Clinical picture and diagnosis of consequences of the traumatic damage to the facial nerve
Background. The consequences of damage to the facial nerve (FN) is a serious medical and social problem, since they have a devastating impact on a number of important aspects of human life (economic, psychological, aesthetic), which significantly reduces the quality of patients’ life. The aim of the study is to improve the results of surgical treatment of patients with FN damage by optimizing the diagnosis of the FN functional state depending on the clinical signs and optimizing the surgical treatment methods. Materials and methods. Additional instrumental methods of research, namely, clinical and neurophysiological, were used in 67 patients with consequences of FN damage from 2012 to 2017. The degree of facial nerve dysfunction was assessed using HouseBrackmann scale. Additionally, the following neuroimaging methods were used: computed tomography, magnetic resonance imaging, Xray and audiometric. Among the methods of neurophysiological diagnosis, we used: stimulation electromyography (EMG), registration of blink reflex and needle EMG. Neurophysiological diagnosis made on the NeuroMVP4 equipment (Neurosoft, RF). Results. The average recovery rate of FN function on the HouseBrackmann scale was 2.94 ± 0.12 points in the group of patients who underwent surgical treatment later than 6 months after the injury, and 2.45 ± 0.10 points in the group of patients who were operated on within 6 months after FN injury. The difference between the groups was obtained at a significance level of p = 0.017. That is, better indicators of the FN function recovery were in patients in whom surgery was performed earlier in the postinjury period (p < 0.05). In our study, the number of patients with high recovery rates (on the scale of HouseBrackmann II–III) within 12 months after the surgery was 60 out of 67 (89.55 %), among them the maximum recovery rates to level II we observed in 27 patients (40.3 %). The worst indicators of the restoration of the facial muscles function (to level IV–V on the HouseBrackmann scale) were observed in 7 patients (10.45 %). Treatment outcome in the latter category of patients was negatively influenced by both the significant timing of surgical treatment after injury, and incomplete compliance with the recommendations for rehabilitation treatment in the postoperative period. Indicators of the difference in clinical outcomes of recovery depending on the etiology of the damage are not statistically significant. Conclusions. Early diagnosis of facial nerve damage with the use of generally accepted scales and additional instrumental methods is important for determining the further management of the patient, the effectiveness of the reinnervation and the prediction of the FN function recovery.
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