Five-year follow-up after neurosurgery complicated by facial neuropathy.

Background: Botulinum toxin A (BTA) injections are effective for facial neuropathy. However, there is insufficient number of studies devoted to long-term management of these patients.

Objective: To evaluate the effectiveness and safety of BTA therapy in patients with facial neuropathy after neurosurgical interventions.

Material And Methods: The study included 86 patients with facial neuropathy after surgical treatment of posterior cranial fossa and cerebellopontine angle tumors. All ones were divided into 2 groups: group I (main) - 57 patients with BTA prescribed early after facial nerve injury, group II (control) - 29 people undergoing exercise therapy, as well as special exercises and acupressure of painful muscle cords. The Sunnybrook Facial Grading Scale (SFGS) was used to assess facial symmetry and synkinesis, the Facial Disability Index (FDI scale) - to assess the quality of life. Overall duration of the study was 5 years (control points: 6 months, 1, 2, 3 and 5 years).

Results: The SFGS scores after 1, 2, 3 and 5 years were significantly better in the main group (resting symmetry <0.01, voluntary movement symmetry <0.01, synkinesis <0.01, general condition of facial muscles <0.01). Scores of physical and social functioning were significantly higher in the main group after 1 (<0.01), 2 (<0.01), 3 (<0.01) and 5 years (<0.01) after surgery. There was no need to change BTA dosage over 5 years. Thus, this form of BTA may be the most effective for synkinesis of facial muscles.

Conclusion: Correction of synkinesis caused by facial neuropathy requires long-term follow-up and long-term treatment. BTA is effective and may be recommended for long-term treatment of these patients.