Facial twitch stylomastoid thermocoagulation

Percutaneous radiofrequency thermocoagulation is a new technology developed since the 1970s. Hori (1981) used it to treat facial muscle twitching, which gradually attracted people's attention. The advantage of this method is as follows: 1 After the needle tip is inserted into the stem of the stem, the position of the electrode can be determined by electrical stimulation, so that the nerve bundle causing facial muscle twitch can be selectively destroyed. 2 Using RF temperature-controlled quantitative destruction method to destroy the facial nerve trunk, by controlling the temperature, time, electrode thickness and shape of the thermocoagulation, the range of tissue damage can be accurately determined, and does not exceed 100 °C, and does not cause tissue charring, adhesion and Postoperative bleeding. This improves surgical safety, creates conditions for the selective manufacture of controllable lesions, is easier to control than ethanol injection, and is completely reliable. Treatment of diseases: facial muscle twitching Indication Facial muscle twitching stem pore thermocoagulation is suitable for patients who can not craniotomy for microvascular neurovascular decompression, and no other treatment, but also tolerate postoperative facial spasm. Although a certain degree of hemifacial spasm can still be produced after surgery, if it is properly controlled, it will not cause permanent facial paralysis and other complications. Surgical procedure The method of stem puncture is the same as the method of "ethanol injection of the facial muscles to suck the stem and the pores of the stems". Generally, after the needle tip is inserted into the stem of the stem, attention should be paid to the changes of the lateral muscle strength. Sometimes the facial paralysis occurs immediately after the needle tip is inserted, indicating that the needle tip is too close to the facial nerve, causing mechanical nerve damage. The needle should be pulled out 2 to 3 mm. After a few minutes, the facial muscle strength is restored, and then the treatment is continued. . If the sputum does not recover after the needle is removed, it indicates that the nerve damage is heavier, and it should be recovered after a few days. If there is still facial muscle convulsion, then treatment. If the puncture is satisfactory, the RF electrode with a miniature thermistor at the head end can be inserted, and the tip 3 to 5 mm is exposed outside the puncture needle, and the square wave current of 60 times per second is used for stimulation. Facial muscle contraction usually occurs at 0.5-1.5V electrical stimulation, indicating that the electrode is already near the nerve, but 0.8-1.2V can cause facial muscle contraction as the most suitable position for the electrode. The voltage is less than 0.8V, indicating that the electrode is too close to the nerve, and the thermal coagulation can cause serious damage to the nerve, and the facial paralysis is not easy to recover. If the voltage exceeds 2V, there is still no response, indicating that the two are far apart and should be re-punctured. According to the anatomical study of Kempe (1980), although the fibers of the total facial nerve are rotated and displaced during the walking, the level of the stem pores can be divided into three groups: the inner bundle of the rim of the rim is located on the anterior medial side. When electrical stimulation can cause movements such as closure, lip extension and whistling; 2 nerve bundles with orbicularis oculi muscle are located in the anterolateral side, electrical stimulation can cause eyelid closure and other actions; 3 dominating facial muscles (including frontal muscles, frowning muscles, The nerve bundles of the upper lip muscle, the horn muscle, the platysma, etc. are mostly located at the back. The electrical stimulation can cause eyebrow lifting, frowning, lifting or lowering of the mouth, deepening of the nasolabial fold or contraction of the platysma. If the electrode is small, the above three different nerve bundles can be distinguished to make a key damage to the corresponding nerve bundle according to the characteristics of the patient's facial muscle twitch. In order to control the facial muscle twitching, it is possible to retain the contraction function of other facial muscles as much as possible, and to reduce the hemifacial spasm. The regulation of the heat setting temperature: the initial use of 45 ~ 50 ° C low temperature, so that only the formation of reversible nerve damage, such as edema, can be gradually increased to 60 ~ 70 ° C, in order to make permanent damage. Each time the heat setting time is 10~15s, it can't exceed 30s, and the heat setting will be interrupted at any time according to the condition of the face, so as not to be too heavy to recover. Sudden convulsions and no face defects, it is easy to relapse. If the convulsion stops and there is a slight facial paralysis, it does not affect the appearance and the effect is lasting. Among them, the condition of the eye muscle is the easiest to grasp. In the treatment, the muscle strength can be divided into 6 levels: 0, can not close the eyes, full sputum; 1 level, only closed eyes movement; 2, closed eyes white (ball conjunctiva); 3, closed eyes exposed; Level 4, can close eyes but weak; level 5, normal. In most patients with muscle strength of 3 to 4, facial muscle twitching can be completely stopped. A small number of patients are close to 3 to 4, and convulsions are still uncontrolled and treatment should be stopped. These patients often stop twitching after 2 to 3 days, possibly due to edema of the nerves and surrounding tissues. A small number of patients with uncontrolled convulsions were treated repeatedly after 1 week. complication As with ethanol injection, the most common is peripheral facial paralysis, but it is easier to control than ethanol injection, so it is less severe. The key to controlling facial paralysis is to properly grasp the extent of facial nerve destruction. As long as the operation is appropriate, the changes in facial muscle strength are constantly observed during the treatment, and the thermocoagulation is stopped at an appropriate time, so that even after a certain degree of facial paralysis occurs, it can be gradually recovered. Another disadvantage of facial muscle twitching stem pore thermocoagulation is that it is prone to recurrence. Generally, the lighter the residual facial paralysis, the lesser the nerve damage and the higher the recurrence rate. Therefore, it should be well treated when mild facial paralysis occurs. . In addition, due to the simple operation of this method, the patient has less pain, and the curative effect is reliable and safe. Repeated treatment can be repeated despite recurrence.

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