PECULIARITIES OF TREATMENT OF A PATIENT WITH FACIAL NURSES AFTER SURVIVAL (CLINICAL CASE)
About the author:
Melnik V. L., Shevchenko V. K., Kostirenko O. P., Shevchenko E. V., Melnik I. V.
Type of article:
Facial nerve paresis occurs (according to Mishchenko TS, Podkortitova VS, Smirnova VA) in 40% of all cases of mononeuropathies and neuralgia. The etiology of lesions of the VII pair of cranial nerves is different, for the most part, it is hypothermia and injury. The disease is characteristic of all age categories and is most common in young productive age, leading to long-term temporary disability. Only 65% of patients have recovery and significant improvement, as complications in every 4-5 patients develop mimic muscle contraction and social maladaptation due to iatrogeny. The disease is more common in women. A patient with this pathology needs to undergo individual specific outpatient or inpatient treatment. In 18-22% of cases, the clinical results of the treatment do not satisfy patients due to residual effects that need to be eliminated during the rehabilitation period. In complex treatment apply manual therapy, physiotherapy and more. Reflexology as a method of rehabilitation is also used in this category of patients. Therefore, complex therapy of residual phenomena in paresis of the facial nerve after a stroke is carried out in specialized recovery centers in combination with the use of elements of acupuncture and lithotherapy. The clinical case. At the Department of Postgraduate Education of Dentists at the Ukrainian Medical Dental Academy patient V., 49 years old, complained of a violation of the sensitivity of the skin of the right half of the face, neck, severe pain in the right ear, hyposthesia on the right. From the anamnesis it is known that after a patient suffering from hemorrhagic stroke with neuropathy of the facial nerve of the right half of the face two years ago, she underwent inpatient treatment at the neurology department of the Poltava Regional Clinical Hospital. M.V. Sklyfosovsky according to the current protocols of the Ministry of Health of Ukraine with little relief health condition. In addition, the patient underwent a course (30 days) of acupuncture, but the expected results were not achieved. When carrying out functional tests in the patient, we discovered residual phenomena in the form of asymmetry of the face with a smile, puffiness of the cheeks, blinking of the eyes. According to the scale, the visual-analogue level of pain intensity was 7-8 points, which corresponds to severe pain.Based on previous positive experience in the treatment of patients with neuropathies of the facial nerve without somatic complications, we proposed to this patient an algorithm of treatment that included the combined use of exclusively elements of lithotherapy and reflexology. Object and methods. To assess the intensity of pain for this patient, we used a visual-analog scale, according to which 0-2 points – no pain; 3-4 – mild pain; 5-6 – moderate pain; 7-8 – severe pain; 9-10 is a very severe pain. In order to evaluate the effectiveness of the patient’s treatment for facial nerve neuropathy using lithotherapy and acupuncture in comparison with the previous traditional treatment, the techniques of semiprecious stone carnelian were applied, taking into account the positive results due to the combination with the techniques of acupuncture. Here is a treatment algorithm: 1. Apply to the skin of the right half of the face pre-heated to a temperature of 60 degrees Celsius stone cornelian with an exposure of two to three minutes (30 sessions). 2. According to the methods of the Beijing School of Acupuncture in the areas of the face and the palm surfaces with the use of silver needles with a length of 3-5 cm, needle buttons, mini-needles. Results of the studies and their discussion. In the patient after 30 complex medical procedures the sensations of pain on the side of the lesion disappeared according to the scale visually-analogue level of pain intensity was 1-2 points (no pain). Restored to normal facial muscle function, symmetry with a smile, cheek swelling, blinking of the eyes. Due to the application of this treatment algorithm, the patient received remission within 1 year with the return of the natural configuration of the face. A comprehensive approach when using the proposed algorithm for the treatment of a patient with neuropathy of the facial nerve after a stroke is effective enough to eliminate asymmetry of the face, restore muscle tone, helps to reduce the time of rehabilitation period compared with drug treatment. Conclusions. Complex treatment with the elements of lithotherapy (cardiac therapy) and acupuncture (Beijing school methods) had a high efficiency. On the side of the lesion the function of facial muscles of the face is restored to normal, the natural symmetry of a smile, the puffiness of the cheeks, the blinking of the eyes, the feeling of pain on the side of the lesion are gone. Steady remission of the disease was achieved in the patient at the observation of 12 months. As a result of our positive result in the treatment of neuropathy of the facial nerve against the background of a stroke, the patient’s incapacity for work decreased (1.5-2 times), and her social adaptability was restored.С
facial nerve paresis, cardiac therapy, acupuncture.
- Sokolova LI, Myalovitska ОА, Illyash ТІ. Nevrologiya z neyrostomatologу. К.: Meditsina; 2018. 128 s. [in Ukrainian].
- Mіschenko TS, Pidkoritova VS. Suchasna diagnostika i likuvannya u nevrologiyi ta psihiatriyi. K.: TOV „Doktor-MedIa”; 2008. 624 s. [in Ukrainian].
- Burchiel KJ. A new classification for facial pain. Neurosurgery. 2003;53(5):1164-7.
- William H, Slattery, Babak Azizzadeb. The Facial Nerve. 1st. New York: Thieme; 2014. 236 р.
- Paul W Brazis, Joseph C. Masdeu. Localization in Clinical Neurology. 6th. Philadelphia: Lippincott Williams & Wilkins; 2011. 668 р.
- Zhao J. Acupuncture treatment of facial paralysis caused by craniocerebral trauma in 50 cases. J. Tradit. Chin. Med. 2003;23(1):47-8.
- Lyapko NG. Applikatoryi Lyapko: metodicheskie rekomendatsii. Donetsk: Agentsiya «A»; 2006. 48 s. [in Russiаn].
- Gaponyuk PYa. Rukovodstvo po akupunkturnoy terapii. M.: FIRN M; 1999. 276 s. [in Russiаn].
- Gonikman EI. Chelovek i kristall – grani edinstva. M.: Veligor; 2013. 220 s. [in Russiаn].
- Dzhasper Stoun. Vsyo o dragotsennyih kamnyah. SPb.: OOO «SZKEO»; 2008. 176 s. [in Russiаn].
- Shtefan LV. Lektsii po mineralogii. Minsk: BGU; 2008. 151 s. [in Russiаn].
- Sposobi likuvannya mineralami [Internet]. Dostupno: http://www.1000listnik.ru/metall/547-zabolevaniya-i-lechebnye-kamni.html, http:// horoscopes.rambler.ru/mineral.htmlid=51309 [in Ukrainian].
- Ginger M, Shtrebel R, Kligel Е, Vays Н, Dombrovski U. Massazh dragotsennyimi kamnyami. SPb.: DILYa; 2010. 160 s. [in Russiаn].
- Borisova EG, Nikitenko VV. Algeologiya v stomatologii. Sankt-Peterburg: Spets Lit; 2017. 101 s. [in Russiаn].
- Melnik VL, Shevchenko VK, Shevchenko EV, Melnik IV. Zastosuvannya elementiv litoterapiyi v kompleksnomu likuvanni patsientiv z nevropatiyami litsevogo nerva. Ukrayinskiy stomatologichniy almanah. 2016;1(1):57-61. [in Ukrainian].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 372-375 pages, index UDK 616.831-005.1:616.833 – 002