Differentiated methods for surgical treatment of patients with facial nerve injury consequences
Background. The symmetry of the face is extremely important for everyone for full interaction and comfortable existence in society. As a result, damage to the facial nerve (FN) becomes a serious problem for a patient, causing several negative consequences in many aspects of a patient’s life. Facial muscle paralysis causes emotion inhibition, facial expressions, impedes full communication, smiles, and negatively affects a patient’s vision. The purpose of the study is to investigate the results of differentiated surgical treatment of facial nerve injury. Materials and methods. Between 1998 and 2018, 199 surgical procedures were performed using various methods of surgical treatment of the effects of FN damage — dynamic and static. Dynamic methods of surgical treatment of facial nerve neuropathy (FNN) were applied in 173 cases (86.9 %), static — in 26 cases (13.1 %). The mean age was 38.2 ± 1.1 years. There were 67.2 % women and 32.8 % of males. The severity of FNN was assessed on a House-Brackmann scale. Patients underwent surgery within 1 month to 15 years after injury (median 7.0 ± 5.9 months). Results. In a total of 199 cases, the median postoperative FN function on the House-Brackmann scale was 3.000 ± 0.067 points. Good recovery rates of FN function (up to II–III points on the House-Brackmann scale) were observed in 160 patients (80.41 %), satisfactory (up to IV–V points on the House-Brackmann scale) — in 39 patients (19.59 %). Analyzing separately the results of surgical treatment by the nerve transfer methods, we obtained the following indicators of FN function recovery. In groups 1–4, nerve transfer significantly improved FN function after surgery (p < 0.01; Wilcoxon Matched Pairs Test, Mann-Whitney U-test). When performing surgical treatment of patients with FN injury by the methods of nerve decompression, suture and nerve grafting, good results of function recovery were obtained in 5 (62.5 %) of 8 patients; after surgical static methods — in 6 (85.7 %) of 7 patients. The non-surgical facelift method was applied in 19 patients with the effects of FN injury after FN neurotization with different donor nerves and improved the aesthetics and facial symmetry parameters in all patients (100 %) (p < 0.001, Wilcoxon Matched Pairs Tests). Conclusions. Facial nerve neurotization with different nerve donors allows achieve good indicators of FN recovery, but for better functional results in patients with consequences of FN damage, we recommend to supplement with static methods of a non-surgical facelift, which eliminates the traditional risks and negative complications of surgical static face correction procedures.
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