Classical electrodiagnostics as a method for determining neuromuscular disorders in the postoperative period of extranasal interventions

Introduction . Due to reactive postoperative process in the soft tissues of the cheek during extranasal procedures, as well as possible direct intraoperative damage to nerve endings (both sensory and motor), changes in neuromuscular conduction can sometimes be observed. To diagnose this phenomenon, it seems reasonable to use classical electrodiagnostics and quantitatively measure the excitability of facial muscles. Purpose : to evaluate changes in neuromuscular conduction in patients undergoing extranasal procedures on the maxillary sinuses, using an additional preoperative planning step – determination of the optimal approach using personalized 3D models. Methods . During the scientific study, electrodiagnostics were performed on all 60 patients from both the control and study groups to assess neuromuscular conduction disturbances. To determine the dynamics of changes in neuromuscular conduction, electrodiagnostics were measured at Erb᾽s motor points corresponding to the levator labii superioris, levator anguli oris, superior and inferior portions of the orbicularis oris, and the exit point of the second branch of the facial nerve before surgery, then on the 10th and 30th days after surgery. To calculate statistically significant differences between groups, the change in rheobase value on day 10 from baseline and on day 30 from baseline was calculated. The following limits were chosen to assess current fluctuations: a change in value within 10 % of baseline, from 10 % to 20 %, and over 20 %. Results . Based on measurements at all points on days 10 and 30 post-surgery, the rheobase change in the group of patients who underwent preoperative planning was statistically significantly less than in the control group, with the exception of the exit point of the second branch of the facial nerve on day 30. In this case, there were no statistically significant differences between the groups. These results indicate less tissue trauma and faster restoration of neuromuscular conduction during surgery with individualized determination of the optimal location of the trepanation defect. Conclusion . Based on the presented calculations, it can be concluded, that in the study group of patients, who additionally underwent preoperative planning to determine the optimal location for the trephine access, the change in rheobase was statistically significantly smaller than in the control group, indicating less tissue trauma during surgery.