Vestibüler Schwannoma Cerrahisi Sonrası Fasiyal Parezisi Gelişen Hastalarda Fizyoterapinin Etkinliğinin Değerlendirilmesi

Year 2019, Issue: 9, 881 - 889, 31.12.2019

Serdar Çevik , Şeyda Öte Karaca

https://doi.org/10.38079/igusabder.647796

Abstract

Amaç: Bu çalışmanın amacı, Vestibüler schwannoma (VS) cerrahisi sonrası fasiyal fonksiyon kaybı gelişen hastalarda erken dönemde uygulanan fizyoterapinin etkinliğini değerlendirmektir.

Yöntem: 2015-2018 yılları arasında retrosigmoid girişim ile tama yakın VS rezeksiyonu uygulanan hastalar retrospektif olarak incelendi. Hastaların demografik bilgileri, nörolojik muayene bulguları ve histopatolojik inceleme raporları tıbbı kayıt sisteminden elde edildi. Fasiyal sinir hasarı değerlendirmesi House–Brackmann derecelendirme ölçeği kullanılarak tanımlandı. Tüm hastalara postoperatif erken dönemde mimik kaslarında hiperemi oluşturmaya ve kas tonusunun korunmasına yönelik masaj uygulaması yapıldı. Bozulan sinir iletiminin elektriksel olarak uyarılması ve kas kitlesinin korunması için elektrik stimülasyonu uygulandı. Ayrıca günde 5 er dakika, 3 mhz frekansında ultrasound uygulaması yapıldı. Ameliyat sonrası tüm hastalar 1,3, 6 ay klinik muayene ve 3. ayda kontrol MRG ile düzenli olarak takip edildi. 

Bulgular: Hastaların postoperatif erken dönem fasiyal sinir fonksiyonu 2.9 (aralık: 2-5) idi ve 1. ay, 3. ay ve 6. ay kontrollerinde ortalama fasiyal sinir fonksiyonu sırasıyla 2.3 (aralık: 1-4), 2.1 (aralık: 1-4) ve 1.8 (aralık: 1-4) idi. Vestibüler schwannoma rezeksiyonu sonrası fasiyal paralizi gelişen hastalarda postoperatif erken dönem ve 6. ay kontrol fasiyal sinir fonksiyonları karşılaştırıldığında istatiksel olarak anlamlı derecede iyileşme olduğu görülmüştür. (p=0.001)

Sonuç: Çalışmamızın sonuçları, erken dönem fizyoterapi ile VS rezeksiyonu sonrası gelişen fasiyal sinir fonksiyon kayıpların geri kazanılmasında etkin olduğunu göstermektedir.

Keywords

Vestibüler Schwannoma, fasiyal parezi, fizyoterapi

Evaluation of the Efficacy of Physiotherapy in Patients with Facial Paresis after Vestibular Schwannoma Surgery

Abstract

Aim: The aim of this study was to evaluate the efficacy of early physiotherapy in patients with facial dysfunction after vestibular schwannoma (VS) surgery.

Methods: The patients who underwent a gross total VS resection by retrosigmoid procedure between 2015-2018 were retrospectively evaluated. Demographic data, neurological examination findings, and histopathological examination reports were obtained from the medical registry. The facial nerve injury was assessed using the House – Brackmann rating scale. All patients underwent massage in the early postoperative period to induce hyperemia in the mimic muscles and to preserve muscle tone. Electrical stimulation was applied to electrical stimulation of impaired nerve conduction and to preserve muscle mass. In addition, 5 minutes per day, 3 MHz frequency ultrasound was applied. Postoperatively, all patients were followed up by clinical examination at 1.3, 6 months, and control MRI at 3 months. 

Results: Early postoperative facial nerve function of the patients was 2.9 (range: 2-5) and the mean facial nerve function was 2.3 (range: 1-4), 2.1 (range: 1) and 1.8 (range: 1-4) at the 1st month, 3rd month and 6th month controls, respectively. In patients who developed facial paralysis after vestibular schwannoma resection, early postoperative and 6th month control facial nerve functions were significantly improved (p = 0.001).

Conclusion: The results of our study show that it is effective in recovering facial nerve function losses after VS resection with early physiotherapy.

Keywords

Vestibular schwannoma, facial nerve paralysis, physiotherapy

References

• Bateman N, Nikolopoulos TP, Robinson K, O’Donoghue GM. Impairments, disabilities, and handicaps after acoustic neuroma surgery. Clin Otolaryngol Allied Sci. 2000;25:62-65.
• da Cruz MJ, Moffat DA, Hardy DG. Postoperative quality of life in vestibular schwannoma patients measured by the SF36 Health Questionnaire. Laryngoscope. 2000;110:151-155.
• Jorgensen BG, Pedersen CB. Acoustic neuroma: follow-up of 78 patients. Clin Otolaryngol Allied Sci. 1994;19:478-484.
• Lohne V, Bjornsborg E, Westerby R, Heiberg E. Effects of facial paralysis after acoustic neuroma surgery in Norway. J Neurosci Nurs. 1987;19:123-131.
• Magliulo G, Zardo F, Damico R, Varacalli S, Forino M. Acoustic neuroma: postoperative quality of life. J Otolaryngol. 2000;29:344-347.
• Martin HC, Sethi J, Lang D, Neil-Dwyer G, Lutman ME, Yardley L. Patient assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg. 2001;94:211-216.
• Samii M, Matthies C. Management of 1000 vestibular schwannomas: surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 1997;40:1-21.
• VanSwearingen JM, Cohn JF, Turnbull J, Mrzai T, Johnson P. Psychological distress: linking impairment with disability in facial neuromotor disorders. Otolaryngol Head Neck Surg. 1998;118:790-796.
• Teixeira LJ, Soares BG, Vieira VP, Prado GF. Physical therapy for Bell s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2008;16:CD006283.
• House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(02):146–147.
• Harner SG, Daube JR, Beatty CW. Intraoperative monitoring of facial nerve. Laryngoscope. 1988;98:209–212.
• Magliulo G, Petti R, Vingolo GM, Ronzoni R, Cristofari P. Facial nerve monitoring of skull base and cerebellopontine angle lesions. Eur Arch Otorhinolaryngol [Suppl]. 1994;251:314–315.
• Prass RL, Kinney SE, Hardy RW, Hahn JF, Ludders H. Acoustic (loudspeaker) facial EMG monitoring: use of evoked EMG activity during acoustic neuroma resection (part 2). Otolaryngol Head Neck Surg. 1987;97:542–551.
• Silverstein H, Rosenberg SI, Flanzer JM, Wanamaker HH, Seidman MD. An algorithm for the management of acoustic neuromas regarding age, hearing, tumor size, and symptoms. Otolaryngol Head Neck Surg. 1993;108:1–10.
• van Leeuwen JP, Cremers CW, Theunissen EJ, Marres EH, Meyer E. Translabyrinthine and transotic surgery for acoustic neuroma. Clin Otolaryngol. 1994;19:491–495.
• Freeman SR, Ramsden RT, Saeed SR, et al. Revision surgery for residual or recurrent vestibular schwannoma. Otol Neurotol. 2007;28:1076–82.
• Ryzenman JM, Pensak ML, Tew JM Jr. Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery. Otol Neurotol. 2005;26:516-521.
• Bradbury ET, Simons W, Sanders R. Psychological and social factors in reconstructive surgery for hemi-facial palsy. J Plast Reconstr Aesthet Surg. 2006;59:272-278.
• Lee J, Fung K, Lownie SP, Parnes LS. Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma. Arch Otolaryngol Head Neck Surg. 2007;133(1):56-60.
• Vanswearingen J. Facial rehabilitation: a neuromuscular reeducation, patient-centered approach. Facial Plast Surg. 2008;24:250-259.