Evaluation of rehabilitation potential of patients with facial paralysis by different scales
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https://www.eduzhai.net American Journal of Medicine and Medical Sciences 2021, 11(5): 447-451 DOI: 10.5923/j.ajmms.20211105.18 Assessment of Rehabilitation Potential in Paralysis of the Facial Nerve Using Different Scales Sharafova Inobat Axmedjanovna, Mavlyanova Zilola Farxadovna, Shmyrina Ksenia Vladimirovna Samarkand State Medical Institute, Samarkand, Uzbekistan Abstract Neuropathy of the facial nerve represents about 4% of diseases of the entire peripheral nervous system. Since the main symptom of the disease, regardless of the topography of the affected area, is a lack of movement in the facial muscles of half of the face, the aim of the study was to assess the degree of damage to the facial nerve in patients with idiopathic neuropathy using the House Brackmann scale and the Nottingham system, as well as to conduct a correlation between them on background of rehabilitation measures. Material and research methods. 65 sick children were examined in the acute period of the disease (main group). The control group consisted of 41 children without focal neurological symptoms. During the observation process, all sick children of the main group were divided into 2 subgroups: the 1st subgroup included 39 (60%) children who, in addition to the main treatment, received electrical stimulation on the affected side on the circular muscles of the eyes and mouth during the entire period of hospitalization and were applied kinesiological tapes on the affected side of the face. The second subgroup of comparison included 26 (40%) children who were prescribed standard treatment for neuropathy of the facial nerve. Results and its discussion. In the comparative subgroup, although there was a positive trend, it was significantly lower in comparison with the main subgroup. Along with this, the use of electromyostimulation in combination with standard therapy in the main subgroup made it possible to achieve the most effective results, due to the suspension of demyelination processes and the highest quality regeneration. The same group of patients showed the greatest increase in the amplitude of the M-response after the treatment. Keywords Children, Neuropathy of the facial nerve, Scales, Rehabilitation 1. Introduction According to various sources, neuropathy of the facial nerve represents about 4% of diseases of the entire peripheral nervous system (17-26 cases per 100,000 population), with no gender differences. At the same time, idiopathic neuropathies account for the majority - 75% of patients, of otogenic origin - 15%, other etiologies are noted in 10% of patients. To date, information on the incidence, course and prognosis of facial nerve neuropathy in children, as well as its prevalence, is very scarce [3,5]. The main symptom of the disease, regardless of the topography of the affected area and the etiological factor, is a lack of movement in the facial muscles of half of the face (prosoparesis, prosoplegia). Objectively: the face is asymmetric, the palpebral fissure is wider and the skin folds are smoothed on the affected side, the angle of the mouth is lowered, lagophthalmos is observed, Bell's symptom, superciliary and corneal reflexes are reduced. It is the severity of prosoparesis and its dynamics that are the most objective criteria for the effectiveness of rehabilitation measures. Received: May 6, 2021; Accepted: May 25, 2021; Published: May 31, 2021 Published online at https://www.eduzhai.net The aim of the study was to assess the degree of damage to the facial nerve using several scales and to correlate them in sick children with idiopathic neuropathy of the facial nerve during rehabilitation. 2. Materials and Research Methods Research and clinical observations were carried out in 65 sick children in the acute period of the disease (main group). 41 children entered the control group. In the main group: boys - 23 (35.4%), girls - 42 (64.6%). The age of the surveyed ranged from 5 to 15 years (mean age 11.7 ± 4.3 years). Children in both observation groups were comparable in age and sex. In the history of the control group, no signs of focal neurological symptoms were observed in children. When examining the main group, the degree of paresis, the presence of synkinesis, dysgeusia, impaired sensitivity, hearing, and the state of secretion of the lacrimal glands were noted. The severity of the lesion was assessed according to the following scales: the 6-point House Brackmann scale and the Nottingham system for assessing the symmetry of facial movement [2,3]. The children and their parents volunteered their consent to conduct the study. 448 Sharafova Inobat Axmedjanovna et al.: Assessment of Rehabilitation Potential in Paralysis of the Facial Nerve Using Different Scales 3. Results and Discussion Table 1. The severity of prosoparesis according to the House - Brackmann scale Power one 2 3 four five 6 Function Norm Mild dysfunction Moderate dysfunction Moderate dysfunction Heavy disfu n Ktsia Total paralysis Description Normal function of all branches A. slight weakness, revealed by a detailed examination, minor synkinesis may be noted. B. at rest, symmetrical face, usual expression. B. Movement: 1) in the forehead: slight moderate movements; 2) in the area of the eye: it closes completely with effort; 3) in the area of the mouth: slight asymmetry. A. obvious, but not disfiguring asymmetry. The unexpressed synkinesis is revealed. B. Movement: 1) in the forehead: slight moderate movements; 2) in the area of the eye: it closes completely with effort; 3) in the area of the mouth: slight weakness with maximum effort. A. Obvious weakness and / or disfiguring asymmetry. B. Movement: 1) in the forehead area: absent. 2) in the eye area: incompletely closed; 3) in the area of the mouth: asymmetry at maximum effort. A. Barely noticeable movements of the facial muscles. B. Asim m etrichnoe face alone. B. Movement: 1) in the forehead area: absent. 2) in the eye area: incompletely closed; No movement examination, the results of electromyography (amplitude of the M-response, the speed of the motor impulse), and neurosonography. Evaluation of the effectiveness of rehabilitation measures was carried out on the basis of the data obtained according to the House-Braakman scales (Table 1) and the Nottingham system for assessing the symmetry of facial movements on the 1st and 15th days after hospitalization and treatment. The severity of facial nerve dysfunction in both subgroups was determined using two scales, which are described below. Further, a correlation is made of the diagnostic significance of one or another scale to identify the rehabilitation potential of patients. The second scale used to diagnose the degree of prosoparesis is the Nottingham system, which consists of three parts. The first part provides an objective measurement of facial movements, while the second and third parts provide a record of the presence or absence of secondary defects. In the first part, the subject with a fixed face fixes his gaze directly at eye level in front of him. An imaginary perpendicular line passes through the subject's face. The point at which this line crosses the upper limit is denoted as supraorbital eyebrow point (supraorbitalis - SO) and the point at which it intersects the the infraorbital region designated as infraorbital point (infraorbitalis - I D). Also marked are the points of the lateral cantus (LC) and the angle of the mouth (mouse - M). Distances SO-I O and LC-M on both sides are measured at rest and with maximum eyebrow lift, eyes tightly closed and smiling (Fig. 1). Clinical symptoms determine the diagnosis and prognosis of the restoration of the function of facial muscles in patients with neuropathy of the facial nerve. During the observation process, all sick children of the main group were divided into 2 subgroups: the 1st subgroup included 39 (60%) children who, in addition to the main treatment, received electrical stimulation on the affected side on the circular muscles of the eyes and mouth during the entire period of hospitalization and were applied kinesiological tapes on the affected side of the face. In addition, the 2nd comparison subgroup included 26 (40%) children who were prescribed standard treatment for neuropathy of the facial nerve. In this study, patients with neuropathy of the facial nerve that developed as a result of neoplasms, trauma, metastatic and leukemic infiltration were excluded. The effectiveness of therapy was assessed according to the data of a clinical and neurological Figure 1. Parameters and measurement points of facial symmetry according to the Nottingham system Informal experiments have shown that it is easier to measure first the state of motion and then the resting position. The distance difference between movement and resting distance is recorded. Calculate the sum of distances for each American Journal of Medicine and Medical Sciences 2021, 11(5): 447-451 449 side, and calculates a difference lesser amount in relation to the greater percentage (Table facial 2). Table 2. The first part of the Nottingham system Signs: Raising an eyebrow: Tightly closed eyes: Smile: (X Y) × (100 ÷ 1) =% On right ∆ SO to I О ∆ SO to I О ∆ LC to M Sum = X: Left ∆ SO to I О ∆ SO to I О ∆ LC to M Sum = Y: In the second part, the doctor records the presence (P = Present) or absence (A = Absent) of any of the secondary complications: hemifacial spasm, contracture or synkinesis (Figure 2). In the third part, the presence (Y) or absence (N) of lacrimation during eating, the presence of dry eyes or dysgeusia is determined by the results of the questionnaire and is filled in by the subjects (Figure 3). The second and third parts do not lend themselves to comparative statistical analysis with other systems. Figure 2. The second part of the Nottingham system Figure 3. The third part of the Nottingham system 450 Sharafova Inobat Axmedjanovna et al.: Assessment of Rehabilitation Potential in Paralysis of the Facial Nerve Using Different Scales The final score is expressed in the table and a correlation is made between the House-Braakman and Nottingham systems for a better understanding of the latter (table 3). Table 3. Correlation between the Haus-Braackman scale and the Nottingham system for assessing facial symmetry Value Normal function of all branches of the facial nerve Mild dysfunction Moderate dysfunction Moderate dysfunction Severe dysfunction Total paralysis Scale House-Braakmana 0 I II III IV V Nottingham system 100% 76% to 99% 51% to 75% 26% to 50% 1% to 25% 0% Prior to treatment severity prosoparesis on scales House-Braakmana and Nottingham system distributed as follows in the main group (p uc unok 4). As can be seen from the diagram, severe facial nerve dysfunction observed but Referring 9 children (23%) at the beginning of hospitalization and after treatment the number decreased to 5 (12%); moderate dysfunction - in 25 (64%) before and after treatment, this figure dropped to 15 (38%); moderate degree of facial nerve dysfunction at the beginning of treatment - in 5 (12%) patients and after treatment in the main group, this figure changed to 10 (25%); patients with easily th dysfunction her facial nerve in the main group absent before the treatment and their number increased after treatment and 9 (23%), which can be reliably considered a positive result of treatment. 25 15 9 10 9 5 5 0 SEVERE DYSFUNCTION 9 5 MODERATE DYSFUNCTION MODERATE DYSFUNCTION MILD DYSFUNCTION 0 9 25 15 5 10 before treatment after treatment2 Figure 4. Dynamics of the severity of the lesion in patients of the main group 12 10 10 9 5 4 2 SEVERE DYSFUNCTION 10 MODERATE DYSFUNCTION MODERATE DYSFUNCTION 12 4 0 MILD DYSFUNCTION 0 до лечения после лечения Figure 5. Dynamics of the severity of the lesion in patients of the comparison group American Journal of Medicine and Medical Sciences 2021, 11(5): 447-451 451 In the study group each patient was assigned a complex of rehabilitation measures, including rate kineziologiche with FIR applications, electromyostimulation th amperage of 20-40 mA for 15-20 minutes on the circular muscles of the mouth and eyes, massage cheek muscles, drug therapy. At the same time, the degree of paresis was assessed using the House-Braakman scales and the Nottingham system of facial symmetry for greater reliability of the degree of paresis. After the treatment, a control electroneuromyography was carried out, which showed a positive dynamics during impulse conduction and an acceleration of the M-response in the main first subgroup. In the comparative second subgroup, after the standard treatment without the use of new technologies in the treatment, control electroneuromyography was also carried out, in which no changes were found in comparison with the previous study. The patients were under observation and treated for 15 days. When analyzing the results of the study, it was revealed that all patients had a clinical effect of varying severity (Figure 5). Prior to treatment the severity of prosoparesis on scales House-Braakmana and Nottingham systems in the comparison group were distributed as follows: severe dysfunction of the facial nerve was observed in 10 children (38.5%) at the beginning of hospitalization and after treatment the amount was reduced to 9 people (34.6%); mid-weight dysfunction - y 12 (46.1%) before and after treatment, this figure dropped to 10 (38,5%); moderate degree of facial nerve dysfunction at the beginning of treatment - in 4 (15.4%) patients and after treatment this figure changed to 5 (19.2%); patients with mild facial nerve dysfunction absent before the treatment and their number increased after treatment to 2 (7.7%) (p uc unok 5). From the above it can be concluded that in the comparative under the group, though there is a positive naya dynamics, but it was significantly lower than in the main under the group. These data confirm the need to start treatment at the earliest possible date when there are no demyelination phenomena. Our research has shown that the use of electromyostimulation in combination with standard therapy in the main under the group allowed to achieve the most effective results, due to the suspension of the process of demyelination and most qualitative recovery. In the same group of patients, according to our data, the greatest increase in the amplitude of the M-response was observed after the treatment (by 12%) [1,2]. No side effects were observed during therapy. From the above, we can conclude that patients with neuropathy of the facial nerve are recommended to conduct electroneuromyographic testing of the affected peripheral muscles in order to correct the treatment; for forecasting and regulating course of the disease it is recommended to perform clinical and neurological examination, not only on the standard scale Hausa-Braakmana, but in Nottingham evaluation system of symmetrical faces, that gives more and the second chance to children with neuropathy facial nerve choose the right rehabilitation therapy to prevent muscle contracture the affected side or the formation of lighter forms. REFERENCES  Baratova S.S., Mavlyanova Z.F., Sharafova I.A. - 2016. -- S. 190-191.  M.T. Nasretdinova, G.E. Karabaev, I.A. Sharafova. (2020). Application of diagnostic techniques in patients with dizziness. CENTRAL ASIAN JOURNAL OF MEDICAL AND NATURAL SCIENCES, 1 (1), 29-33.  Neuropathy of the facial nerve // Private neurology: textbook. n special / ed. M.M. The same. Moscow: Medical Information Agency, 2009. P. 110-114. [Nevropatija licevogo nerva // Chastnaja nevrologija: ucheb. posobie / pod red. MM. Odinaka. M.: Medicinskoe informacionnoe agentstvo, 2009. S. 110-114 (in Russian)].  Petrukhin A.S. Pediatric neurology // T. - 2012.-- T. 2. - S. 28-34.  Petrukhin A.S. Pediatric neurology. 2 volume. - 2012.  Sharafova I.A., Kim O.A.Changes in heart rate indices in adolescent athletes engaged in taekwondo in the city of Samarkand // Materials of the XXIII Congress of the Physiological Society named after V.I. IP Pavlova with international participation. - 2017.-- S. 2108-2109.  Sharafova I.A., Kim O.A.A comprehensive approach to the treatment and rehabilitation of patients with neuropathy of the facial nerve // Youth and medical science in the XXI century. - 2019. -- S. 210-210.  Sharafova I. A., Mavlyanova Z. F., Baratova S. S. THERAPEUTIC GYMNASTICS AS AN IMPORTANT PART OF REHABILITATION IN FACIAL NERVE NEUROPATHY // Achievements of Science and Education. 2019. - No. 12 (53).  Sharafova IA Neuroimaging as a modern method for the diagnosis and prognosis of rehabilitation with the defeat of the facial nerve in children // Ukraї on. Health of the nation. 2020. - T. 2. - No. 3.  Sharafova IA et al. Kinesiotaping: New Look at the Rehabilitation of Facial Nerve Neuropathy in Children // Annals of the Romanian Society for Cell Biology. - 2021. With. 4763-4768. Copyright © 2021 The Author(s). Published by Scientific & Academic Publishing This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/
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