Indications and contraindications for the surgical treatment of the consequences of damage to the facial nerve
Keywords:trauma, facial nerve, surgical treatment, facial muscles
AbstractBackground. The problem of restoration of physio-logical facial symmetry is extremely urgent and important in patients with lesions of the facial nerve (FN). The inability to fully express emotions greatly affects the psychological state of patients, and facial asymmetry limits the comfortable stay in society and leads to the emergence of depressive disorders in such a category of patients. The purpose was to determine clear indications and contraindications to the surgical treatment of patients with consequences of injury to the FN. Materials and methods. The results of treatment were analyzed retrospectively in 178 patients with consequences of facial nerve damage, who were operated from 1998 to 2018. Sex distribution was as follows: 117 (65.7 %) women and 61 (34.3 %) men. The diagnostic complex included a clinical evaluation of the severity of FN lesions and electroneuromyographic examination. The patients underwent the following types of surgical treatment: FN neurotization with different donor nerves, FN decompression (including the implantation of device for long-term electrical stimulation), FN neurorrhaphy, FN autografting, static methods of face correction, muscle transposition and more. Results. In general, according to the results of surgical treatment by all methods, the effectiveness of the treatment was as follows: 144 patients (80.9 %) achieved the restoration of FN function to grade II–III on the House-Brackmann scale; 34 patients (19.1 %) — to grade IV–V. Good results (up to grade II–III on the House-Brackmann scale) for each treatment method are shown separately: FN decompression — 66.6 %; FN decompression + implantation of device for long-term electrical stimulation) — 93.3 %; FN neurotization + implantation of device for long-term electrical stimulation — 100 %; FN neurorrhaphy — 50 %; FN autografting — 100 %; muscle transposition (temporal muscle) — 100 %; static methods of face correction — 87.5 % of patients. Conclusions. Surgical treatment aimed at restoring the functions of the facial nerve and facial muscles should only be performed if there are clear indications for this and if the conservative treatment was unsuccessful. The best results of the restoration of the FN function are observed in patients, who were operated within a period of up to 12 months after injury.
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