SURGICAL RESTORATION OF ISOLATED MOVEMENTS OF FACIAL MUSCLES IN PATIENTS WITH FACIAL PARALYSIS

Аннотация

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 https://scientific-jl.org/obr 2 9 4 Выпуск журнала №-69 Часть–2_ Мая –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 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 https://scientific-jl.org/obr 2 9 5 Выпуск журнала №-69 Часть–2_ Мая –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 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 pati