Orlova O R, Akulov M A, Usachev D Iu, Taniashin S V, Zakharov V O, Saksonova E V, Mingazova L R, Surovykh S V
GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.I. Sechenova" Minzdrava Rossii, Moskva; Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva.
FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva.
Zh Vopr Neirokhir Im N N Burdenko. 2014;78(6):50-54. doi: 10.17116/neiro201478650-54.
To evaluate the role of botulinum toxin type A in the acute phase of facial nerve injury after neurosurgical surgery.
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.
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).
The use of botulinum toxin type A is reasonable in acute facial nerve injury and should be mandatory in combined therapy of these patients.
评估A型肉毒毒素在神经外科手术后面神经损伤急性期的作用。
本研究纳入了55例因后颅窝和桥小脑角（CPA）手术导致面神经损伤而出现急性面部肌肉麻痹的患者。第一组由35例患者组成（平均年龄48.14±1.26岁），在患侧面部肌肉每点注射2 - 3单位的A型肉毒毒素（Xeomin）。对照组包括20例患者（平均年龄49.85±1.4岁），接受该病症的标准康复治疗。使用House - Brackmann量表、柳原面部分级系统、面部残疾指数（FDI）和桑尼布鲁克面部分级（SFG）量表评估治疗效果。
治疗前，两组患者根据House - Brackmann量表均存在严重功能障碍。在开始A型肉毒毒素治疗一个月后，接受肉毒毒素治疗的患者组在所有量表上均有显著改善（p<0.05），而第二组面神经功能仅在康复治疗第3个月时才出现改善（p<0.05）。术后一年，未接受肉毒毒素治疗的患者联动症数量比第一组高46%（p = 0.019），术后两年则高91%（p<0.001）。
在急性面神经损伤中使用A型肉毒毒素是合理的，并且在这些患者的联合治疗中应强制使用。
