTM on the affected side and access is by bilateral preauricular incisions. End to end coaptations are made to the facial nerve on the donor side and on the recipient a standard CFNG is combined with an end to side NTM coaptation. Follow up was a minimum of 9 months from surgery. RESULTS: Overall improvement in the Sunnybrook scale averaged 33, from a pre-operative score of 40 (pâ¯<â¯0.05). Average upgrade of 4.7â¯mm of increased movement at the modiolus was achieved (pâ¯<â¯0.05), 43% improvement compared to the normal side. An improved resting symmetry of 3.8â¯mm was achieved in relevant cases. Where eye closure was strengthened the average improvement was 5â¯mm of increased lid closure. The smile achieved was spontaneous in 22 of 27 cases. CONCLUSION: The study confirms the hypothesis that CFNG with NTM transfer offers a physiological upgrade of facial movement in partial facial paralysis, applicable in both early and longstanding cases.
Assuntos
Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Músculo Masseter/inervação , Músculo Masseter/transplante , Transferência de Nervo/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SorrisoRESUMO
The masseteric nerve is often used as a donor nerve in the treatment of facial paralysis. Even if several anatomical studies described landmarks for its identification, their main disadvantages are the anatomical variability and the changes due to surgery. Sixteen dissections were performed on cadaveric specimens. The masseteric muscle (MM), the zygomatic arch (ZA), the masseteric nerve (MN) and the zygomatic branch of the facial nerve (ZB) were identified and their relationships were measured. The relationships between MN and ZB resulted to be constant, with MN intersecting ZB at a depth of 0,78â¯cm in the muscle, 1,6â¯cm below ZA and 0,8â¯cm from the posterior border of MM. The measures obtained demonstrated as the main zygomatic branch of the facial nerve can be a suitable landmark for the identification of the masseteric nerve, with no variations due to the surgical procedure or patient characteristics.
Assuntos
Pontos de Referência Anatômicos , Nervo Mandibular/anatomia & histologia , Músculo Masseter/inervação , Cadáver , Dissecação , Feminino , Humanos , Masculino , Zigoma/inervaçãoRESUMO
BACKGROUND: In the last decade, some institutions have begun combining the CFNG and masseteric nerve to provide dual innervation to the gracilis muscle for dynamic facial reanimation in facial paralysis patients. We reviewed the various ways that these two nerves have been coapted to provide dual innervation, and summarized the functional outcome for these methods. METHODS: A search of the Ovid EMBASE, MEDLINE, Cochrane, and Scopus databases was performed from 1946 to May 2019 for dual innervation of gracilis muscle using CFNG plus masseteric nerve for facial reanimation. RESULTS: A total of 184 articles were identified in the initial search, of which seven met our inclusion criteria. Three additional abstracts with 43 patients were identified but the level of details was not sufficient to include the results in the analysis. A total of 57 patients were reviewed (mean age of 42.1 years (6-79 years)). The majority of dual innervation procedures were performed using the ipsilateral masseteric nerve sutured end-to-end to the obturator nerve, and an additional CFNG connected end-to-side to the obturator nerve. In the 26 patients with Terzis scores available, there were no differences between masseteric nerve coapted end-to-end and CFNG as end-to-side to the obturator, or the reverse coaptation. All but two patients achieved function of the gracilis activated by the masseteric nerve within 2-5 months. CONCLUSIONS: This review shows that dual innervation of the gracilis is safe; and in some cases, does appear to provide early onset gracilis activation as well as an eventual spontaneous smile.
Assuntos
Paralisia Facial/cirurgia , Músculo Grácil/inervação , Músculo Grácil/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/inervação , Retalhos Cirúrgicos/transplante , Expressão Facial , Humanos , Músculo Masseter/inervação , Músculo Masseter/transplante , Transferência de Nervo/métodosRESUMO
OBJECTIVE: The purpose of this study is to illustrate the efficacy of masseteric-to-zygomatic nerve transfer to address eye closure-smile excursion synkinesis after facial nerve paralysis. BACKGROUND: Synkinesis after facial nerve paralysis represents a wide range of facial movement disability. One manifestation is involuntary smiling with eye closure and a concomitant reduction of oral commissure movement with attempted smile ("frozen smile") - arising as a result of aberrant fibers populating the zygomatic branch-muscle complex. This is a particularly difficult area to treat with conservative management. We propose a single-stage procedure to sever the dysfunctional zygomatic nerve and perform a masseteric-zygomatic nerve coaptation to recover a voluntary smile. METHODS: We present a case series of eight patients with eye closure/smile excursion synkinesis who underwent single-stage masseteric-zygomatic nerve transfer by a single surgeon. The surgical technique and indications for surgery were reviewed. Patients underwent facial movement analysis using Emotrics. RESULTS: We analyzed the pre- and post- surgical photographic images of 8 patients with synkinesis (7 female, 1 male). Masseteric-facial nerve transfer was performed from 18 months to 22 years after the initial facial paralysis. Eyelid and brow positioning were more symmetric after surgery, with discrepancy between affected and unaffected side decreasing from 2.1 to 1.0 mm (p < .05) and 1.74 to 1.29 mm (p < .05), respectively. Symmetry of smile excursion postoperatively was also improved with commissure excursion discrepancy decreasing from 8.8 to 3.78 mm (p < .05). Discrepancy in the smile angle when comparing affected to unaffected side improved postoperatively from 10.3 to 5.2 degrees (p < .05). Improvement in oral commissure height was noted, but not statistically significant. CONCLUSIONS: The masseteric-zygomatic nerve transfer is a useful technique for the treatment of eye closure/smile excursion synkinesis after failure of chemodenervation and/or physical therapy.