[The use of botulinum toxin type a in the acute phase of facial nerve injury after neurosurgical surgery].

AIM: To evaluate the role of botulinum toxin type A in the acute phase of facial nerve injury after neurosurgical surgery. MATERIALS AND METHODS: The study involved 55 patients with acute facial muscle paresis caused by facial nerve injury during surgery on the posterior cranial fossa and cerebello-pontine angle (CPA). The first group consisted of 35 patients (mean age, 48.14±1.26 years) who were administered botulinum toxin type A (xeomin) at a dose of 2-3 U per point in muscles of the intact side of the face. The control group included 20 patients (mean age, 49.85±1.4 years) who underwent standard rehabilitation treatment of this pathology. The treatment efficacy was evaluated using the House-Brackmann Scale, the Yanagihara facial grading system, the Facial Disability Index (FDI), and the Sunnybrook Facial Grading (SFG) Scale. RESULTS: Before treatment, patients of both groups experienced severe dysfunction according to the House-Brackmann Scale. A month after the botulinium toxin type A therapy had been started, a significant improvement in the group of patients who received botulinum toxin was observed at all scales (p<0.05), whereas improvement in the facial nerve function in the second group was observed only by the 3rd month of rehabilitation treatment (p<0.05). The number of synkineses in the patients who did not receive botulinum toxin was 46% higher than that in the first group (p=0.019) one year after the surgery, and it was higher by 91% after 2 years (p<0.001). CONCLUSIONS: The use of botulinum toxin type A is reasonable in acute facial nerve injury and should be mandatory in combined therapy of these patients.

[The functional asymmetry of the facial neuromotor apparatus in patients with facial nerve neuropathy and its treatment with botulinum toxin type A lantox].

A clinical and electrophysiological (EMG, ENMG, the blink reflex) examination has been carried out in 85 patients with facial nerve lesions of different etiology. A control group included 25 healthy people. Two schemes of botulinum toxin type A (lantox) injections into hyperactive facial muscles have been elaborated. The second examination has been conducted 14 days after injections. The compensatory tug of paretic muscles accompanied by the hypertonic activity of facial muscles of an intact side has been observed in patients with facial nerve neuropathy. The results of the study have been analyzed in 64 patients stratified into two subgroups: 29 patients with prosopoplegia and 35 patients with late complications. After the treatment, the tone of facial muscles has decreased thus promoting the balance between facial muscles on both sides of the face, decrease in facial asymmetry, increase of the functional muscle interaction between both sides, reduction of pathological synkinetic activity. The authors emphasize that the use of botulinum toxin type A both in the early and recovery stages allows to obtain high functional and esthetic results.