【 文献重点摘要 】
 

Background: To address functional and smile dysfunction associated with post–facial paralysis synkinesis, the senior author (B.A.) has offered “modified selective neurectomy” of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure.

Methods: A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure.

Results: Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery.

Conclusion: Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post–facial paralysis synkinesis.

背景：为了解决与面瘫后联动相关的功能性和微笑功能障碍，资深作者(B.A.)。提供了面神经下部的“改良选择性神经切除术”作为长期解决方案。本文将检查此过程的技术考虑因素和结果。

方法：回顾性分析4年半来由一位外科医生实施的改良选择性面神经颊颈支切除术的临床资料。检查手术前后的House-Brackmann面部评分、电子临床医生分级面部功能评分和On abotulinumtoxinA(A型肉毒毒素)剂量。

结果：在2013年6月20日至2017年8月12日期间，63名患者接受了改良的选择性神经切除术。无严重并发症。修正率为17%。据报道，术后有7名患者(11%)出现暂时性口腔功能不全。电子临床分级面部功能量表分析结果显示：静息状态下鼻唇皱褶深度、微笑时口腔连合运动、微笑时鼻唇皱褶方向、微笑时鼻唇沟深度、下唇下压肌运动、面中部联动、大脑联会、颈阔肌联会、静态评分、动态评分、联会评分、眼周评分、面颈部下部评分、面中部及微笑评分均有显著改善(P<0.0 5或P<0.0 1)，其中静态评分、动态评分、突触评分、眼周评分、面颈部下部评分、面中部及微笑评分均有显著性差异(P<0.0 5)。术后A型肉毒毒素用量和House-Brackmann评分均明显降低。

结论：改良选择性面神经颊颈段切断术是治疗面瘫后面瘫后联动患者微笑功能障碍的长期有效方法。