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Multi-Disciplinary Evaluation Methods for Facial Paralysis Patients Who Has Received Functioning Free Muscle Transplantation

採用多方位評估方式探討接受游離功能性肌肉轉移手術的顏面神經麻痺病患

摘要


背景:改善顏面神經麻痺病患的微笑方式有包括靜態及動態的手術,其中以游離功能性肌肉轉移手術已為標準手術來提供病患再度微笑的機會。文獻上已有許多可以用來比較術前及術後結果的方法,但仍然未有一個標準的方法來。目的及目標:某些顏面神經病患在重建手術術後雖然功能上有改善,但仍然對結果不滿意,尤其是先天性顏面神經的病患。在這篇文章裡我們採用多方位的評估方式來探討各層面術後結果以提供改善的方法。材料及方法:從1986年1月到2010年1月,總共有26位顏面神經麻痺(包括單側及雙側)的病患接受採用第11對腦神經所支配的游離功能性肌肉轉移手術來重建微笑。評估的方法包括微笑程度量表(分數從0到4)、游離功能性肌肉轉變成獨立自然階段的評估(階段從I到V)以及採用問卷方式來詢問病患滿意度(分數從1到5)。結果:在這26位顏面神經麻痺病患中總共接受了32個游離功能性肌肉轉移手術。平均微笑程度從術前0.5改善到3.4分。84%的病患能進步到獨立階段的功能,而滿意度上至少有90%的病患是等於或高於3分以上。但有高達50%的病患比較在意術後外觀的結果多於功能上的影響而要求進一步改善。結論:這篇文章中所提出的評估方式讓外科醫師可以以客觀及主觀的層面來多了解術後的結果。藉由病患的角度及觀感可以讓外科醫生更加深入去探討各種術後表現並提供改善的方法。

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並列摘要


Background:Treatments for facial paralysis patients include static and dynamic procedures. Functioning free muscle transplantation (FFMT) has now become a standard procedure in providing active facial reanimation. Multiple methods have been used to evaluate the pre- and post- operative results, but none of which holds as the benchmark for proper evaluation.Aims and Objectives:Facial paralysis patients who show good functional results are not always satisfied, especially congenital facial paralysis patients like Möbius syndrome. The aims of this article are to use multidisciplinary methods to gain further insights subjectively and objectively for patient outcomes evaluation.Materials and Methods:From January 1986 to January 2010, a total of 26 facial paralysis patients (both unilateral and bilateral) received Spinal accessory nerve (XI) innervated muscle for smile reconstruction. The evaluation methods used were composed of a Smile Excursion Score (from 0 to 4) to evaluate muscle excursion, a staging system (from Stage I to V) to determine the Cortical Adaptation Stage of the functioning muscle, and a questionnaire to assess the satisfaction of the patients (from 1 to 5).Results:A total of 32 functioning free muscle transplantations were performed on 26 patients. The mean Smile Excursion Score improved from 0.5 to 3.4 postoperatively. 84% of the patients showed independent smile, while 90% of patients showed at least a satisfaction score of 3 or more out of 5. Majority of the patients (50%) were more concerned with the aesthetic look rather than the functional status.Conclusion:The aforementioned evaluation methods provide not only objective results but also subjective outcomes that allow surgeons to better understand the postoperative presentations. Subjective feedbacks directly from the patients can allow surgeons to gain further insights and enlighten surgeons on possible revisions to improve the final outcomes.

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