ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
https://scientific-jl.org/obr
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Часть–2_ Мая –2025
294
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SURGICAL RESTORATION OF ISOLATED MOVEMENTS OF
FACIAL MUSCLES IN PATIENTS WITH FACIAL PARALYSIS
Rashidov Muhsin Narzi o’g’li
Bukhara State Medical Institute
named after Abu Ali Ibn Sino
Tel : +998911329697
MukhsinRashidov
@gmail.com
ABSTRACT
.
Due to the growing social significance of correction of
pathological lesions of the maxillofacial region, the relevance of searching for highly
effective methods and means of their treatment increases [10]. Currently, the number
of patients with facial nerve damage is growing, which is due to the increase in the
number of cases of traumatic damage to the maxillofacial region, gunshot wounds to
the head, an increase in the percentage of oncological diseases of the facial region,
pathologies of the parotid salivary gland and complications after plastic surgery and
cosmetic manipulations [11, 12, 54, 80, 84]. Facial nerve damage ranks second among
diseases of the peripheral nervous system and first in the structure of cranial nerve
diseases [27, 90, 101, 108]. Treatment of paresis and paralysis of the facial muscles
was one of the most difficult problems of plastic surgery in the middle of the last
century. Currently, the restoration of functional, social, cosmetic, psychological and
economic aspects of human life remains a priority task [2, 19, 37, 47, 50].
Pathology of the facial nerve is a problem that neurologists, maxillofacial and
plastic surgeons most often encounter [1, 63, 127]. The goal of treating a paralyzed
face is to restore the motor activity of the facial muscles, eliminate functional
discomfort when eating, and restore facial symmetry, both at rest and during active
movements. This goal can be achieved using various methods of reinnervation of the
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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facial muscles using the masticatory, hypoglossal, accessory, mylohyoid nerves,
including the cross-plastic method [9, 17, 69, 73, 74, 87].
Restoration of the integrity of the facial nerve becomes impossible when the main
trunk is lost - when it is damaged inside the fallopian canal or at the intracranial level
[8, 21, 25, 52, 53, 55].
According to literary sources, the criterion for successful treatment is
reinnervation performed before the onset of atrophy of the facial muscles [19, 34, 44,
66, 67, 91, 96, 120]. However, a detailed study of the available publications revealed
that almost all patients require repeated corrective surgeries or cosmetic procedures.
Rehabilitation of patients with this pathology is one of the most difficult problems of
maxillofacial reconstructive surgery and neurology. This is primarily due to the
structural features and innervation of the facial muscles, their ability to reproduce
complex synchronous and isolated movements. None of the existing methods of facial
muscle reinnervation make it possible to reproduce isolated movements. Moreover, all
movements are performed synchronously, which is due to the structure of the motor
nucleus and the number of motor neurons of the donor nerve, which uncontrollably
grow into the trunk of the facial nerve (sprouting) during neuroplasty [103, 118, 126].
The appearance of facial muscle movements in patients after neurorrhaphy can be
regarded as a satisfactory functional result for the surgeon, but for the patient it will be
questionable, since the simultaneous movement of all facial muscles does not give a
good functional and aesthetic result and does not improve his psychoemotional state.
This is why the problem of social rehabilitation of such patients remains one of the
most pressing issues of modern neurosurgery [26, 76, 116, 122].
It should be noted that in order to achieve a good functional and aesthetic result
in patients with paralysis of the facial muscles, it is necessary to obtain isolated
movements of the facial muscles [32, 43, 51, 116]. Theoretically, it can be assumed
that by isolating individual branches of the facial nerve and suturing them with
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
https://scientific-jl.org/obr
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different branches of the donor nerves, it is possible to achieve individual independent
contractions of different groups of facial muscles.
The level of development of the research topic
The literature covers numerous methods of reconstructive surgeries aimed at
restoring the function of facial muscles using various methods of reinnervation with
the use of the masticatory, accessory, hypoglossal nerves and achieving functional
effects. However, having analyzed modern publications in both domestic and foreign
literature, we can confidently say that today surgical restoration of the integrity of the
facial nerve remains an urgent task. Modern medicine has various methods for treating
facial nerve injuries: neurorrhaphy, anastomoses of the facial nerve with the
masticatory, hypoglossal nerve and other nerves, cross-plasty, muscle transposition,
muscle autotransplantation with simultaneous reinnervation, etc. The choice of the
optimal method of surgical treatment is due not only to achieving a good functional
result, but also to maximum aesthetic rehabilitation of patients, which allows avoiding
unnecessary stages of aesthetic surgery, which only mask the defect, but do not solve
the problem. It is with these that the constant search and improvement of surgical
treatment methods is associated.
The purpose of the study is to increase the effectiveness of treatment of patients
with facial muscle paralysis with a denervation period of up to 18 months.
Research objectives
1. To analyze the results of surgical treatment of patients with facial muscle
paralysis based on archival material of the Federal State Budgetary Institution of
Science "Central Research Institute of Cardiovascular and Maxillofacial Surgery" of
the Ministry of Health of the Russian Federation for the period from 2010 to 2018.
2. To develop new methods of triple reinnervation of facial muscles using the
masticatory and hypoglossal nerves.
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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3. Based on electromyography and anthropometry data, conduct a comparative
analysis of the results of surgical treatment of patients depending on the method of
reinnervation based on archival material and our own research.
4. To identify a correlation between new methods of triple reinnervation of facial
muscles, the duration of paralysis and the age of patients.
Novelty of the study
1. For the first time, an analysis of the results of various neuroplasticity options
in patients with facial muscle paralysis was conducted based on archival material,
indicating that reinnervation of the facial muscles through the main trunk using one
donor nerve leads to such undesirable consequences as synkinesis, which often entails
the development of contracture of the facial muscles.
2. For the first time, new methods of surgical treatment of patients with facial
muscle paralysis were developed, consisting of selective triple reinnervation of the
branches of the facial nerve, which allow separating the movements of the middle and
lower zones of the face, which minimizes the risk of synkinesis and helps to achieve
the maximum possible symmetry of the face at rest.
3. For the first time, a comparative assessment of synkinesis was applied
depending on the source of reinnervation, which was based on the assessment scales
of facial asymmetry (House-Brackman, F.N.G.S. 2.0, May&Schaitkin, Shurgaya
Ts.M.).
Theoretical and practical significance of the work
Data on the degree of facial asymmetry before and after various reinnervation
options were systematized, which made it possible to simplify the choice of optimal
surgical treatment tactics depending on the degree of asymmetry and the duration of
paralysis.
ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ
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New methods of triple selective reinnervation of the facial muscles using the
masticatory
and
hypoglossal
nerves
in
combination
with
cross-facial
autotransplantation of the sural nerve were developed.
The proposed treatment algorithm allows to improve functional and aesthetic
results, accelerate the rehabilitation of patients with paralysis of the facial muscles.
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