Kills the nasal bladder brain cells

The face on the left was numb after the blow. Contusion of the trigeminal nerve after a blow. Facial nerve injury

All people, regardless of age, are exposed to bruises on their faces. A relatively simple injury can hide serious damage to the deep layers of facial tissues and bones of the facial skeleton, which can lead to complications.

Proper first aid, timely access to doctors, and appropriate treatment tactics help avoid complications and aesthetic discomfort.

Bruise - closed damage to tissue structures: subcutaneous fat, blood vessels and muscles without violating the integrity of the skin. In this case, a complex occurs on pathological changes in the affected area. Local changes are characterized by sprains and ruptures of soft tissues, vascular injuries, effusions of blood and lymph, necrosis and disintegration of cell elements.

With bruises on the face, bleeding is characteristic, which has two mechanisms of development:

  • the formation of a cavity in the space that fills it with blood;
  • Soak tissues with blood without forming a cavity (intake).

This creates a hematoma (bruise) - a limited collection of blood that is often accompanied by post-traumatic edema. Depending on the traumatic pathogen, the intensity of the injury and the location of the lesion, the hematoma can be localized superficially and deeply.

Superficial bleeding affects only the subcutaneous fat, and deep hematomas are typically found in the thickness of the muscles or under the periosteum of the facial skeleton.

Causes and Symptoms of Bruising

The main causes of bruises on the face are: falling from a height, being hit by a hard object, squeezing the face towel in a traffic accident or natural disaster.

The first sign of an injured face is pain. This is a signal that nerve fibers are damaged or irritated. The intensity of the pain depends on the severity of the injury and the location of the affected area.

The longest lasting pain occurs when the nerve trunks of the face are damaged. In this case, the injured person has pain with a sharp, burning and shooting character. It intensifies with every movement of the facial muscles.

After exposure to a traumatic agent, the skin acquires a bright red hue. The blood that gets into the space shines through the skin. Gradually, its concentration increases, and the affected area changes its hue to blue - purple.

Gradually, the breakdown of hemoglobin in the hematoma begins. After 3-4 days, a product from the breakdown of blood cells hemosiderin is formed in it, which causes a green color, and after 5-6 days, hematoidin, which glows yellow.

This alternative change in the color of the hematoma is popularly known as a "blooming bruise". Without complications, the hematoma disappears on April 14-16. Day completely.

Reasons for immediate medical treatment include clear fluid from the ear, cyanosis (blue discoloration) of the eye area, seizures, loss of consciousness, nausea, and vomiting. These are signs of a severe traumatic brain injury that requires detailed examination of the body and certain treatment tactics.

Classification of soft tissue injuries

In traumatology, bruises are classified according to their severity. This will allow you to determine treatment tactics and assess the possible risk of complications.

Bruises are characterized by minor damage to the subcutaneous fat. They are not a cause for concern, do not require a referral to a specialist, and resolve themselves within 5 days. Mild pain and blue discoloration of the damaged area are possible.

Severe damage to the subcutaneous fat. Bruises are accompanied by bruises, swelling, and severe pain. In this case, complex treatment with pharmacological preparations is required.

A severe bruise that affects the muscles and periosteum is often associated with a violation of the integrity of the skin. The risk of bacterial infection is high. In these cases, a visit to a traumatologist is mandatory.

It is classified as extremely difficult. In this case, the functionality of the facial skeleton is impaired and the risk of complications from the brain is high. The condition of an injured person requires emergency medical care.

First aid

It is interesting that everyone has heard of the impact of cold on the injury spots. However, since not everyone knows how cold works, this important point is often ignored when providing first aid for bruises.

Under the influence of cold, blood vessels constrict. This significantly stops the bleeding into the space and determines the severity of the hematoma.

Cold suppresses the release of inflammatory mediators, reduces the sensitivity of the injured area, which affects the intensity of pain.

Use for cryotherapy:

  • ice cubes;
  • cryopackages from the pharmacy;
  • a towel dipped in cold water;
  • cold items from the refrigerator.

On average, the duration of a single exposure to cold in the injured area is 15 to 20 minutes. In the case of severe bruises with persistent pain, the process is repeated every 2 hours.

In this case, you need to rely on subjective sensations and monitor the condition of the skin. It should be numb and red. Lightening of the injured area and adjacent tissues indicates a violation of the local blood circulation due to a prolonged state of vasoconstriction.

Cold treatment is contraindicated for pathological circulatory disorders and diabetes mellitus. Ice and cold objects are only applied to the face through the cloth. Direct contact can cause skin cell frostbite and the appearance of a pigmented area after necrosis.

For abrasions and wounds with bruises, the edges of the damaged area are treated with antiseptics:

  • bright green;
  • hydrogen peroxide;
  • furacilin;
  • 0.01% potassium permanganate solution.

Heat and massage should not be applied to the injured area for the first 48 hours. For cupping severe pain, take oral analgesics: Ketanov, Nurofen, Ibuprofen.

Treatment complex

External medication, light massage, and heat therapy are used to treat bruises. During this time, the use of alcohol, which dilates the blood vessels, and blood-thinning drugs are excluded.

Medication

In pharmacies you can buy medicines in the form of an ointment, cream or gel with cooling, resorbing, regenerating and analgesic properties. Therefore, it is not difficult to cure a bruise and get rid of a hematoma on the face quickly. In this overview we have selected the most effective drugs.

Coolant

Medicines in this group contain menthol, essential oils, analgesics and other active ingredients. The drugs eliminate pain, reduce blood flow to the injury site, and prevent bruising.

Preparations:

It is advisable to use medicines within 48 hours of the injury.

Absorbent and pain relievers

The active ingredients of these drugs prevent thrombus formation, improve tissue trophism, help eliminate edema and resorption of hematoma. In addition, drugs relieve anesthesia, relieve itching, disinfect the affected surface and have anti-inflammatory effects.

Preparations:

  • heparin (heparin ointment, Lioton, Flenox, Hepavenol plus, Dolobe, Panthevenol);
  • badyaga (Badyaga forte, Doctor, Express Bruise);
  • troxerutin (Venolan, Troxegel, Troxevasin, Febaton, Indovazin);
  • Sinyakov-OFF;
  • Savior;
  • Traumeel S.

Before using the drug, you need to read the instructions. Some of them have specific contraindications.

The preparations are applied to cleansed skin in a thin layer with massage movements. The number of repetitions depends on the activity of the drug. So please follow the instructions.

Gel formulations have several advantages over ointments. There is no oily sheen on the face after application, and clothes and bed linen are relatively little soiled. The active ingredients of these drugs are dissolved on a water basis and therefore penetrate the skin faster.

It is advisable to use ointments for very dry skin and scabs on the wound surface. In these cases, the oily base softens the outer layers of the skin and allows the active ingredients to reach the exposure site.

Folk remedies used at home

Many plants and common foods in the daily diet contain ingredients that can heal bruises on the face quickly. This treatment is harmless to the body and is suitable for grade 1 and 2 bruises.

For treatment, components are used that have anti-inflammatory, anticoagulant and anti-inflammatory properties. Folk remedies improve tissue trophism, promote the resorption of blood clots, stimulate local immunity and metabolism, and have a moderate analgesic effect.

Cabbage, potatoes and burdock

For treatment, a leaf of kale is washed under cold water, several small incisions are made on the surface and applied to the site of the injury. The compress can be secured with tape. The remedy is kept until the sheet dries, the process is repeated 4-6 times a day.

To increase the anti-edema effect, compresses of cabbage leaf can be combined with the use of raw potatoes. To do this, grated potatoes are applied to the surface of the bruise, covered with gauze and left for 30 minutes.

In summer you can use the burdock leaf. It is washed with cold water, cuts are made and applied to the bruise with the light side.

Aloe and honey

For the manufacture of herbal remedies, a large leaf of a plant that is at least 2 years old is selected. The crushed raw materials are mixed with honey in the same proportion, put in a glass container and stored in the refrigerator.

Every day, a thick layer of ointment is applied to the surface of the injury and covered with gauze. The duration of the procedure is 20 minutes, the amount is 2-3 times a day.

If there is no way to find aloe, the plant can be replaced with grated fresh beets.

Banana and pineapple

To reduce bruises and swelling, simply apply a banana peel or pineapple slice to the injured surface. The duration of the compress is 30 minutes. To get a quick effect, you need at least 4 procedures per day.

Apple Cider Vinegar

To make a medicinal solution, vinegar (2 teaspoons) is diluted in cold water (1 liter). A cheesecloth soaked in a solution is applied to the injury for 30 minutes 2-3 times a day.

Heat therapy

Heat stimulates local blood and lymph circulation, immunity and metabolism. This accelerates the processes of tissue cell regeneration and hematoma resorption.

Heat can be treated 2 days after the injury. For the best results, the procedures are combined with a massage.

To use the procedure at home, the gauze fabric is folded in 5-6 layers, moistened in hot water and applied to the injured area. A plastic wrap and a thick cloth are placed on top of the fabric. The exposure time is 15-20 minutes, the number of procedures is 2 times a day.

The warming effect of the compress is enhanced by 40% ethyl alcohol, vodka, camphor or salicyl alcohol. They are diluted with hot water.

massage

Reflexes and mechanical shocks with the hands stimulate the contraction of the muscles and subcutaneous tissues of the face. It improves blood circulation, microcirculation and metabolism. This accelerates the absorption processes of the infiltrate, edema and hematomas and reduces the risk of muscle atrophy.

Begin massaging the adjacent areas 6-8 hours after the injury. To do this, they perform the techniques of deep stroking, kneading and vibrating. The duration of the procedure is 10 minutes, the amount is 2 times a day.

Massage of the injured surface can only be performed 48 hours after the injury, provided there are no ruptures of large vessels and an extensive wound surface.

In this case, only superficial stroking and vibration are allowed. The duration of the procedure is increased to 15 minutes.

Possible consequences of a bruise

The usual pain, bruising, and swelling can hide damage to the brain and facial skeleton. Ignoring a visit to a traumatologist and the lack of timely treatment lead to serious consequences and complicate the life of the injured person in the future.

Possible consequences:

  • traumatic brain injury;
  • deformation of the structures of the nose;
  • the development of chronic rhinitis, sinusitis, sinusitis;
  • violation of the respiratory process;
  • concussion of various degrees;
  • fractures of the facial skeleton;
  • perforation of the eardrum;
  • infectious inflammation of the hematoma.

An oblique impact often causes the subcutaneous tissue to detach, which contributes to the formation of a large and deeply located hematoma. When they thicken, they form traumatic cysts. Such pathological formations can only be cured by a surgical procedure.

How can you disguise a hematoma?

Not all traumatized people manage to take time out from work or exclude visits to public places. Therefore, a bruise on the face often turns into acute feelings and discomfort. In these cases, a few simple steps to mask the hematoma and relieve any swelling can help.

Salt compress

This is the fastest way to treat post-traumatic edema, but it is very harmful to the skin. Therefore, it is used only in extreme cases, when it is necessary to fix the appearance of the face in a short period of time.

To make the product, salt (3 tbsp L.) is dissolved in warm boiling water (1 l). A cheesecloth is dipped in the solution for 5 minutes so that it is saturated with salt crystals. The compress is applied to the bruise for 20 minutes, the skin is washed with warm water.

Concealer

These concealers are designed to cover imperfections on the skin. The main thing is to choose the right color for the concealer:

  • with a fresh blue-purple bruise - orange;
  • for green hematoma - yellow;
  • with a yellow bruise - lilac, lavender.

Large bruises are best masked with a Caverstick, and small bruises can be treated well with a cream or pencil.

Many people are used to treating facial bruises as minor injuries. Treatment is often limited to the use of the common cold and pain relievers. The face is part of the cranial-facial skeleton, inextricably linked with the brain, the respiratory and hearing organs. Therefore, it is important to watch out for injuries and bruises on the face, including minor ones.

An acquaintance during training received a strong slap in the face under the left eye. There is a bruise, almost no swelling, but there is no tenderness of the part of the left cheek, half of the upper lip on the left, the wing of the nose on the left, the teeth from the upper front left and in the left nostril, as was also found with the nasal blowing. I did not lose consciousness, I had a headache on the day of the injury, there was confusion, but on the evening of the same day my condition improved, a day later my state of health was restored, but the sensitivity of the above-mentioned places for the fourth day is also absent . What can it be, what is the likelihood of recovery?

Asked 11 years ago

Doctors' answers

Hello Il.

Hello Il.

You wrote that the blow to the face was under the left eye ... in this area the maxillary sinus may be damaged if the blow was too strong ...; the development of a hematoma, both external and internal (within the maxillary sinus itself). and it is possible that the trigeminal nerve branch breaks or breaks if the blow falls in the area of ​​the lower edge of the orbit, or simply the compression of this nerve by the hematoma formed - this is exactly what it is (violation of impulses along the supraorbital branch the left side) trigeminal nerve) and served as the development of the symptom - a violation of the sensitivity of the areas of the face described above ... Such innervation disorders can recover immediately after the resolution of the hematoma .. usually after 7-10 days ...
Even so, there is still a risk that the hematoma may have developed in connection with a fracture of the facial skull. So do not delay the investigation. It is best to get an MRI of the head right away or, in extreme cases, an x-ray of the skull in 2 projections.
Since the symptoms of confusion and headache suggest a concussion that occurred at the time of the injury, do not delay contacting a doctor (neurologist). Treating a concussion is imperative to avoid various long-term consequences.

The brain is a unique organ whose most complex functions - thinking, memory, language - actually turn a person into a person. This holy of holies is reliably protected from external influences by the skull bone, and yet the brain remains the most endangered human organ.

The fact is, it absolutely needs an uninterrupted supply of oxygen in order to work. Therefore, when breathing stops, the brain dies first. After 5-6 minutes of clinical death, irreversible changes occur; Personality ceases to exist.

Few people know that the brain is the first to age. Age-related changes in the metabolic processes in its tissues begin at around 25-30 years of age. It is not without reason that after thirty, fortunately, not everyone loses their previous learning and creativity.

Almost everyone has different symptoms of brain aging. Those of the very young are not familiar with the temporary weakening of memory, attention, concentration; Irritability caused by, for example, family stress or a rush to work?

Over the years, the functioning of the brain gradually slows down: the speed of reaction decreases, the coordination of movements deteriorates, the clarity of thought disappears. We call the final stage of this process senile marasmus and we hope to avoid it or not to survive. Unfortunately, the work of the brain is often disrupted in unexpected and dramatic ways.

The brain's worst enemy

The most terrible enemy of brain activity is a stroke or acute cerebral circulation violation.

This is a real disaster that overtakes three hundred thousand of our compatriots every year.

For about half of them, a stroke is the last event in their life.

60-80% of those who survived to the end of their life remain disabled and need outside help. And even those recovering to full social and day-to-day adjustment live at constant risk of the tragedy recurring.

The famous novel "The Count of Monte Cristo" says about a stroke like this:

"Not only death, old age and madness are terrible. There is apoplexy, for example - this is a thunderous blow that hits you, but not destroys you, but after it is all over. You are still and no longer you; you, the one you were almost an angel, become a motionless mass that is almost an animal ... "

At the time of Dumas in Europe, they did not know of any medication to alleviate the patient's condition after a stroke. Hence, a stroke meant death or months or years of semi-vegetative existence. Even today, however, a stroke leads to death or severe disability in many cases.

Stroke requires a lot of courage from the patient and a lot of patience and love from those who are close to them. it causes partial or total damage to the main functions of the body - movement, language, memory; and behavioral, mental, and emotional disorders that sometimes take years to deal with.

How does a stroke occur?

Hemorrhagic strokeis usually a complication of hypertension. Cannot stand high blood pressure on the wall, the vessel bursts. The resulting bleeding compresses the tissue, causing edema - and the brain area dies.

In case of ischemic stroke The vessel maintains its integrity, but blood flow through the vessel stops due to a spasm or blockage from a thrombus, which is a blood clot that has formed on the wall of a vessel affected by atherosclerosis.

Stress, fluctuations in air pressure, overwork, bad habits: alcohol and smoking, sharp fluctuations in blood sugar levels - these reasons can cause persistent spasm of the cerebral vessels with all the characteristics of ischemic stroke.

Contrary to popular belief, a stroke is not a one-time event, but a process that evolves in time and space: from minor functional changes to irreversible structural damage - necrosis.

The disease is insidious in that there can be no pain in the first hours of its development until the onset of paralysis, loss of speech or coma. Hand and cheek become numb, speech changes slightly, sometimes dizziness or blurred vision occurs. Neither the patient himself nor his relatives suspect that a brain disaster is taking place, valuable time is lost. The "therapeutic window", the period in which intensive care can reverse the disease, is only about six hours.

"Steps to Stroke"

In old age, circulatory disorders overtake everyone to one degree or another. However, it should be noted that the first signs of metabolic disorders in the brain tissue are recognized quite early.

Diseases like vegetative-vascular dystonia, the first manifestations of cerebrovascular insufficiency (NPNMK), encephalopathycan be considered different stages of the same process: chronic vascular pathology of the brain. Not only are they a serious risk factor for strokes, they also have a significant impact on the quality of life.

Frequent headaches, dizziness, movement disorders, attention, memory, blurred speech, numbness of the extremities, tinnitus, hearing disorders and short-term loss of consciousness are evidence of the existing disorders of the brain functions.

If two or more of the listed symptoms are observed at least once a week for at least three months, especially against the background of diseases such as high blood pressure and atherosclerosis, it is very, very dangerous to neglect.

One step closer to having a stroke are what are known as transient cerebrovascular accidents or ischemic transistor attacks. They differ from strokes only in that they last a few minutes, less often hours, but no longer than a day, and end with a complete restoration of the impaired functions.

What are the main signs of an impending stroke?

Doctors differentiate between focal and cerebral symptoms.

Julia Mikoyan

Comment on the article "Stroke: When the brain needs help"

Great article! In 1989 mine
father had a stroke. I didn't know what it was. And everyone should know that. After all, we have old parents. It happens to them. If there is a knowledgeable relative, children, we will star
the role of salvation. Doctors will continue to help and
then thorough grooming. Papa lives. And we
were able to cope with the disease very quickly. He did it himself. I helped him. At first it gave me hope. is he
he didn't move, couldn't speak, tears ran down his cheeks. After medical help, I rubbed him, hands, feet, head, raised
arms and legs, threw her hands behind the headboard to grab. She did this the whole time while sitting next to him. All day.
And there was sensitivity. Then he moved, raised his hands, and turned his head. Then I recorded it. We fell on the bed. It's heavy, it's big. I am small When
we went into the corridor, the entire hospital department ran to look. Such an amazing success in a short period of time. But even his bowel did not work, he had no stool for half a month. He wasn't lying, he was moving all the time. The houses on the third floor went down 5-6 steps each day. He only had one eye. It was necessary to train him too. But I didn't know anything about it. We really need knowledge. Thank you! Now he takes care of his health with Antiox.
It is the most powerful antioxidant with gingo biloba and knots and purple grapes. The natural vitamin complex There is no like in the world.
Since I know how to protect myself from a stroke, I'll take it too.
I also eat pax to improve memory
also a complex for the brain and stress reliever. I've had a headache for so many years. Finally they disappeared.
You can see how I did it
website http://www.nnabieva.narod.ru/health.html in the section about yourself.
I have used and won many methods. Even the ischemia of the posterior wall of the left ventricle of the heart was gone. I have changed
lifestyle, thinking, eating, I take a lot of vitamins and minerals. Due to a brain problem on the left side, the right eye is difficult to see. But this problem is also curable. I changed my glasses to lower diopters.
I am very grateful to you!
With best regards,
Nina Petrovna
Email: [Email protected]

04/05/2001 17:03:53, Nina

A total of 3 posts.

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Good evening everyone! I ask for advice from anyone who has encountered this calamity! My grandmother is 91 years old, she suffers from senile dementia (marasmus), physically the grandmother is strong, she will give the boys a head start, but her head is in complete trouble, she does not recognize anyone, she confuses everything, constantly asks, letting her go home (although she is in the house where she already lives 70 years old), does not sleep at night, becomes aggressive, it constantly seems to her that we want to poison her ... kill her ... im General utter horror!

Stroke: When the brain needs help. ... at least three months, especially against the background of diseases such as high blood pressure and arteriosclerosis. The patient spends the first two to four weeks in a specialist hospital.

Stroke: When the brain needs help. At the time of Dumas in Europe, they did not know of any medication to alleviate the patient's condition after a stroke. Even today, however, a stroke leads to death or severe disability in many cases.

Stroke: When the brain needs help. Hemorrhagic stroke is usually a complication of hypertension. Numbness of the extremities, tinnitus, hearing loss, short-term loss of consciousness.

Stroke: When the brain needs help. Treating stroke is the job of doctors: neuropathologists, resuscitators, and sometimes neurosurgeons. After discharge, the patient should be monitored by a local neurologist at the place of residence.

Neuralgia is a disease of the peripheral nerves that is accompanied by severe attacks of pain. The most common condition affecting 50 people, and most commonly women over 50, is trigeminal neuralgia, which is responsible for facial tenderness.

Therefore, painful sensations occur in certain areas of the face during the irritation of the trigeminal branches. The pain caused by this disease is sharp like an electric shock, severe and very excruciating.

Trigeminal neuralgia results from facial trauma, infections and colds, sinus inflammation, pulpitis, and hypothermia.

Pain attacks can occur at any time: as a reaction to cold or warm food, too bright light and loud noises, even when brushing your teeth, with every movement of the facial or chewing muscles. In addition, there are zones on the face (trigger or trigger), even a light touch that provokes a strong attack of pain - these are the nasolabial folds, the upper lip and gums, the tip and wings of the nose, the eyebrows. The "harbinger" of an attack can be an itchy skin on the face or a feeling of "creeping". There is then a sharp, "shooting" excruciating pain in tears that usually lasts no more than two minutes and is often repeated at any time of the day for several weeks.

  • typical: cyclical with decay periods
  • atypical: covers a large part of the face and is usually constant (up to several days). In this case, there is no period of pain relief, which gives rise to speaking of a neuralgic status - the most severe form of this disease.

Symptoms

Most patients found that the pain started spontaneously for no apparent reason. In some patients, seizures start after a slap in the face, chewing, speaking, washing, dental work, etc. Often times, the pain begins in the lower or lower part of the maxilla and is similar to pain caused by dental problems. However, a dental restoration does not solve the problem.

With trigeminal neuralgia, you may experience one or more of the following symptoms of the disease:

Damage to the nerve centers of the brain

2. Damage to the facial nerve branches

  • non-cyclical, monotonous pain in a specific part of the face;
  • possible absence of pain with increased sensitivity or numbness of the jaw, lips, wings of the nose, cheek, eyelid, or forehead;
  • damage to the trigeminal nerve associated with dental disease can worsen symptoms when the jaw is clenched or chewed.

Effects

How severe can the consequences of trigeminal neuralgia be? In general, attacks of pain caused by this disease do not pose a direct threat to life, although they can sometimes lead to disability. It would be more accurate to say that this pathology itself is a consequence of the causes that irritate the trigeminal nerve:

  • contact of a vein or artery due to various inflammations with a nerve at the base of the skull, which leads to its compression and provokes an attack;
  • a tumor that compresses the nerve;
  • multiple sclerosis, which leads to the destruction of the myelin sheath of the nerve.

It should be noted that the remission times become shorter with increasing age.Therefore, an unresolved root cause of trigeminal neuralgia can have sequelae in the form of frequent, excruciating, and debilitating pain.

Treatment methods and possible complications

Before starting treatment, it is necessary to consult a neurologist and make an accurate diagnosis. Magnetic resonance imaging is an effective method for detecting tumors and multiple sclerosis. However, when other causes of nervous disease are identified, this method is practically powerless. The symptoms of trigeminal neuralgia are relieved by analgesics, anticonvulsants, and antidepressants. At the same time, the search for the damaged site of the trigeminal nerve is necessarily carried out and its treatment is carried out, which boils down to the selection of analgesics and procedures that will relieve pressure on the nerve.

The most commonly used drugs are carbamazepine, feiitoin (Dilantin), oxcarbazepine (Trileptal), finlepsin. Some of these drugs (carbamazepine, finlepsin) lose their effectiveness with prolonged use and require an increase in the dose, which can lead to negative consequences.

Percutaneous treatments are used to damage nerve roots and reduce or block pain signals. These procedures include: percutaneous nerve balloon compression, percutaneous rhizotomy with glycerol solution, percutaneous stereotactic high frequency thermal rhizotomy.

If necessary, they resort to surgical interventions: microvascular decompression consists in the displacement of the vessels compressing the nerve. Despite the maximum percentage of successful operations, they are fraught with risks and can have serious complications: significant hearing loss, weakness of the facial muscles, stroke. Another type of surgery - interrupting a nerve with a laser or electrode - is less traumatic and is performed under local anesthesia.

Prevention consists in the timely treatment of inflammatory and infectious diseases.

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We all know from childhood that toothaches are the worst and most uncomfortable. Read completely

Most dental diseases occur due to poor care, while the causes of periodontal disease are quite unusual: immune system malfunction.

The main tool for caring for the oral cavity is a toothbrush. Of course, toothpicks, mouthwash, dental floss and other aids are also needed.

All materials are for informational purposes only.

The blow pinched the trigeminal nerve and numbed the right side of the face

From the slap in the face, there was a fracture of the cheekbone, the trigeminal nerve was pinched, and the right side of the face - the nose, upper lip, and teeth - near the eye were numb. What can be done, which specialist should I contact? Neurologists shrug their shoulders! Have you met such cases, there is no pain, but constant discomfort and irritability. Two years have passed since the injury, numbness has occurred immediately after the blow until today ?!

Hello! You need to go to maxillofacial surgery. There you will receive the appropriate technical support and advice. However, your appeal should be made immediately, and not two years later, when the options for restoring the pinched nerve (if any) are unfortunately very limited.

Exactly the same case happened to me. I went to the oral surgeon and he sent me to a neurologist. I was prescribed and drug therapy and physiotherapy, I went to acupuncture, massage. But unfortunately no effect for this period. The sensitivity appeared on its own about 5 years after the injury. I think it is imperative to see a doctor. If I hadn't started treatment then, maybe nothing would have passed.

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Loss of sensitivity of the face after an injury.

An acquaintance during training received a strong slap in the face under the left eye. There is a bruise, almost no swelling, but there is no tenderness of the part of the left cheek, half of the upper lip on the left, the wing of the nose on the left, the teeth from the upper front left and in the left nostril, as was also found with the nasal blowing. I did not lose consciousness, I had a headache on the day of the injury, there was confusion, but on the evening of the same day my condition improved, a day later my state of health was restored, but the sensitivity of the above-mentioned places for the fourth day is also absent . What can it be, what is the likelihood of recovery?

The question was asked 9 years ago

Doctors' answers

However, there is a risk that the hematoma may have developed due to a broken bone on the face. therefore do not delay the examination. It is best to get an MRI of the head right away or, in extreme cases, an x-ray of the skull in 2 projections.

As the symptoms of confusion and headache suggest a concussion that was occurring at the time of the injury. then it is not worth delaying the visit to the doctor. Treating a concussion is imperative to avoid various long-term consequences.

Good day. Any transferred craniocerebral trauma requires personal advice from a neurologist. As it is very problematic to assess the condition and possible risks in the absence. I advise you not to postpone your visit to the doctor. Good luck.

Cranial nerve injury

Cranial nerve injuries (CRN) are often the leading cause of disability in patients with traumatic brain injuries. In many cases, PSI occurs with mild to moderate trauma to the skull and brain, sometimes against a background of retained consciousness (at the time of the injury and after). The meaning of PNP can vary: if damage to the olfactory nerves results in a decrease or absence of odor, patients may not notice or ignore the defect. At the same time, the image can be damaged or facial nerve can lead to severe disability and social maladjustment of patients due to visual impairment or the appearance of gross cosmetic defect.

It is noted that direct damage to the intracranial segments of the CN by the type of neurotransition (rupture) or neuropraxia (intraneural destruction) is very rare, as the length of the intracranial segments increases the distance between the exit points from the brain stem and the cranial cavity due to the shock-absorbing properties of the cerebrospinal fluid contained in the basal cisterns exceeds several millimeters.

In TBI, damage to the cranial nerves is most often caused by their compression in the bone canals (I, II, VII, VIII nn) or by their compression by the edematous brain or intracranial hematoma (III n) or in the wall of the cavernous sinus with traumatic carotid cavern causing anastomosis (III, IV, VI, first branch V).

Special mechanisms of damage to the cranial nerve in wounds foreign bodies and gunshot wounds.

According to literature V (from 19 to 26 %) and VII nerves (from 18 to 23%), less often III nerves (from 9 to 12%), XII nerves (from 8 to 14%),

VI nerve (from 7 to 11%), IX nerve (from 6 to K)%). Please note that damage to a number of cranial nerves is covered in the chapters on the neuro-ophthalmological and otoneurological consequences of TBI.

TRIPLE NERVOUS DAMAGE

The trigeminal nerve has three main branches. I branch - the orbital nerve - innervates the skin of the forehead, the temple and apex regions, the upper eyelid, the bridge of the nose, the nasal mucosa and its paranasal sinuses, the shell of the eyeball and the lacrimal gland. When exiting the Gasser node, the nerve passes the thickness of the outer wall of the cavernous sinus and enters orbit through the superior orbital fissure.

The II branch - the maxillary nerve - innervates the hard shell of the brain, the skin of the lower eyelid, the outer corner of the palpebral fissure, the anterior part of the temporal area, the upper part of the cheek, the wings of the nose, the skin and the mucous membrane the upper lip, the mucous membrane of the maxillary sinus, the palate and the teeth of the upper jaw ... The maxillary nerve leaves the cranial cavity through a round opening in the pterygopalatine fossa. The infraorbital nerve, which is a continuation of the II branch, runs in the infraorbital sulcus and reaches the face through the infraorbital foramen.

The III. Branch - mandibular nerve - innervates the dura mater, the skin of the lower lip, chin, lower part of the cheek, anterior part of the auricle and anterior ear canal, ear drum, mucous membrane of the cheek, floor of the mouth and anterior 2/3 the tongue, the teeth of the lower jaw and chew muscles and muscles of the palatal curtain. It exits the cranial cavity through the foramen ovale into the infratemporal fossa and forms a series of branches.

Damage Mechanisms

Damage to the Gasser node and the roots of the trigeminal nerve occurs in fractures of the base of the skull. Damage to the temporal bone, progressing into the holes in the main bone, the base of the middle fossa, can lead to compression or rupture of the branches of the trigeminal nerve. Direct damage to the soft tissues of the face, dislocations of the orbital structures, injuries to the upper and lower jaw can also damage the trigeminal nerve.

Clinic and diagnostics

If the gas node is damaged, then in the innervation zone of all branches of the trigeminal nerve dull, periodically worsening pain, sensory disorders and herpes outbreaks, as well as neurotrophic complications (keratitis, conjunctivitis) appear. When the branches of the V nerve are damaged, pain syndromes of various severity are manifested, localized in the zones of their innervation. Detection of damage to the trigeminal nerve is based on characteristic signs - hypesthesia or hyperpathia in the zones of its innervation, disorders of chewing and movement of the lower jaw, irritation or oppression of the cornea and other reflexes caused by the V nerve, as well as autonomic disorders .

treatment

For post-traumatic trigeminal pain syndromes, a complex of pain relief, absorption, vascular and metabolic therapy is used.

The primary indication for an operation is damage to the I branch of the trigeminal nerve, which leads to neuroparalytic keratitis with the formation of corneal ulcers. A retroganglionic injury to the 1st branch of the trigeminal nerve can be treated by combined plasticity of the trigeminal nerve with an autograft from the lower leg that is connected to the greater occipital nerve. The operation consists of a frontolateral epidural approach with an approach to the roof of the orbit, its opening and isolation of the ocular nerve.

The sural autograft is sutured with one end to the branch of the eye and the other end to the greater occipitalis nerve. Restoration of sensitivity is possible after 6 months.

The indication for the reconstruction of the alveolar nerve is anesthesia of the lower lip, its dysfunction and possible trauma. The operation is performed by neurosurgeons together with maxillofacial surgeons. The distal and proximal ends of the nerve in the lower jaw and in the chin foramen are isolated, identified and, if necessary, marked with an autograft with subsequent suturing of the nerve.

DAMAGE TO THE FACIAL NERVES

One of the serious complications of traumatic brain injury is peripheral paralysis of the facial nerve. In terms of frequency of occurrence, traumatic injuries to the facial nerve rank second after idiopathic Bell's palsy. In the structure of traumatic brain injuries, injuries to the facial nerve are observed in 7-53% of patients with fractures of the base of the skull.

Injuries to the facial nerve as a result of a fracture of the base of the skull are classified as early and late. Paresis and paralysis that occurred immediately after the injury, indicating direct damage to the nerve, usually have an unfavorable outcome. Peripheral paresis of the facial nerve can also occur later after the injury, usually within 12 to 14 days. This paresis is caused by secondary compression, edema, or hematoma in the nerve sheath. In these cases the continuity of the nerve is preserved.

Damage Mechanisms

Longitudinal fractures of the temporal bone account for over 80% of all temporal bone fractures. Lateral, oblique blows to the head are more common. The fracture line runs parallel to the axis of the pyramid and often deviates to the sides, bypassing the labyrinth capsule, splitting the eardrum cavity, displacing the malleus and the incus, which leads to fractures and dislocations of the stapes. A hearing disorder with a longitudinal fracture occurs as a conduction disorder (conductive hearing loss). As a rule, otorrhea occurs on the side of the lesion, the eardrum is injured.

Transverse fractures occur in 10-20% of cases. The mechanism by which a fracture occurs is a blow to the head in an anteroposterior direction. The break line runs from the tympanic cavity through the wall of the facial nerve canal in its horizontal segment to the internal auditory canal through the vestibule of the labyrinth. Transverse fractures are also divided into external and internal fractures depending on how the fracture communicates with the external auditory canal. Hearing impairment occurs as sensory hearing loss. The eardrum can remain intact, which does not rule out the possibility of hematotympanum formation on the affected side. The appearance of rhinorrhea in these fractures is explained by the penetration of cerebrospinal fluid from the middle ear through the Eustachian tube into the nasal cavity. A loss of vestibular function is possible in 50%. Damage to the facial nerve with transverse fractures is much more severe and more common than with longitudinal fractures.

In gunshot wounds, the nerve is damaged in 50% of cases. The nerve can be crossed by a wounded projectile (bullet, splinter), which is secondarily damaged by the kinetic energy of the bullet. Gunshot wounds are more severe than splinter wounds. The bullet has a much greater mass than the fragments and does more damage at higher speeds. Most commonly, the mastoid process, the site where the nerve exits the stylo-mastoid opening, and the eardrum are damaged in a gunshot wound.

Pathohistology

With traumatic injuries to the facial nerve, various biochemical and histological changes occur not only distally, but also in the proximal part of the nerve. At the same time, in addition to the type of injury (intersection point during surgery, traumatic compression), the severity of the clinical manifestation of damage depends on the proximity to the nucleus of the facial nerve - the closer it is, the more severe the degree of damage to the nerve trunk.

A histopathological classification has been proposed to assess the degree of damage to the facial nerve (Sunderland S.):

Grade 1 - Neuropraxia block of impulse conduction with compression of the nerve trunk. At the same time, the integrity of the nerve and its elements is preserved

(Endo-Periepineurium). Valero degeneration is not observed in this case. When the pressure is removed, nerve function is fully restored in a relatively short period of time.

Grade 2 - axonotmesis - parietal tear of the axon with the outflow of axoplasmic fluid. In this case, valerian degeneration occurs

Expressed distal to the site of damage to the nerve stem. The nerve sheath is preserved and the connective tissue elements remain intact. The nerve retains the ability to regenerate distally (at a rate of 1 mm per day), which may facilitate recovery.

Grade 3 - Endoneurotmesis - The endoneurium and axon are damaged, parietal degeneration occurs, but the perineurium remains intact. Valerovsky degeneration is partially distal and proximal to the damage in both directions. Axons can regenerate in this case, but full recovery is impossible due to the cicatricial-adhesive process that develops at the site of the injury and disrupts the movement of the fibers. This leads to a partial re-innervation of the nerve stem. In addition, the directional growth of the axon changes, which leads to synkinesis and incomplete restoration of nerve functions.

4 degrees - perineurotmesis. Only the epineurium remains intact, while the axon, endo- and perineurium are destroyed. Pronounced valerian degeneration. This is a different form of regeneration because there is no chance of restoring nerve functions without a surgical comparison.

5 degrees - epineurotmesis. Complete damage to all elements of the nerve trunk, the emergence of neuromas. Restoration, also partially, in

this phase does not occur. A surgical solution to the problem also does not lead to the desired results.

clinic

The clinical picture of facial nerve damage is known and depends on the extent of the damage and the degree of conduction disorder. The main symptom of facial nerve damage is peripheral paresis or paralysis of the facial muscles on the corresponding half of the face.

Facial nerve syndrome (synonym: Bell syndrome) includes paralysis of all facial muscles of the homolateral half of the face (inability to frown and frown, inability to close the palpebral fissure, flattening of the nasolabial fold, lowering of the corner of the mouth, inability to grin and teeth blowing out the cheeks, mask-like half of the face) and is often supplemented by a taste disturbance in the front 2/3 of the tongue half of the same name, hyperacusia (unpleasant, improved sound perception), tear disorders (hyper- or alacrimania), dry eyes.

There are 3 segments of the facial nerve: intracranial, including a segment from the nerve exit from the brain stem to the internal auditory canal, intrapyramidal from the internal auditory canal to the styloid foramen, and extracranial. Features of the topographical anatomy of the facial nerve due to its location in the immediate vicinity of the brain stem, the cochleovestibular nerve, the structures of the inner and middle ear, the parotid salivary gland cause both the high frequency of its lesions and the difficulties of surgical treatment.

Bell syndrome has several topical variants depending on the degree of involvement (Figure 12-1).

If the root of the facial nerve emerging from the brain stem in the lateral cistern of the pons (cerebellar pontine angle) is damaged along with the cranial nerves V, VI and VIII of its half, the clinical picture of the syndrome includes symptoms of dysfunction of these nerves. Pain and disorders of all kinds of sensitivity in the area of ​​the innervation of the trigeminal branches are noted, sometimes combined with damage to the homolateral masticatory muscles (damage to the V nerve), peripheral paralysis of the facial nerve, hearing loss, noise and vestibular disorders (damage to the VIII Nerve), sometimes combined with cerebellar symptoms.Is that on this page:

Topical variants of VII nerve syndrome, when it is damaged in the fallopian tube, depend on the degree of damage:

In the case of a lesion before the discharge of Item Petrosus Major, in which all the accompanying fibers are involved in the process, in the clinical picture in addition to peripheral paralysis of the facial muscles, dryness of the eye (defeat of Item Petrosus), hyperacusis (defeat of Item Stapedius), Taste disturbance in the anterior region 2/3 of the tongue (Chordae tympani lesion);

Number: 12-1. Extent of damage to the facial nerve and its detection.

With a lower localization of the lesion above the discharge point of the object stapedius, in addition to the peripheral paralysis of the facial muscles of the half of the face of the same name, hyperacusis is observed, a taste violation in the anterior 2/3 of the tongue of the half of the same name. Dry eye gives way to increased lacrimation;

If the lesion is over the discharge of the Chordae tympani, lacrimation and taste disturbances occur in the front 2/3 of the tongue;

With a lesion below the discharge of the chordae tympani or when leaving the thyroid opening, paralysis of all facial muscles in half occurs, combined with lacrimation.

The most common defeat of the VII nerve at the exit of the facial canal and after leaving the skull.

With complete damage to the facial nerve (core and trunk of the facial nerve), peripheral paralysis of all facial muscles occurs - the affected side is mask-like, there are no nasolabial and frontal folds. The face is asymmetrical - the muscle tone of the healthy half of the face "pulls" the mouth to the healthy side. The eye is open (lesion of the orbicularis oris muscle) - lagophthalmus - "rabbit's eye". When trying to close the eye, the eyeball shifts upwards, the iris goes under the upper eyelid, the palpebral fissure is not closed (Bell symptom). With incomplete damage to the eye muscle, the palpebral fissure closes, but less tightly than on the healthy side, and eyelashes are often visible (a symptom of eyelashes). Lacrimation is often observed with La Gophthalmus (if the normal function of the lacrimal glands is maintained). Due to the defeat of M. orbicularis oris, whistling is impossible, speaking is somewhat difficult. Liquid food is poured from the mouth on the affected side. In the future, atrophy of isolated muscles develops and a corresponding degenerative reaction, as well as changes in the EMG of a peripheral nature are observed. There are no superciliary, corneal and conjunctival reflexes (lesion of the efferent part of the corresponding reflex arc).

diagnosis

In addition to the neurological symptoms described, various tests and techniques are used to detect damage to the facial nerve.

Schirmer's test involves the identification of dysfunction of the superficial petrous nerve through the study of lacrimation. Two strips of filter paper 7 cm long and 1 cm wide are inserted into the conjunctival sac for two minutes, and the area where the strips are soaked with a tear is determined in millimeters. After 3-5 minutes, compare the length of the wetted section of the paper. A 25% reduction in the length of the wetted area is considered a manifestation of damage at this level. Damage near the geniculate can lead to keratitis.

Stapedius reflex is designed to test the branch of the facial nerve - the stacked nerve that leaves the main nerve trunk immediately after the second knee in the mastoid process. The most correct of all the tests. Examine using standard audiograms. This test is only important for trauma, it is not informative for infectious lesions of the nerve.

Examination of taste sensitivity by applying various taste paper tests to the front 2/3 of the tongue shows damage at the level of the chorda tympani. However, this test is not entirely objective. In this case, it is more correct to study the reaction of the papillae of the tongue to various taste tests in the form of a change in the shape of the papillae under a microscope. In the first 10 days after the injury, however, the papillae do not respond to the taste stimulus. Recently, the taste has been studied electrometric (electrogustometry), Determining the threshold sensation of electric current that causes a particular sour taste when the tongue is irritated.

Drool test - also shows damage to the facial nerve at the level of the eardrum. The Varton canal is cannulated from 2 sides and the saliva flow is measured for 5 minutes. It's also an impractical and not entirely objective test.

Electrophysiological tests are the most informative studies in patients with complete facial nerve paralysis, both to prognosticate and study the dynamics of axon growth, as well as to decide whether or not to perform nerve decompression.

Tests for excitability, maximal stimulation, electroneuronography. They give the most accurate results within the first 72 hours after a nerve injury. After 3-4 days, due to the increase in nerve degeneration, these research methods are transferred to the category of therapeutic methods (nerve regeneration is accelerated).

Excitability Test - Stimulation electrodes are located in the styloid opening on either side, to which electrical discharges are applied. Furthermore, the indicators are compared with each other and, depending on the results obtained, a prognosis is made about the restoration of the functions of the nerve. Quite a cheap test, but with a large number of bugs.

Maximum stimulation of the branches of the facial nerve is a modified version of the first test. The mechanism is the depolarization of all facies branches. The test begins on the 3rd day after the injury and is repeated regularly.

Electroprography - This is an objective test that consists in the qualitative study of nerve degeneration by stimulating the nerve in the styloid foramen with direct current pulses. The response to stimuli is recorded using bipolar electrodes placed near the nasolabial fold. The number of evoked potentials corresponds to the number of undamaged axons, and the unaffected side is compared as a percentage with the damaged side. The identification of evoked potentials in less than 10% indicates a poor prognosis for spontaneous recovery. The disadvantage of this test is the patient's discomfort, the difficult position of the electrodes, and the high cost of the study.

Electromyography using 2x and 3x phase potentials through the needle trans-cutan electrodes installed in the facial muscles records the potentials of the latter and shows the electrical conductivity of the facial nerve. The method is of limited value because up to 2 weeks after the injury it is not possible to get real results due to the flickering of the facial muscles (caused by neural degeneration). But it becomes important after 2 weeks because the axons get back into the muscles. The registration of multiphase potentials indicates the beginning of reinnervation.

treatment

Surgical methods for persistent syndromes with complete disruption of facial nerve conduction can be divided into two groups:

1. Surgical interventions on the facial nerve to restore its conduction and voluntary motor function of the facial muscles (decompression surgery).

2. Plastic surgery on the skin, muscles and tendons of the face to reduce the cosmetic defect and replace the function of paralyzed muscles.

With fractures of the temporal bone, decompression of the nerve occurs at the site of compression - removal of the bone, evacuation of the hematoma; If a nerve rupture is found, the perineural membrane should be sutured around the circumference with at least three sutures, with the nerve endings freshened up at a right angle beforehand. On the other hand, clinical experience shows that in 2/3 of the victims, nerve function can be restored to a certain extent without surgery. Kamerer D.B., Kazanijian V.H., and others recommend decompressing as early as possible in all cases of paralysis (in the first 24-48 hours). Most experts consider the time of 4 to 8 weeks after the injury to be optimal for the surgical treatment of severe damage to the VII nerve, as the results of the operations are available after 8 to 10 weeks. from the development of paralysis are ineffective. Fisch U. thinks it advisable to intervene on the 7th day after the onset of paralysis in the 7th century. In the past, you identified the dynamics of the process. CT, MRI, and electrodiagnostics are necessary for a timely decision about surgery for a VII nerve injury.

The facial nerve became the first nerve to be reinnerved (neuroplasty, nerve anastomosis), which consisted of suturing a peripheral segment of the facial nerve to the central segment of another specially cut motor nerve. For the first time in the clinic, the reinervation of the facial nerve with the accessory nerve was performed hypoglossal by Drobnik in 1879 and by Korte in 1902. Soon these operations were used by many surgeons. In addition to the accessory and hypoglossal nerves, the glossopharyngeal nerve, the phrenic nerve, and the descending branch of the hypoglossal nerve have been used as donor nerves for the reinervation of the facial nerve; II and III cervical nerves, the muscle branch of the accessory nerve to the sternoclavicular-nasal muscle. To date, considerable experience has been gained with operations for extracranial reinnervation of the facial nerve.

Reinnervation of the facial nerve with the accessory nerve: The main effect of the operation is to prevent muscle atrophy and restore muscle tone.

Reinnervation of the facial nerve with the hypoglossal nerve is the most commonly used technique for extracranial reinnervation of the facial nerve. Many authors who prefer this technique emphasize that there is a functional relationship between the motor zones of the face and the tongue in the central nervous system.

Reinnervation of the facial nerve with the hypoglossal nerve with simultaneous reinnervation of the hypoglossal nerve through its descending branch is the most common operation for facial nerve injuries.

Reinnervation of the facial nerve with the phrenic nerve. The transection of the phrenic nerve is usually not associated with serious neurological damage. The restoration of the function of the facial muscles after re-elevation of the facial nerve with the phrenic nerve is accompanied by pronounced friendly movements, synchronized with breathing, the elimination of which requires long-term conservative treatment.

Reinnervation of the facial nerve by the anterior branch of the 2nd cervical nerve, the glossopharyngeal nerve, is not widespread in clinical practice.

Methods of extracranial reinnervation of the facial nerve are technically simple and less traumatic and restore the function of the facial muscles. However, they have a number of serious disadvantages. The severing of the donor nerve brings with it additional neurological disorders, the restoration of the function of the facial muscles is accompanied by friendly movements that are not always successfully retrained. These drawbacks greatly reduce the efficiency of the operations, and the results are not entirely satisfactory for patients and surgeons.

Cross-face anastomosis, cross-face nerve graft. First publications on cross transplantation L. Scaramella, J.W. Smith, H. Andrel. The essence of the operation is the re-innervation of the affected facial nerve or its branches with separate branches of the healthy facial nerve through autografts, which allows connections to be made between the corresponding branches of the facial nerves. Usually three autografts are used (one for the muscles of the eye and two for the muscles of the cheek and the circumference of the mouth). The operation can be performed in one or (more often) in two stages. Early appointments are preferred. The surgical technique is of great importance.

To improve the results, plastic surgery is also applied to the face, which can be divided into static and dynamic. Static surgeries are aimed at reducing facial asymmetry - tarsorrhaphy, to reduce lagophthalmos and tighten the skin of the face.

Multidirectional suspension methods have been proposed to eliminate eyebrow overhang, lagophthalmos, and puberty of the cheek and corner of the mouth. For this purpose, fascia bands are used, which are cut from the fascia lata of the thigh. Even cases of the implantation of a metal spring in the upper eyelid have been reported. However, the authors themselves state that a rejection reaction can develop. If the spring is not properly attached, it can be pushed out even if the skin is perforated. A similar complication occurs when magnets are implanted in the eyelids (rejection reaction in 15% of cases).

Plastic operations are intended to replace the function of the paralyzed muscles. In 1971, the first free muscle-tendon autograft was performed. This operation was performed by many surgeons. The authors note that transplanted muscles often experience cicatricial degeneration. With the development of microsurgical technique, muscle transplantation with microvascular and nerve anastomosis and the movement of muscle valves from the temporal muscle, the masseter muscle, and the subcutaneous neck muscle have become increasingly popular. The following indications for the use of plastic surgery have been formulated:

1. Improving results after facial nerve surgery.

2. In the later periods after the defeat of the facial nerve (4 years or more).

3. After extensive facial damage, when facial nerve surgery is not possible.

Conservative treatment

Treatment of lesions of the facial nerve should be comprehensive. Conservative treatment should be carried out from the first week. The regimens of conservative treatment and methods of gradual exercise therapy were developed to eliminate the friendly movements of the facial muscles in patients in whom the facial nerve has been reinnervated.

Physical therapy during surgical treatment of facial nerve injuries can be divided into three different periods: preoperative, early postoperative, late postoperative.

In the preoperative phase, the main task is to actively prevent asymmetries between the healthy and the diseased side of the face. The sharp asymmetry of the face, which appeared on the first day after the main operation, requires immediate and strictly directed correction. Such correction is achieved using two methodical techniques: positional treatment with the help of tape tension and special exercises for the muscles of the healthy half of the face.

The tape tension is carried out in such a way that the adhesive plaster is applied to the active points healthy side linden tree - the area of ​​the square muscle of the upper lip, the circular muscle of the mouth (from the healthy side) and with a fairly strong tension that goes to the diseased side is attached to a special helmet mask or a post-operative bandage on the side straps. Such tension is carried out during the day from 2 to 6 hours per day with a gradual increase in the time of the position treatment. Such a bandage is especially important in active imitation actions: eating, speech articulation, emotional situations, since the weakening of the asymmetrical traction of the muscles of the healthy side improves the general functional position of the paralyzed muscles, which plays a major role in the postoperative period, especially after germination of the sewn nerve.

Treatment with the position of the circular eye muscle from the affected side is considered separately. Here, goosefoot adhesive plaster is applied to the center of the upper and lower eyelids and pulled outward and slightly upward. At the same time, the palpebral fissure is significantly narrowed, which ensures an almost complete closing of the upper and lower eyelids when blinking, normalizes tearing, protects the cornea from dehydration and ulcers. While you sleep, most of the tape tension is removed, but it can remain in the eye area.

Special gymnastics at this time is also mainly aimed at the muscles of the healthy side - training is carried out to actively relax the muscles, in doses and, of course, to imitate the tension of the main muscle groups - the zygomatic muscles of the mouth and eye muscles, the triangular muscle. Such exercises with the muscles of the healthy half also improve the symmetry of the face, prepare these muscles for such dosed tension, which in subsequent periods represents the most suitable, functionally beneficial and slowly recovering paretic muscles.

The second phase, early postoperatively - from the moment of plastic surgery to the first signs of nerve invasion. During this period, basically the same rehabilitation measures as in the first period are continued: positional treatment and special gymnastics, which are mainly aimed at a dosed training of the muscles of the healthy side of the face. In addition to the previous exercises, there is a need for reflex exercises - static tension of the muscles of the tongue and training for forced swallowing.

Tongue tension is achieved in the following way: the patient is instructed to "rest" the tip of the tongue against the line of closed teeth (2-3 seconds of tension), then relax and "rest" on the gums again - now over the teeth. After relaxation - a focus on the gums under the teeth. Similar series of loads (emphasis in the middle, top, bottom) are carried out 3-4 times a day, 5-8 times during each series.

Swallowing also takes place in series, 3-4 sips in a row. You can combine regular swallowing with pouring liquid, especially if the patient complains of dry mouth. Combined movements are also possible - static tension of the tongue and swallowing at the same time. After such a combined exercise, you will need a longer break (3-4 minutes) than after individual exercises. During this period, you can recommend various types of strengthening treatment - vitamin therapy, massage of the collar zone, etc. Drug treatment with dibazol is recommended for 2 months. Massage of the face, especially the affected side, is considered inappropriate during this time.

The third, late postoperative period begins at the moment of the first clinical manifestations of nerve invasion. Earlier than others there is a movement of the laughing muscles and one of the parts of the zygomatic muscle. During this time, the focus is on medical gymnastics. Static exercises for the muscles of the tongue and swallowing continue, but the number of sessions increases significantly - 5-6 times a day and the duration of these sessions. Massage of the affected half of the face is recommended before and after class.

A massage from the inside of the mouth is especially valuable when the movement therapy instructor (with one hand in a surgical glove) massages individual (if possible) muscle groups - the square muscle of the upper lip, the zygomatic muscle, the circular muscle of the mouth and the buccal muscle.

As the amplitude of voluntary movements increases, exercises in symmetrical tension are added on both sides - healthy and affected. An important methodological principle here is the need to equate the strength and amplitude of the contraction of the muscles of the healthy side with the limited capabilities of the muscles of the affected side, but not vice versa, since tertiary muscles cannot equate with healthy muscles even at maximum contraction and thereby ensure symmetry of the face. Only when healthy muscles are equated with paretic will asymmetries be eliminated and the overall effect of the surgical treatment increased.

The movements of the circular muscle of the eye occur much later and initially act synergistically on the contractions of the muscles of the lower and middle parts of the face. This synergy should be increased in every possible way (by joint contractions of all muscles on the affected side) within two to three months. After a sufficient contraction amplitude of the circular eye muscle has been reached, a differentiated separation of these contractions must be achieved. This is achieved through a specific function of the muscles and the transfer of the separate muscle contraction ability of the healthy side (see first period) to the affected side. During the same period, it is recommended to carry out treatment with one position according to a known method, but the time is reduced to 2-3 hours every other day.

Apply drug treatment ;; Recovery course: Gliatilin 1000 mg 2 times a day, with a gradual decrease in dosage to 400 mg 2 times a day for a month; Preaching 400 mg once a day for 10 days; Cavinton 5 mg 2 times a day for a month. Two weeks after the course, start taking 2 ml of Vazobral and 250 mg of Pantogam once a day for a month, followed by taking glycine 1/2 tab. At night under the tongue, further increasing the dose on 1 tablet.

With paresis of the VII nerve, physical methods of treatment are often used in the absence of contraindications (severe general condition of the patient, trophic disorders on the face, presence of blood in the cerebrospinal fluid, development of meningoencephalitis after trauma). For the first 7-10 days after nerve damage, a Solux is prescribed, Minin's reflector on the affected half of the face, 10-15 minutes a day. Iodine electrophoresis of the ear is used endoaurally. To do this, the ear canal and auricle are filled with a gauze swab dipped in a medicinal solution. An electrode cathode is placed on the swab. The second electrode 6 x 8 cm is placed on the opposite cheek every other day or daily, current strength 1-2 mA, 15-20 minutes. Electroplating is also used with a current of 1 mA to 5 mA for 15 to 20 minutes and 10 to 15 procedures. Electrophoresis with proserine 0.1% and 10% 2% in the form of a Bourguignon half mask are often shown; Amperage from 1 mA to 3-5 mA for 20 minutes, 10-15 sessions per course; UHF with a power of 40-60 watts at a distance of electrodes 2 cm from the face for 10-15 minutes, without feeling hot, 10-15 sessions per course.

To restore the functions of the facial muscles, electrical stimulation is advisable. It begins 3-4 weeks after the injury, taking into account the data of electrical diagnostics. Typically, a technique is used that combines electrical stimulation with "voluntary" movements - the so-called "active" stimulation method. The electrical stimulation of paretic mice is carried out under control of the patient's reactions (occurrence of pain) taking into account his general condition (daily sessions for 15 to 20 minutes with two electrodes with an area of ​​2 to 3 cm², a pulse current with a pulse frequency of 100 and a current strength from 8 to 16 mA). With the occurrence of a pronounced pain reaction, the strength of the current decreases.

The treatment with heat in the form of paraffin, ozokerite and mud applications is also shown (session duration 15 to 20 minutes, temperature 50 to 52 ° C, for a course of 12 to 18 procedures). Heat applications should cover the face, mastoid and neck areas.

Complications

Motor deficit due to paresis of the VII nerve not only leads to a cosmetic defect, but also interferes with the usefulness of chewing and swallowing and changes phonation. Neuroparalytic keratitis, which is caused by lagophthalmos in patients with facial nerve damage and lacrimation disorders, ultimately leads to scarring of the cornea and even loss of the eye. All of this together reduces the quality of life of the victim and causes them severe emotional trauma.

CAUDAL NERVE DAMAGE

Caudal nerves suffer from: severe TBI when the brain stem is damaged, craniocervical injury with damage to the atlas, penetrating wounds of the craniocervical region with damage to the soft tissues of the neck. A case of tongue paralysis due to tractional detachment of both nerves from the base of the skull during head trauma is described.

With a bilateral lesion of the glossopharyngeal nerve, movement disorders can be one of the manifestations of bulbar paralysis, which occurs with combined damage to the nuclei, roots or trunks of nerves IX, X, XII. When the vagus nerve is damaged, swallowing, voice, articulation, and breathing disorders develop (bulbar palsy). Lesions of the vagus nerve manifest as symptoms of irritation or symptoms of loss of function.

In case of damage to the tail nerves, conservative therapy is prescribed aimed at improving conduction of excitation in the neuromuscular synapses and restoring neuromuscular conduction (Proserin 0.05%, 1 ml subcutaneously daily for 10 days, then Galantamine 1%, 1 ml subcutaneously; Oxazil 0.05, Gliatilin 1 g twice daily Preventing aspiration of food and saliva is important.

If the trapezoid muscles are paralyzed, the accessory nerve is surgically reconstructed on its additional skull segments. No description of the reconstruction of intracranial segments has been found in the literature. Damage to the tongue nerve is often associated with damage to the extracranial part of the carotid artery (in the neck). In this regard, the reconstruction operation in the acute phase of the trauma is performed using microsurgical techniques.

O. N. Dreval, I. A. Shirshov, E. B. Sungurov, A. V. Kuznetsov

Focal macrostructural damage to the substance as a result of trauma is known as brain contusion.

According to the unified clinical classification of TBI adopted in Russia, focal brain injuries are divided into three degrees of severity: 1) mild, 2) moderate, and 3) severe.

Diffuse axonal brain injuries include complete and / or partially widespread axonal ruptures in more frequent combination with small focal hemorrhages caused by trauma of a predominantly sluggish type. At the same time, the most characteristic areas are axonal and vascular bunks.

In most cases it is a complication of high blood pressure and arteriosclerosis. More rarely, they are caused by valve disorders, myocardial infarction, severe cerebral vascular abnormalities, hemorrhagic syndrome, and arteritis. A distinction is made between ischemic and hemorrhagic strokes and p.

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