The way to restore the function of facial muscles

 

(57) Abstract:

The invention relates to medicine, and neurology. Carry out the administration of drugs in acupuncture points affected neuromuscular structures of the face. Medicines are chosen depending on the state of the neuromuscular structures. Followed by stimulation precicesly facial muscles with reduced anxiety. The method provides the most complete recovery of muscle function.

The invention relates to medicine, namely physiotherapy, rehabilitation, neurosurgery, neuropathology and can be used for restorative treatment of children and adults with paralysis and paresis of the facial muscles due to lesions of the facial nerve trauma, vascular, inflammatory, toxic and other Genesis, after neurosurgical interventions, in particular tumors of the cerebellopontine angle brain.

Known way to restore the function of facial muscles by electromyostimulation after relaxation parenterally or orally administered sodium oxybutyrate prevention of contractures and pathological Cincinnati facial muscles (A. C. USSR N 73. the. sodium oxybutyrate reduces the excitability of all muscle groups, regardless of the source of their level of excitability, while contracture caused by the perversion of excitability of neighboring muscle groups: an increase in one group and decrease in the other. In addition, the effect of subsequent electromyostimulation, is negligible due to the braking action of sodium oxybutyrate on the nervous and muscular system.

A prototype of the proposed method is a way to restore the function of facial muscles by electromyostimulation sinusoidal modulated current (SMC) 2 type of work (pp), post-relaxation compress of sodium oxybutyrate, lidocaine and Dimexidum on the affected half of the face (Ovcharenko A. A. , Peleg L. E. et al. The use of electrical stimulation in rehabilitation of patients with musculoskeletal cerebral defect. Met. rivers.- Kiev, 1986.-S. 10).

The disadvantage of this method is not sufficiently complete rehabilitation paretic facial muscles, because the method does not allow:

- differentially modify perverted anxiety paretic facial muscles, namely to reduce excitability in muscle group with local Hyper - mainly buccal mouse is shown, as in the known method lidocaine and sodium oxybutyrate reduce anxiety all paretic facial muscles, regardless of the source of their level of excitability;

- carry out a full electrical gymnastics paretic facial muscles with the source of reduced excitability, which after relaxation is reduced even more, in particular functionally the most important facial muscles: circular muscles of the eye and the circular muscles of the mouth;

- optimally to prevent progression of the contraction of facial muscles and increase "local hypertonus" in the muscles from the source increased excitability, which increases further due to their stimulation of SMC 2 pp (send-off) with the greatest effect in a known way.

The invention is directed to a method of recovery of function of the facial muscles, providing the most complete restore functional ability of the paretic facial muscles with lesions of the facial nerve.

The method consists in carrying out medical relaxation affected by blockade of the neuromuscular structures of the face with increased excitability of local anesthetic injected at acupuncture points (THAT) person in the projection ETA with reduced excitability of the introduction of ATP in THE face in the projection of these structures and subsequent stimulation 15-20 min CMT 4 pp (intermittent frequency) paretic facial muscles only with reduced anxiety.

The proposed method differs from the prototype in that is injected into THE area affected neuromuscular structures of the face of increased excitability of the local anesthetic, and with reduced anxiety - ATP, and then stimulate the ITC 4 pp paretic facial muscles only with reduced anxiety.

The method is as follows: first by the electric diagnostics variable and/or constant CMT (I-II mode) 2 pp frequency of 10-50 Hz depth of modulation of 100% at a ratio of current and pause 2:3 and identify the initial level of excitability of the affected neuromuscular structures of the face, comparing the performance of excitability of the forehead, cheek, orbital, mouth, chin muscles and branches of the facial nerve, Innervate. Take into account clinical data: the presence of pathological Cincinnati and myofascially, indicating contraction of facial muscles.

Treatments begin on the day after the electric diagnostics. Patient is placed high on the couch in a comfortable position on his back with freely elongated limbs and turned to the medical staff of the affected half of the face. 1-3 THE area affected neuromuscular structures of the face with increased excitability, i.e. finding the spas anesthetic). Use THE following: di-Tsang, si-Bai Ju-Liao, Xia, Quan, Quan-Liao, er-men and-Feng, Tian-Rong, ting Gong, ting-Hui. This blockage allows you to achieve rapid reduction of excitability of the neuromuscular structures, in particular the buccal branches of the facial nerve innervated her cheek muscles most affected "Hyper local". The number of injections per procedure depends on the severity of the signs of contracture.

Then 1-2 THE area affected neuromuscular structures of the face of reduced excitability enter 0.2-0.5 ml of ATP to stimulate their excitability and contractility, as well as compensation of the energy consumption in the subsequent stimulation. Use THE following: Quan Zhu, Yu-Yao si-Ju-kun, Tun-Tzu-Liao, Cheng-Chi, tai-Yang, Qing-min, Ren-Zhong, Duy-Duan, Ian-Jiang, da-in.

Conducted medical training allows to normalize perverted tonic relationship paretic facial muscles and to complete the electrical stimulation is functionally the most important muscles: circular muscles of the eye, ensuring protects the eyeball from harmful environmental factors (wind, dust, cold, solar radiation and others) especially in cases of dryness with the defeat after the current function.

After 15-20 min conducting electrical stimulation of the affected neuromuscular structures of the face of reduced excitability. The circular muscles of the eyes and mouth to stimulate 1-3 each field, overlaying the 2-pole electrode horizontally in the upper and lower part muscles and vertically in the outer part. Stimulate variables CMT (1 mode) 4 pp stimulating frequency 80 Hz depth modulations 75% when the ratio of current and pause 2:3. Such current has a gentle stimulating effect in comparison with conventional stimulation of the neuromuscular system CMT 2 pp, and also provides improved muscle trophism. The current amplitude is chosen by the easy stress-stimulated muscle and/or sensations of vibration under the electrode. There should be no voltage neighboring muscles, located in the local Hyper". Children each field stimulated for 30 sec - 1 min in adults - 2 minutes treatment is 5-10 procedures performed daily or every other day. THE change in each procedure, the same THAT can be used with interval of 3 days.

The method developed in the Polenov research neurosurgical Institute them. Professor A. L. Polenov and passed clinical trials in the treatment of 10 patients with paralysis and paresis of the facial muscles due to lesions of the facial nerve travmaticheskih received useful or almost complete restoration of function of the facial muscles without signs of contracture or with minimal signs in such cases, the late start of treatment.

Here is an example extract from the history.

Patient K. , 19 years old, was admitted with a diagnosis of damage to the facial nerve due to injury with a knife right parotid region from 19.02.94. Received electromyostimulation according to the standard technique. Upon examination revealed signs of contracture paretic facial muscles as facciolati cheek muscles and panoramaweg pathological Cincinnati. Active contraction of the circular muscles of the eye no more than 1 point, when you try to close my eyes remained open eye slit of 5 mm, the reduction in the circular muscle of the mouth were absent (0 points), when you try to close the lips of the corner of his mouth pulled upwards and outwards. When you re-inspection of the marked increase in myofascially to coarse spontaneous contractions of a group of buccal muscles 19-20 1 min, expressed pathological Cincinnati. The interference electromigrate showed a constant pathological activity in the rest of the zygomatic muscles, increasing when trying to close his eyes and close his lips, which confirmed the pronounced contraction of facial muscles. The electric diagnostics showed increased excitability cheek muscles and decreased excitability of the circular muscles of the eyes and mouth.

According to the proposed method course started by lichenometry introduced a 2% solution of lidocaine. With 3 days on the background of distinct reduction myofascially performed procedures in full. For medical blockade used the following combinations: di-Tsang, Chuan-Liao and tin-Gong; si-Bai-Feng, Tian-Rong; Ju-Liao and Xia-Guan; er-men and Chuan-Liao; ting-Hui and di-Tsang; si-Bai ting Gong. Then one of THE persons in the projection of the neuromuscular structures with reduced excitability were injected with 0.2-0.5 ml of ATP. Alternated THE projection of the circular muscles of the eye: tai-Yang, Quan Zhu, Yu-Yao, s-EIC-kun, Cheng-qi and THE projection of the circular muscle of the mouth: Ren-gion, Ian-Jiang, Duy-Duan, Hae-Liao. After 15-20 min was performed electrical stimulation of the circular muscles of the eye 2 field applying electrode horizontally in the upper part of the muscle and vertically in the outer and circular muscle of the mouth in 1 field applying electrode horizontally in the lower part of the muscle. Other fields are not stimulated, because when the irritation has occurred, the voltage of the adjacent cheek muscles. Used AC CMT (I mode) 4 pp with stimulating frequency 80 Hz depth modulations 75% when the ratio of current and pause 2:3.

After a course of treatment consisting of 10 daily procedures, disappeared rough cheek muscles twitching and myofascially, increased the power of the circular muscles of the eye to 2-3 points, eye shehaby without concomitant earlier this movement of the lead angle of the mouth. Control electromyography 18.10.95 showed the disappearance of pathological spontaneous activity in the zygomatic muscle and a significant reduction of Cincinnati.

Thus, in a patient with dysfunction of the facial muscles due to traumatic lesion of the right facial nerve complicated by contracture of the facial muscles, which worsened after a course of traditional electrical stimulation in the treatment process according to the proposed method marked a clear positive trend in the reduction of signs of contacturi and recovery of active contractions useful extent functionally the most important facial muscles, protecting the eyeball, the act of eating and speech.

Using the proposed method allows to fully restore the function of the paretic facial muscles due to:

- normalization perverted excitability paretic facial muscles by relaxation of local anesthetic neuromuscular structures only with increased excitability and stimulation (pharmacological and electrical) of the neuromuscular structures only with reduced excitability;

- full electric gymnastics paretic facial muscles with the outcome of the person placed on the projection of all paretic muscles, as well as additional drug stimulation of contractility and excitability of these muscles with ATP;

optimal prevention of the progression of the contraction of facial muscles by eliminating the stimulation of muscles from the source increased excitability and conduction electromyostimulation neighboring muscles with reduced excitability in a sparing mode CMT 4 pp, which significantly reduces the irradiation of irritation to surrounding structures.

In addition, the introduction of drugs in THE high biological activity, helps to optimize the efficiency of the used therapeutic manipulation.

The way to restore the function of facial muscles by electrical stimulation with sinusoidal modulated currents conducted after drug exposure, characterized in that the acupuncture points affected neuromuscular structures of the face of increased excitability of the injected local anesthetic, and with reduced anxiety - ATP, and then stimulate parethesia facial muscles with reduced excitability of the sinusoidal modulated current 4 kind of work.

 

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