Botulinum therapy within a three-stage medical rehabilitation framework for patients with disorders of craniofacial muscles

Disorders of craniofacial muscles (CFM) frequently arise from various conditions and injuries affecting the central and peripheral nervous systems, as well as from neurosurgical, reconstructive, and cosmetic interventions. The principal clinical manifestations include facial asymmetry, lagophthalmos, paralytic strabismus, synkinesis, contractures, trismus, bruxism, temporomandibular joint dysfunction, chronic facial pain, and sialorrhea. Such disorders not only restrict daily functioning but also lead to significant psychosocial maladjustment, a decline in quality of life, and increased disability among affected individuals. Despite the high prevalence of CFM dysfunction, contemporary methods for the medical rehabilitation of patients remain inconsistent, with poor regulation governing continuity among the various stages of care. This paper posits the establishment of «facial rehabilitation» as a distinct interdisciplinary approach within medical rehabilitation, integrated into the established three-stage medical rehabilitation framework in the Russian Federation. A thorough review of current literature and pertinent Russian regulatory documents has been conducted. The objectives of facial rehabilitation across the first, second, and third stages are analyzed, along with the role of botulinum therapy in comprehensive rehabilitation programs aimed at restoring impaired functions. The potential of this method for a wide range of functional, structural, and autonomic disorders of the face is considered, given the multifaceted mechanisms of action of botulinum toxin type A (BTA), including muscle-relaxant, antinociceptive, neuromodulatory, and anti-inflammatory effects. The authors present their own clinical experience demonstrating the effective use of botulinum therapy to treat trismus, paralytic strabismus, lagophthalmos, and pronounced facial asymmetry in patients with complications from neurological conditions and injuries. The findings underscore the efficacy of integrating botulinum therapy into three-stage medical rehabilitation programs, highlighting its role in preventing complications and enhancing rehabilitation potential and quality of life for patients.