SU1500317A1 - Method of rehabilitation of the function of the mimicry muscles in case of disturbance of anatomical continuity of the facial nerve - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery. The purpose of the invention is the prevention of atrophy of the facial muscles in violation of the anatomical integrity of the facial nerve. This is achieved by conducting its electrostimulation through electrodes located distal to the injury site for 2–3 weeks, followed by neuroplasty of the facial nerve (by imposing an anastomosis between other motor nerves). Thereafter, electrostimulation is continued through electrodes located above and below the anastomosis site, with rectangular biphasic pulses with a duration of 0.1–0.5 ms, a frequency of 5–50 Hz, and an amplitude of 5–50 µA 4–5 times a day, 5 each day. -10 min, and after neuroplasty, electrical stimulation is carried out for at least 3 weeks. The treatment by the proposed method provides the prevention of atrophy of the mimic muscles and in most cases leads to the full restoration of movements and muscle tone by the first year after the operation.

Description

The invention relates to medicine, namely to neurosurgery.

The aim of the invention is to prevent the atrophy of the facial muscles by electrostimulation of the facial nerve.

The method is carried out as follows. .

A patient during neurosurgical operation (removal of the tumor, decompressing the damaged facial nerve in the bone canal) into a segment located distal to the injury site in the internal auditory canal, a beam of 2 electrodes is inserted through which, in the postoperative period, electrostimulation is performed for 2- 3 weeks.

After 2-3 weeks, when the patient's condition allows to perform a plastic surgery of the facial nerve with other motor nerves (Diphragmal, pharyngeal branch of the subsomalus nerve), when applying the anastomosis, 2 electrodes are inserted, one more maximally, another distal to it . The electron beam in the internal auditory canal is removed by pushing. Electrostimulation of the anastomosis begins on the following day after surgery and lasts 3 weeks, after which it is also removed

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by pushing. Both in the first and in the second case, electrostimulation sessions are carried out daily 4-5 times a day for 5-10 minutes with rectangular bi-phase pulses with a duration of 0.1-0.5 ms, a frequency of 5-50 Hz and an amplitude of 5-50 µA .

Electrostimulation of the distal segment of the nerve prevents degenerative changes in it, thus maintaining the tone of the mimic minus during their denervation.

The preservation of the tone of the facial muscles is observed for 3 weeks, which is sufficient to prepare the patient for the second stage of the operation, namely the plastic of the facial nerve,

Electrostimulation after imposing neuroanastomosis through electrodes inserted proximally and distally from it prevents the degeneration of nerves included in the anastomosis, accelerates the germination of the diaphragm nerve, as evidenced by a decrease in the severity of pathological symptoms already in the first days of stimulation.

Electrical stimulations with an amplitude of pulses of less than 5 µA did not cause any of the observations in the work of neural fibers according to electromyographic research data. Therefore, electrostimulation with an amplitude of less than 5 µA does not make sense.

Exceeding an amplitude of more than 50 µA causes negative consequences: polarisation, and inhibition of the nerve elements leading to various clinical manifestations. Thus, in patients with an increase in the amplitude of stimulating impulses up to 60 µA, pain in the ear region developed. cheek parasthesia on the side of stimulation.

A decrease in the pulse duration of less than 0.1 ms does not lead to a reaction of the nerve fibers according to electromyography and does not manifest clinically. With a pulse duration of more than 0.5 ms (1 ms), after 10–15 mk. After the electrostimulation session, the patients developed unpleasant painful sensations in the ear and cheek area on the stimulation side.

Interpulse intervals must be at least 20 ms, since the period

The relative refractoriness of the facial nerve fibers is normally 6–10 ms, and with the development of pathology it increases 1.5–2 times. Stimulating impulses in the period of relative refractoriness do not cause full excitation of nerve fibers. Interpulse intervals should not be more than 200 ms, so that there is no weakening or even disappearance of the positive potentiator. the effect of rhythmic electrostimul 1D1I on the neuromuscular transmission.

During electrical stimulation of the facial nerve for 10 minutes, patients had unpleasant sensations on the side of stimulation. The electromyography data at the same time testified to a decrease in the reactivity of nerve fibers to electrical stimulation, which was compensated after 2-3 hours after the end of the session. Therefore, each session is limited to 10 minutes, but can be repeated after 3-4 hours, i.e. 4-5 times a day to maintain the highest possible muscle tone,

Example 1. Ill G., 30 years. Diagnosis: acoustic neuroma of the fourth stage on the right. Operation - removal of the neuroma of the auditory nerve stage IV to the right. Removal of the tumor was accompanied by the intersection of VII and Vlir nerves. In the internal auditory canal, to the cult of the VII nerve, introduced a double electrode. On the 2nd day, electrostimulation was started for 5 min with the following parameters: amplitude 5 μA, pulse duration 0.1 ms, frequency 25 Hz, 4 times a day.

In the postoperative period marked paralysis of the facial nerve in a peripheral type to the right. By the 3rd day, a hollow lagophthalmos and paralysis of the facial muscles were registered, and the corner of the mouth hangs to the right. By day 5, there was a marked increase in the tone of the facial muscles of the face, salivation decreased from the corner of the mouth on the paretic side of the face, the patient acquired the ability to retain fluid and liquid food in the oral cavity ..

Electrostimulation continued up to 14 days. On the 14th day after the violation of the anatomical integrity of the facial nerve, the facial nerve plastics were made diaphragmatic. At the distal end of the phrenic nerve and

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The proximal end of the facial nerve at a distance of 0.5 cm from the anastomosis introduced electrodes. On the 2nd day of the onset of electro-stimulation in the mode: amplitude 30 μA, pulse duration 0.5 ms, frequency 50 Hz, 5 times a day for 5 minutes. On the 3rd day of stimulation, the tone of the facial muscles . The face alone is symmetrical; the angle of the mouth is set- with flush with the healthy side. Well holds in the mouth liquid food and water. Food did not accumulate in the space between and the lower guard. During the period of electrical stimulation, there was a tingling sensation in the right side of the face. Electrodes removed. Electrostimulation was discontinued 3 weeks after surgery. On the 23rd day after neuroplasty, the patient was discharged from the clinic in a satisfactory condition.

Inspection before discharge; at rest, the face is symmetrical, reliably holds food in the oral cavity, the size of the eye slit is 2-3 mm, there is no inflammation of the eye.

Example 2. Ill M., 49 years. Diagnosis: acoustic neuroma of stage IV. The operation is the removal of stage IV neurinomas of the auditory nerve with the intersection of the seventh nerve.

A double electrode is introduced into the inner auditory canal to the VII nerve cult. On the 2nd day, electrostimulation was started in the mode: amplitude 30 μA, pulse duration 0.5 ms, frequency 50 Hz, 4 times a day for 5 minutes. Electrostimulation lasted 12 days. On the 12th day, the facial nerve plastic was made diaphragmically with the introduction of electrodes into the areas of the facial and phrenic nerves adjacent to the anastomosis at a distance of 8 mm from each other.

From the 2nd day, electrical stimulation was carried out 4 times a day for 5 min with the following parameters: amplitude 50 μA, pulse duration 0.5 ms, frequency 20-Hz. Electrostimulation was performed for 15 days. Discharged from the clinic. Inspection in front of the viscera: the face is at rest symmetrically, there are no inflammatory changes in the eye, the size of the eye cavity is 2-3 mm The patient indicates that in the course of the treatment she has gained the opportunity to chew both

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From the lower jaw, hold water and food in the mouth.

Example 3. Ill K., 36 years old. Diagnosis: neuroma VIII nerve stage III-IV on the left. Surgery with intersection of nerves VII and VIII. After removal of the tumor, a double electrode is inserted into the internal auditory canal, which leads to the cult of nerves VII and VIII. Electrostimulation in a mode of a thinness of 20 µA, a pulse duration of 0.1 ms, a frequency of 5 Hz, started from 3 days after surgery for 2 weeks. In the postoperative period, the patient maintained the tone of the minuscule of the left half of the face; there is no asymmetry of the face at rest; it keeps the liquid in the oral cavity; Eye patch in eyelid attempt at eyelid closure by 2 mm.

Neuroplasty of the phrenic nerve on the 12th day after surgery c. implantation of electrodes proximal and distal to the site of the anastomosis. Electrode from internal auditory canal removed. Electrostimulation through the newly introduced electrodes started from the 2nd day after the operation. Parameters of the conducted stimulations: amplitude 50 μA, pulse duration 0.5 ms, frequency. 20 Hz.

Within 2 weeks, electrostimulations were performed in the clinic and for 10 more days on an outpatient basis at home by the patient or her relatives. On the 24th day after the operation, there is no asymmetry of the face. Completely kait the palpebral fissure, retains fluid and air in the mouth. Active voluntary movements of mimic muscles have not yet been noted.

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The proposed method provides

prevention of mimic muscular atrophy and connective tissue degeneration. An increase in the function of the tonal activity of the anastomosis due to electrostimulation is associated with the accelerated growth of the phrenic nerve and the maintenance of muscle tone. This provides a more effective treatment of paresis and paralysis of the facial nerve in comparison with the known methods, since in the first days of treatment it is possible not only to stop the development of atrophy, but also to partially restore some functions of the facial muscles.

The method was applied to the pepschek 15 patients. The results of the treatment are tracked from 4 to 17 months. Improvement of mimic functions, which clinically manifested itself as an increase in muscle tone, a decrease in facial asymmetry at rest, the possibility of retention, fluid and food in the oral cavity, and the appearance of contractions of individual muscle fibers were noted in 7 patients by the end of the 4th week after surgery, and by the end of the 2nd month. - all 15 patients.

The complete restoration of the tone, the elimination of asymmetry of the face at rest, and the restoration of the full volume of involuntary movements of the mimic muscles synchronous with breathing, occurred in the period from the 3rd to the 4th month. after surgery in 7 patients, after 6 months. after surgery in all 15 patients.

In the treatment of 14 patients using the prototype method (only neuroplastic surgery), the improvement of the functions of the facial muscles was observed by the end of the 4th month. after operation. Full restoration of movements and muscle tone took place after 6 months. in 7 patients, a year later - in 11 patients.

Complications with the combined treatment was noted. Medicomen

This therapy, which included absorbable, vasodilating and stimulating agents in patients, lasted 2-4 weeks and did not require repeated courses. Similar therapy in patients who underwent only neuroplasty was longer (up to 2 months) and required 2-3 additional courses.

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Claims (1)

Formula inventions The method of restoring the functions of mimic mi sh1ts at. violation of the anatomical integrity of the facial nerve by imposing an anastomosis between the facial and other motor nerves, characterized in that, in order to prevent atrophy of the mimic muscles, electrodes are inserted into the facial nerve distal to the site of its damage and within 2-3 weeks electrostimulation,. and after applying the anastomosis, electrodes are introduced, one proximal, the other distal to it, and stimulation is performed through these electrodes for at least 3 weeks, and in this and other cases, stimulation is carried out 4-5 times a day for 5- The world is 10 square-wave biphasic pulses with a duration of 0.1-0.5 ms, a frequency of 5-50 Hz and an amplitude of 5-50 µA.