背景:舌下神经-面神经(12-7)吻合术可以恢复面神经麻痹患者的对称性和随意运动。传统的12-7转移包括直接的端到端神经吻合,牺牲整个舌下神经.当代,端侧吻合,或分裂吻合技术通过保留一些舌下神经来限制舌头的发病率。这些技术之间的直接结果比较是有限的。目的:比较面部运动的报告结果,舌头,演讲,不同类型舌下神经-面神经吻合方案的吞咽结局。证据综述:对于本系统综述和荟萃分析,设计了一个全面的策略来搜索PubMed,Scopus,和Cochrane数据库从开始到2021年1月,根据系统审查和荟萃分析的首选报告项目,报告指南产生383个结果。任何使用三种技术中的任何一种进行12-7转移的参与者,有或没有插入移植物,并用经过验证的仪器如House-Brackmann(HB)记录了术前和术后对面神经功能的评估,被考虑纳入。联合运动的次要结果,舌萎缩,还比较了言语或吞咽功能障碍。49项研究符合纳入标准,代表961例接受12-7次转移的患者的数据.结果:良好的HB结局(HBI-III)的比例因吻合类型而异:端侧和端端端吻合(73%vs.59%,p=0.07),分裂和端到端吻合术(62%vs.59%,p=0.88),端侧吻合和劈开吻合(73%vs.62%,p=0.46)。吻合类型之间报告的联合运动率没有差异。然而,端侧吻合术(z=6.55,p<0.01)和裂口吻合术(z=3.58,p<0.01)比端端端吻合术产生的舌萎缩少。端侧吻合比端端端吻合少言语/吞咽功能障碍(z=3.21,p<0.01)。结论:端侧吻合术和裂开吻合术与传统的端端端12-7吻合术产生相似的HB面神经结果。与端到端吻合相比,端到端吻合减少了舌萎缩和言语/吞咽功能障碍的并发症。此外,与端到端吻合术相比,分裂吻合术降低了舌萎缩率。
Background: Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. Objective: To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. Evidence
Review: For this systematic
review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. Results: The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01). Conclusion: End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.