The assessment of the early rehabilitation's impact on the level of disorders occurring and the process of reinnervation, on the example of facial twigs of the motor nerve in patients with craniofacial injuries

Abstract

Introduction. Lymphoedema of the skull's facial part is one of the main complications observed in a patient after surgical treatment of disorders of this area. Another noticeable and frequently reported complication by the patient is irregularities in facial expression muscles' work. A relationship between them and reducing edema performed in patients in the first days after surgery will reduce the noted disturbances in motor branches' function. Aim. To investigate the impact of early swelling reduction on the extent of nervous system disorders and its reinnervation rate. Materials and methods. Patients of the Maxillofacial Surgery Clinic of the University Clinical Hospital of the Military Medical Academy in Łódź were enrolled in the study. The study was conducted on 60 people who underwent maxillofacial surgery procedures from February to December 2019. Lymphatic drainage and dynamic taping were used to reduce patients' edema. Forty-five people were divided into three equal groups. Fifteen patients constituted the comparative group. The research tools were a survey created following the author's idea, linear measurements for measuring edema, and the Pietruski scale for assessing the state of reinnervation imaged by mimic muscle motility. On the first day after surgery, patients were examined four times, then on the third and seventh day after surgery, and finally four months after surgery. Results. The use of anti-edema therapy noticeably (from 2-5 points on the Pietruski scale) reduces the disturbances in facial expression muscles' function. The difference has been visible already on the third day after surgery. Regarding the patient's pain, the lack of manual lymphatic system development resulted in pain sensations remaining in each of the three tests performed. The occurrence of edema, pain level, and level of facial expression muscle disorders were similar between groups and made the following research objective in terms of observed relationships. Conclusions. The level of disturbances in the area of the mobility of expressive facial muscles (based on Pietruski scale) indicates that the implementation of anti edematous therapy, and thus the reduction of excess lymph, already in the first days after surgery provides a reduction of disorders of conduction of efferent impulses of motor fibers, appearing already in the first days after surgery. Increased drainage rate also accelerates the reinnervation process, shortens it by several weeks, and reduces pain symptoms.