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Diagnosis, treatment and rehabilitation of patients with facial neuropathy (FN) is a significant medical problem. The aim of the work was to create, implement and evaluate the effectiveness of an internal algorithm for working with patients suffering from FN.Material and methods. The study included 53 patients: group 1 (n = 27) — treatment in the first 2 weeks from the moment of development of symptoms, group 2 (n = 11) — for more than 2 weeks to 3 months, group 3 (n = 15) — for more than 1 year. The algorithm of diagnosis and treatment were created in the N.V. Sklifosovskii Research Institute of Emergency Medical Care. It includes a multidisciplinary approach, teamwork and continuity.Results. In patients with FN diff erent genesis, at the beginning of treatment in the acute period, complete restoration of the function of the facial nerve and facial muscles occurred in 74% of cases in the period from 2 weeks to 9 months, the period depended on the severity of clinical manifestations (House–Brackmann scale) (r = 0.539, p = 0.014), the degree of nerve damage according to electroneuromyography (ENMG) (r = 0.595, p = 0.006), the severity of complications (contractures and synkinesias) (r = 0.524, p = 0.018). In patients with idiopathic FN, at the beginning of treatment in the acute period, complete recovery was observed in 81.3% of cases. At the beginning of treatment of patients with a disease period of more than a year, conservative tactics led to an improvement in 67% of cases.There was an incomplete correspondence between the clinical (House–Brackmann scale) and degree of nerve damage according to ENMG (r = 0.620, p = 0.004). ENMG should be performed when the House–Brackmann is VI degree. In cases of a decrease in the amplitude of the M-response by 90% or more compared to the healthy side, needle myography (IMG) is indicated. In the absence of motor unit potentials (PDE), it is necessary to consider the issue of surgical treatment, which is indicated in the acute period of FN to every 10 patients, and after a year in cases of lack of recovery — to every second.FN should be considered a progressive disease due to the development of complications, such as the consequences of lagophthalmos, contracture, synkinesia. Lagophthalmos occurs in 73.5% of patients with various consequences — from dry eye syndrome to corneal ulcers, so it is important to use local protective and regenerating drugs early to prevent the development of keratopathies, even with a mild degree of lagophthalmos. Hypertonus of facial muscles is formed already on the 7th day of the disease on the healthy side of the face in an average of 67% of patients, and in the absence of timely treatment — in more than 90% of patients. Synkinesia develops in the period from 4 months to a year in every fifth patient. Timely detection and correction of complications prevents their further development and leads to a complete restoration of the facial nerve function.The success of recovery in FN depends more on identifying the risks of complications and carrying out their prevention. Risk factors for the development of contractures and synkinesias are: prosoplegia, facial nerve damage by more than 90% according to ENMG and gross exercises. FN, despite the different causes of its development, clinically has similar sanogenetic mechanisms, which should be used in rehabilitation.

Facial nerve neuropathy can manifest itself with gross organic and functional disorders. The esthetic defect worsens social adaptation and quality of life. However, there is no consensus, protocol or algorithm of treatment of the patient with this pathology. In article we present a modern way of treatment and rehabilitation of patients with neuropathy of a facial nerve of various etiology. Conservative and surgical types of treatment are applied during the different periods of a disease. Surgical methods of treatment can be divided into two groups: reconstructive, decompressive and also plastic. The choice of a type of operation is defined individually with many factors, including an etiology and time of a disease. Both the new and tested by time techniques are applied. Conservative therapy includes corticosteroids, antiviral, antibacterial drugs depending on a clinical situation. Traditionally specialists of policlinics and hospitals appoint additional therapy (group B vitamins, cholinesterase inhibitors, antioxidants, neuroprotectors, nootropic drugs), however single small researches couldn't enforce these drugs recommendations. Botulinum toxin type A is effective in the acute and chronic periods of a disease. Depending on a clinical situation of botulinum toxin type A are injected both in affected, and in healthy part of the face. Patients with incomplete eye closure are given keratoprotection as early as possible, and blepharography is performed in case of pronounced deficit. As an alternative method, botulinum toxin type A injections are used into the upper eyelid lifting muscle. One of the most effective methods of rehabilitation of patients with facial nerve neuropathy is therapeutic physical education such as neuromuscular retraining with biological feedback. The most optimal combination is the injection of botulinum toxin type A and therapeutic physical education.

Cases of thallium poisonings are regularly reported in media. In the present work, the world experience in diagnostics and treatment of victims with thallium poisoning has been compiled and summarized, search for clinical guidelines for the diagnostics, treatment and rehabilitation of patients has been carried out. The toxicokinetics and toxicodynamics, as well as pathophysiological mechanisms of thallium influence on the body are described in detail. Toxic and lethal concentrations of poison in biological media, as well as its tropicity to various tissues and body systems were determined. The clinical picture depending on the timing of poisoning and the dose of poison is described in detail. Difficulties of the differential diagnosis are defined. The most interesting cases of criminal and household poisonings with various terms of establishment of the diagnosis, doses of poisoning and outcomes are presented.