Клинический случай лечения повреждения лицевого и тройничного нервов у пациентки с колото-резаным ранением шеи

Завалий Л.Б., Рамазанов Г.Р., Петриков С.С. и др. Клинический случай лечения повреждения лицевого и тройничного нервов у пациентки с колото-резаным ранением шеи. Consilium Medicum. 2019; 21 (9): 54–57. DOI: 10.26442/20751753.2019.9.190370

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Zavaliy L.B., Ramazanov G.R., Petrikov S.S. et al. A clinical case of treatment of damage to the facial and trigeminal nerves in a patient with a stab and cut wound of the neck. Consilium Medicum. 2019; 21 (9): 54–57. DOI: 10.26442/20751753.2019.9.190370

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Аннотация

В стационаре скоропомощного профиля распространенной патологией являются травмы области лица и шеи с повреждением черепных нервов, в том числе лицевого нерва (ЛН). Травма ЛН клинически проявляется преимущественно парезом мимических мышц и асимметрией лица. Послед-ствия патологии доставляют не только функциональные, но и значимые эстетические неудобства, социально дезадаптируют пациентов. Основ-ным методом реабилитационного лечения повреждения ЛН любой этиологии является лечебная физкультура. В статье представлен клинический случай лечения травматического повреждения ЛН и тройничного нерва у пациентки с колото-резаным ранением шеи. Данный клинический случай демонстрирует важность неврологической оценки пациентов с травмами области лица и шеи и своевременного реабилитационного лечения. Для каждого этапа восстановления необходим определенный подход к диагностике и лечению. Актуален вопрос целесообразности применения боту-линотерапии у лиц с невропатией ЛН для коррекции асимметрии и синкинезий. При наличии гипотрофии мышц лечение синкинезий должно быть отложено. При обследовании пациентов неврологического профиля ультразвуковое исследование может быть быстрым и эффективным альтер-нативным методом диагностики и динамического наблюдения.

Ключевые слова: лицевой нерв, травма лицевого нерва, невропатия лицевого нерва, реабилитация.

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A trauma to the face and neck with damage to the cranial nerves, including the facial nerve (FN), is common in the emergency hospital. FN injury is clinically manifested mainly by mimetic muscles paresis and facial asymmetry. This results in not only functional, but also significant aesthetic inconveniences as well as in social maladaptation of patients. The main method of rehabilitation treatment of FN injuries regardless of their etiology is physical therapy. The article presents a clinical case of a treatment of FN and trigeminal nerve injury in a patient with a stab and cut wound of the neck. This clinical case demonstrates the im-portance of a neurological assessment of patients with injuries of the face and neck and timely rehabilitation treatment. Each stage of patient recovery requires a specific approach to the diagnosis and treatment. The issue of a rationality of using botulinum therapy in individuals with FN neuropathy to correct asymmetry and synkinesis is of great importance. If a patient has muscle hypotrophy treatment of synkinesis should be postponed. When examining neurological patients, ultrasound can be a quick and effective alternative method for diagnosis and dynamic follow-up.

Key words: facial nerve, facial nerve injury, facial neuropathy, rehabilitation.

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Список литературы

1. Fisch U. Management of intratemporal facial nerve injuries. J Laringol Otol 1980; 94 (1): 129–34.
2. De Almeida JR, Guyatt GH et al. Management of Bell palsy: clinical practice guideline. CMAJ 2014; 186 (12): 917–22.
3. Garro A, Nigrovic LE. Managing Peripheral Facial Palsy. Ann Emerg Med 2018; 71 (5): 618–24.
4. Van Landingham SW, Diels J, Lucarelli MJ. Physical therapy for facial nerve palsy: applications for the physician. Curr Opin Ophthalmol 2018; 29 (5): 469–75.
5. Adour KK, Byl FM, Hilsinger RL et al. The true nature of Bell’s palsy: analysis of 1000 consecutive patients. Laryngoscope 1978; 88 (5): 787–801.
6. Armstrong MW, Mountain RE, Murray JA. Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy. Clin Otolaryngol Allied Sci 1996; 21 (1): 15–20.
7. Guntinas-Lichius O, Streppel M, Stennert E. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 2006; 191 (1): 61–7.
8. Anonsen CK, Trachy RE, Hibbert J, Cummings CW. Assessment of facial reinnervation by use of chronic electromyographic monitoring. Otolaryngol Head Neck Surg 1986; 94 (1): 32–6.
9. Guntinas-Lichius O, Irintchev A, Streppel M et al. Factors limiting motor recovery after facial nerve transection in the rat: combined structural and functional analyses. Eur J Neurosci 2005; 21 (2): 391–402.
10. Eccles JC, Libet B, Young RR. The behaviour of chromatolysed motoneurones studied by intracellular recording. J Physiol 1958; 143 (1): 11–40.
11. Titmus MJ, Faber DS. Axotomy-induced alterations in the electrophysiological characteristics of neurons. Prog Neurobiol 1990; 35 (1): 1–51.
12. Lieberman AR. The axon reaction: a review of the principal features of perikaryal responses to axon injury. Int Rev Neurobiol 1971; 14: 49–124.
13. Blinzinger K, Kreutzberg G. Displacement of synaptic terminals from regenerating motoneurons by microglial cells. Z Zellforsch Mikrosk Anat 1968; 85 (2): 145–57.
14. Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: Improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg 2009; 33 (4): 582–90.
15. Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: A systematic review. J Plast Reconst Aesthet Surg 2017; 70 (6): 833–41.
16. Borodic G, Bartley M, Slattery W et al. Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebocontrolled trial using subjective endpoints. Plast Reconstr Surg 2005; 116 (1): 36–43.
17. Monini S, de Carlo A, Biagini M et al. Combined protocol for treatment of secondary effects from facial nerve palsy. Acta Oto-Laryngol 2011; 131 (8): 882–6.
18. Choi KH, Rho SH, Lee JM et al. Botulinumtoxin injection of both sides of the face to treat post-paralytic facial synkinesis. J Plast Reconstr Aesthet Surg 2013; 66 (8): 1058–63.
19. Догра В., Рубенс Д.Дж. Секреты ультразвуковой диагностики. М.: Медицинская литература, 2017: с. 10–5.
[Dogra V., Rubens D.Dzh. The secrets of ultrasound diagnosis. Moscow: Meditsinskaia Literatura, 2017: p. 10–5. (in Russian).]
20. Капустин С.В., Пиманов С.И., Жерко О.М., Чуванов А.Н. Ультразвуковое исследование в таблицах и схемах. М., 2018: с. 89–92.
[Kapustin S.V., Pimanov S.I., Zherko O.M., Chuvanov A.N. Ultrasound examination in tables and diagrams. Moscow, 2018: p. 89–92. (in Russian).]
21. МакНелли Юдж. Ультразвуковые исследования костно-мышечной системы: практическое руководство. М.: ВИДАР, 2007; c. 273–92.
[MakNelli Iudzh. Ultrasound studies of the musculoskeletal system: a practical guide. Moscow: VIDAR, 2007; p. 273–92 (in Russian).]
22. Баженов Д.В., Калиниченко В.М. Анатомия головы и шеи. Введение в клиническую анатомию. М.: ГЭОТАР-Медиa, 2014.
[Bazhenov D.V., Kalinichenko V.M. Anatomy of the head and neck. Introduction to clinical anatomy. Moscow: GEOTAR-Media, 2014. (in Russian).]

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1. Fisch U. Management of intratemporal facial nerve injuries. J Laringol Otol 1980; 94 (1): 129–34.
2. De Almeida JR, Guyatt GH et al. Management of Bell palsy: clinical practice guideline. CMAJ 2014; 186 (12): 917–22.
3. Garro A, Nigrovic LE. Managing Peripheral Facial Palsy. Ann Emerg Med 2018; 71 (5): 618–24.
4. Van Landingham SW, Diels J, Lucarelli MJ. Physical therapy for facial nerve palsy: applications for the physician. Curr Opin Ophthalmol 2018; 29 (5): 469–75.
5. Adour KK, Byl FM, Hilsinger RL et al. The true nature of Bell’s palsy: analysis of 1000 consecutive patients. Laryngoscope 1978; 88 (5): 787–801.
6. Armstrong MW, Mountain RE, Murray JA. Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy. Clin Otolaryngol Allied Sci 1996; 21 (1): 15–20.
7. Guntinas-Lichius O, Streppel M, Stennert E. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 2006; 191 (1): 61–7.
8. Anonsen CK, Trachy RE, Hibbert J, Cummings CW. Assessment of facial reinnervation by use of chronic electromyographic monitoring. Otolaryngol Head Neck Surg 1986; 94 (1): 32–6.
9. Guntinas-Lichius O, Irintchev A, Streppel M et al. Factors limiting motor recovery after facial nerve transection in the rat: combined structural and functional analyses. Eur J Neurosci 2005; 21 (2): 391–402.
10. Eccles JC, Libet B, Young RR. The behaviour of chromatolysed motoneurones studied by intracellular recording. J Physiol 1958; 143 (1): 11–40.
11. Titmus MJ, Faber DS. Axotomy-induced alterations in the electrophysiological characteristics of neurons. Prog Neurobiol 1990; 35 (1): 1–51.
12. Lieberman AR. The axon reaction: a review of the principal features of perikaryal responses to axon injury. Int Rev Neurobiol 1971; 14: 49–124.
13. Blinzinger K, Kreutzberg G. Displacement of synaptic terminals from regenerating motoneurons by microglial cells. Z Zellforsch Mikrosk Anat 1968; 85 (2): 145–57.
14. Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: Improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg 2009; 33 (4): 582–90.
15. Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: A systematic review. J Plast Reconst Aesthet Surg 2017; 70 (6): 833–41.
16. Borodic G, Bartley M, Slattery W et al. Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebocontrolled trial using subjective endpoints. Plast Reconstr Surg 2005; 116 (1): 36–43.
17. Monini S, de Carlo A, Biagini M et al. Combined protocol for treatment of secondary effects from facial nerve palsy. Acta Oto-Laryngol 2011; 131 (8): 882–6.
18. Choi KH, Rho SH, Lee JM et al. Botulinumtoxin injection of both sides of the face to treat post-paralytic facial synkinesis. J Plast Reconstr Aesthet Surg 2013; 66 (8): 1058–63.
19. Dogra V., Rubens D.Dzh. The secrets of ultrasound diagnosis. Moscow: Meditsinskaia Literatura, 2017: p. 10–5. (in Russian).
20. Kapustin S.V., Pimanov S.I., Zherko O.M., Chuvanov A.N. Ultrasound examination in tables and diagrams. Moscow, 2018: p. 89–92. (in Russian).
21. MakNelli Iudzh. Ultrasound studies of the musculoskeletal system: a practical guide. Moscow: VIDAR, 2007; p. 273–92 (in Russian).
22. Bazhenov D.V., Kalinichenko V.M. Anatomy of the head and neck. Introduction to clinical anatomy. Moscow: GEOTAR-Media, 2014. (in Russian).

Авторы

Л.Б. Завалий*1, Г.Р. Рамазанов1, С.С. Петриков1,2, К.Р. Джаграев1, К.И. Чехонацкая1, Ж.Х. Гаджиева1

1 ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского Департамента здравоохранения г. Москвы», Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*l.zav@bk.ru

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Lesya B. Zavaliy*1, Ganipa R. Ramazanov1, Sergey S. Petrikov1,2, Karen R. Dzhagraev1, Karina I. Chekhonatskaya1, Zhamilat H. Gadzhieva1

1 Sklifosovskii Research Institute of Emergency Medical Care, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*l.zav@bk.ru

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