Treatment of central and peripheral paresis of the facial nerve. Lesions of the facial nerve in medical practice. Artemisia applications

Description:

The facial nerve is characterized by a relatively acute development of dysfunction of the facial muscles. At the same time, on the affected side there are no folds in the forehead, the nasolabial fold is smoothed, and the corner of the mouth is lowered. The patient cannot wrinkle his forehead, frown his eyebrows, close his eye (“hare eye”), puff out his cheek, whistle, or blow out a burning candle. When teeth are bared, a lack of movement on the affected side is revealed, and slower and less frequent blinking occurs here. On the side of the muscle paralysis, salivation is increased, saliva flows from the corner of the mouth. When the peripheral parts of the nerve are damaged, facial pain is often observed, which may precede the development of paralysis of the facial muscles. Depending on the level of nerve damage, motor disturbances may be combined with taste disorders on the anterior half of the tongue and increased hearing. A hare's eye is often combined with impaired lacrimation (dry conjunctiva), which can lead to the development.
The onset of the disease is acute, then during the first 2 weeks the condition begins to improve. The lack of restoration of movements of facial muscles within a month is alarming regarding the possibility of the development of irreversible changes in the nerve. In this case, an unfavorable symptom is the development of keratitis (due to drying of the conjunctiva of the eye on the side of paralysis) and paralyzed muscles (the nasolabial fold is emphasized, as a result of contraction of the orbicularis oculi muscle, the palpebral fissure narrows, tic-like twitching of the facial muscles is observed).

Symptoms:

Damage to the motor portion of the facial nerve leads to peripheral paralysis of the innervated muscles - the so-called. peripheral paralysis n.facialis. In this case, facial asymmetry develops, noticeable at rest and sharply increasing with facial movements. Half of the face on the affected side is motionless. When trying to wrinkle the skin of the forehead into folds on this side, the skin of the forehead does not gather, and the patient is unable to close his eyes. When you try to close your eyes, the eyeball on the affected side turns upward (Bell's sign) and a strip of sclera becomes visible through the gaping palpebral fissure (hare's eye). In the case of moderate paresis of the orbicularis oculi muscle, the patient is usually able to close both eyes, but cannot close the eye on the affected side, while leaving the eye on the healthy side open (eyelid dyskinesia, or Revillot's sign). It should be noted that during sleep the eye closes better (relaxation of the muscle that lifts the upper eyelid). When the cheeks are puffed out, the air comes out through the paralyzed corner of the mouth, the cheek on the same side “sails” (sail symptom). The nasolabial fold on the side of the muscle paralysis is smoothed, the corner of the mouth is lowered. Passive lifting of the corners of the patient's mouth with fingers leads to the fact that the corner of the mouth on the side of the lesion of the facial nerve rises higher due to decreased muscle tone (Russetsky's symptom). When you try to bare your teeth on the side of the paralyzed orbicularis oris muscle, they remain covered with your lips. In this regard, the asymmetry of the oral fissure is roughly expressed; the oral fissure is somewhat reminiscent of a tennis racket, with the handle turned towards the affected side (racket symptom). A patient with paralysis of the facial muscles caused by damage to the facial nerve experiences difficulty while eating; food constantly falls behind the cheek and has to be removed from there with the tongue. Sometimes there is biting of the mucous membrane of the cheek on the side of paralysis. Liquid food and saliva may leak from the corner of the mouth on the affected side. The patient also experiences a certain awkwardness when speaking. It is difficult for him to whistle or blow out a candle.

Due to paresis of the orbicularis oculi muscle (paretic lower eyelid), the tear does not completely enter the lacrimal canal and flows out - the impression of increased lacrimation is created.

With neuropathy of the facial nerve in the late period, contracture may appear with the face pulled to the healthy side.

After peripheral paralysis of the n.facialis, partial or incorrect regeneration of damaged fibers, especially vegetative ones, is possible. The surviving fibers can send new axons to the damaged parts of the nerve. Such pathological reinnervation can explain the occurrence of contractures or synkinesis in the facial muscles. Imperfect reinnervation is associated with crocodile tears syndrome (paradoxical taste-tear reflex). It is believed that secretory fibers for the salivary glands grow into the Schwann membranes of degenerated damaged fibers that originally supplied the lacrimal gland.

Causes:

Peripheral paralysis of the facial nerve develops under the influence of cooling, infection and some other factors; spasm of the vessels of the facial nerve occurs, which leads to its swelling and a discrepancy between the diameters of the facial nerve and its canal.

Treatment:

For treatment the following is prescribed:

It is advisable to carry out treatment in a hospital setting. Treatment tactics depend on the cause, period of the disease, and the level of nerve damage. If the cause of the disease is infectious, semi-bed rest is recommended for 2-3 days, and anti-inflammatory therapy is used. In the early stages of the disease, treatment with hormones - corticosteroids (prednisolone and its analogues) is effective. Due to swelling of the nerve and pinching of it in the bone canal, diuretics (furosemide, diacarb, triampur) are used. Regardless of the cause of neuropathy, medications are prescribed that improve blood circulation in the nerve (nicotinic acid, complamine). To prevent dryness of the conjunctiva and the development of trophic disorders, it is necessary to instill albucid and vitamin drops into the eye 2-3 times a day. From 5-7 days vitamin therapy is added, on days 7-10 drugs are added that improve nerve conduction and neuromuscular transmission (prozerin). The course of treatment necessarily includes physical therapy: infrared rays, UHF electric field, laser therapy, sinusoidal modulated currents, ultrasound, massage of the collar area. From the first days of the disease, therapeutic exercises are prescribed. Acupuncture is used for all forms of the disease.

Facial nerve paresis is a disease of the nervous system characterized by impaired functioning of the facial muscles. As a rule, a unilateral lesion is observed, but total paresis is not excluded. The pathogenesis of the disease is based on a disruption in the transmission of nerve impulses due to trauma to the trigeminal nerve. The main symptom indicating the progression of facial nerve paresis is facial asymmetry or the complete absence of motor activity of muscle structures on the side of the lesion.

The most common cause of paresis is an infectious disease that affects the upper airways. But in fact, there are much more reasons that can provoke nerve paresis. This pathology can be eliminated if you contact a medical facility in a timely manner and undergo a full course of treatment, including drug therapy, massage, and physiotherapy.

Facial nerve paresis is a disease that is not uncommon. Medical statistics are such that it is diagnosed in approximately 20 people out of 100 thousand people. More often it progresses in people over 40 years of age. Pathology has no restrictions regarding gender. It affects both men and women with equal frequency. Trigeminal nerve palsy is often detected in newborns.

The main task of the trigeminal nerve is to innervate the muscle structures of the face. If it is injured, nerve impulses cannot fully travel along the nerve fiber. As a result, muscle structures weaken and cannot fully perform their functions. The trigeminal nerve also innervates the lacrimal and salivary glands, sensory fibers of the epidermis on the face and taste buds located on the surface of the tongue. If the nerve fiber is damaged, all of these elements cease to function normally.

Etiology

Paresis of the facial nerve can act in two qualities - an independent nosological unit, and a symptom of a pathology already progressing in the human body. The reasons for the progression of the disease are different, therefore, based on them, it is classified into:

• idiopathic lesion;
• secondary damage (progressing due to trauma or inflammation).

The most common cause of nerve fiber paresis in the facial area is severe hypothermia of the head and parotid area. But the following reasons can also provoke the disease:

• pathogenic activity of the virus;
• respiratory pathologies of the upper airways;
• head injuries of varying severity;
• damage to the nerve fiber;
• damage to the nerve fiber during surgery in the facial area;

Another reason that can provoke paresis is a violation of blood circulation in the facial area. This is often observed with the following ailments:

The trigeminal nerve is often damaged during various dental procedures. For example, tooth extraction, root apex resection, opening of abscesses, root canal treatment.

Varieties

Clinicians distinguish three types of trigeminal nerve paresis:

• peripheral. This is the type that is diagnosed most often. It can manifest itself in both an adult and a child. The first symptom of peripheral paresis is severe pain behind the ears. As a rule, it appears on one side of the head. If you palpate the muscle structures at this time, you can identify their weakness. The peripheral form of the disease is usually a consequence of the progression of inflammatory processes that provoke swelling of the nerve fiber. As a result, nerve impulses sent by the brain cannot fully pass through the face. In the medical literature, peripheral paralysis is also called Bell's palsy;
• central. This form of the disease is diagnosed somewhat less frequently than the peripheral one. It is very severe and difficult to treat. It can develop in both adults and children. With central paresis, atrophy of the muscle structures on the face is observed, as a result of which everything that is localized below the nose sags. The pathological process does not affect the forehead and visual apparatus. It is noteworthy that as a result of this the patient does not lose his ability to distinguish taste. During palpation, it can be noted that the muscles are under strong tension. Central paresis does not always manifest itself unilaterally. Bilateral damage is also possible. The main reason for the progression of the disease is damage to neurons located in the brain;
• congenital. Trigeminal nerve palsy in newborns is rarely diagnosed. If the pathology is mild or moderate in severity, then doctors prescribe massage and gymnastics for the child. Massage of the facial area will help normalize the functioning of the affected nerve fiber, and also normalize blood circulation in this area. In severe cases, massage is not an effective treatment method, so doctors resort to surgical intervention. Only this method of treatment will restore innervation to the facial area.

Degrees

Doctors divide the severity of trigeminal nerve paresis into three degrees:

• light. In this case, the symptoms are mild. A slight distortion of the mouth may occur on the side where the lesion is localized. A sick person must make an effort to frown or close his eyes;
• average. A characteristic symptom is lagophthalmos. A person can practically not move the muscles in the upper part of the face. If you ask him to move his lips or puff out his cheeks, he will not be able to do this;
• heavy. The asymmetry of the face is very pronounced. Characteristic symptoms are that the mouth is severely distorted, the eye on the affected side practically cannot close.

Symptoms

The severity of symptoms directly depends on the type of lesion, as well as on the severity of the pathological process:

• smoothing the nasolabial fold;
• drooping corner of the mouth;
• the eye on the affected side may be unnaturally wide open. Lagophthalmos is also observed;
• water and food flows out of the slightly open half of the mouth;
• a sick person cannot wrinkle his forehead much;
• a characteristic symptom is deterioration or complete loss of taste;
• auditory function may become somewhat worse in the first few days of pathology progression. This causes great discomfort to the patient;
• lacrimation. This symptom manifests itself especially clearly during meals;
• the patient cannot pull the lip into a “tube”;
• pain syndrome localized behind the ear.

Diagnostics

A doctor’s pathology clinic usually leaves no doubt that the patient’s trigeminal nerve paresis is progressing. In order to exclude pathologies of the ENT organs, the patient may additionally be referred for a consultation with an otolaryngologist. If the cause of such symptoms cannot be clarified, then the following diagnostic techniques may be additionally prescribed:

• head scan;
• electromyography.

Therapeutic measures

This disease must be treated as soon as the diagnosis has been made. Timely and complete treatment is the key to restoring the functioning of the nerve fibers of the facial area. If the disease is neglected, the consequences can be disastrous.

Treatment of paresis should only be comprehensive and include:

• eliminating the factor that provoked the disease;
• drug treatment;
• physiotherapeutic procedures;
• massage;
• surgical intervention (in severe cases).

Drug treatment of paresis involves the use of the following pharmaceuticals:

• analgesics;
• decongestants;
• vitamin and mineral complexes;
• corticosteroids. Prescribe with caution if the pathology progresses in the child;
• vasodilators;
• artificial tears;
• sedatives.

Physiotherapeutic treatment:

• Sollux lamp;
• paraffin therapy;
• phonophoresis.

Massage for paresis is prescribed to everyone - from newborns to adults. This method of treatment produces the most positive results in cases of mild to moderate damage. Massage helps restore the functioning of muscle structures. Sessions are carried out a week after the onset of paresis progression. It is worth considering that massage has specific features, so it should only be entrusted to a highly qualified specialist.

Massage technique:

• warming up the neck muscles - you should bend your head;
• massage begins with the neck and back of the head;
• You should massage not only the sore side, but also the healthy one;
• an important condition for a quality massage is that all movements should be carried out along the lines of lymph outflow;
• if the muscle structures are very painful, then the massage should be superficial and light;
• It is not recommended to massage the localization of lymph nodes.

Pathology should be treated only in a hospital setting. Only in this way will doctors have the opportunity to monitor the patient’s condition and observe if there are positive dynamics from the chosen treatment tactics. If necessary, the treatment plan can be adjusted.

Some people prefer traditional medicine, but it is not recommended to treat paresis in this way alone. They can be used as an adjunct to primary therapy, but not as individual therapy. Otherwise, the consequences of such treatment can be disastrous.

Complications

In case of untimely or incomplete therapy, the consequences may be as follows:

• irreversible damage to the nerve fiber;
• improper nerve restoration;
• complete or partial blindness.

When the pathological focus is localized in the cerebral cortex or along the corticonuclear pathways related to the facial nerve system, central paralysis of the facial nerve develops. In this case, central paralysis or, more often, paresis develops on the side opposite to the pathological focus, only in the muscles of the lower part of the face, the innervation of which is provided through the lower part of the nucleus of the facial nerve. Paresis of the facial muscles of the central type is usually combined with hemiparesis.

With a purely limited focus in the cortical projection zone of the facial nerve, a lag in the corner of the mouth on the opposite half of the face in relation to the pathological focus is detected only with arbitrary baring of the teeth. This asymmetry is completely leveled out during emotionally expressive reactions (during laughter and crying), because the reflex ring of these reactions closes at the level of the limbic-subcortical-reticular complex. In this regard, despite the existence of supranuclear palsy, the facial muscles are capable of involuntary movements in the form of a clonic tic or tonic facial spasm, since the connections of the facial nerve with the extrapyramidal system are preserved. A combination of isolated supranuclear palsy and attacks of Jacksonian epilepsy is possible.

VIII pair of cranial nerves - prevestibulocochlearis nerve (n. Vestibulocochlearis) General characteristics

The prevestibular nerve is a nerve of special (vestibular and auditory) sensitivity. Consists of two parts – pre-auditory and auditory.

The vestibular nerve (n.vestibularis) is formed by the central processes of the bipolar cells of the ganglion vestibulare Scarpe, located at the bottom of the internal auditory canal. The peripheral processes of the cells of the node are directed to the receptors of the vestibular analyzer, which are located in the ampoules of the semicircular canals, the sac and the uterus of the vestibule. The area occupied by the terminal perceptive apparatus in the utriculus et sacculus is called the macula, and in the ampullae of the semicircular canals - crista. In the uterus (utriculus) and sac (sacculus), on top of the hairs of sensitive cells, there is a gelatinous mass containing crystals of lime carbonate (otoliths). The ampoules of the semicircular canals have projections (crista), there are no otoliths, but the gelatinous mass is also located on top of the epithelial hairs. The semicircular canals regulate the dynamic balance of a person (in a state of movement); the receptors of the utricle and saccule are regulators of static balance, that is, the balance of posture. The peripheral processes of the cells of the vestibular node, going to the receptors, form the anterior, posterior and lateral ampullary nerves (nn. ampullares ant., post. et lat.); elliptical - saccular - ampullary nerve (n. utriculoampullaris) and spherical - saccular nerve (n. saccularis). The central processes of the cells of the Scarpian ganglion, forming the vestibular part of the VIII nerve, are sent to the brain stem and end on the vestibular nuclei of the pons.

The auditory (cochlear) part of the VIII nerve (n. cochlearis) starts from the ganglion spirale (spiral or cochlear node), located at the base of the bony spiral plate of the cochlea. The dendrites of the bipolar cells of this node go to the receptor cells of the organ of Corti, which is the peripheral part of the auditory analyzer. The central processes of these cells follow through the canalis longitudinalis modioli into the internal auditory canal, join the vestibular part of the prevestibular nerve and enter the brainstem in the region of the cerebellopontine angle and end at the superior and inferior auditory nuclei of the pons.

The facial nerve passes through a narrow canal, which causes its possible damage due to infections, injuries, and hormonal imbalances. When this happens, facial nerve paresis (paralysis) occurs, with possible pain. This disease usually involves weakening of the facial muscles; its symptoms are noticeable: one half of the face “sags”, the folds on it are smoothed out, and the mouth warps to one side. When it is severe, it becomes difficult to cover the eye with the eyelid.

The disease has an acute course, develops in a few hours and lasts two weeks (as can be judged from the patients’ medical histories), after which the symptoms, under therapeutic influence or independently, weaken and go away. Treatment should be prescribed from the first days of the onset of paresis to avoid the development of complications.

When doctors talk about paresis, they mean weakened function. Paralysis means its complete loss and absence of voluntary movements.

When does paresis develop?

The main possible reasons for the development of the disease:

• traumatic brain injury;
• infectious diseases (borreliosis, herpes, chickenpox, influenza, measles, etc.);
• hypothermia (mainly, infection develops against its background);
• circulatory disorders, stroke;
• otitis;
• neurosurgical treatment;
• inflammation of the brain and its membranes;
• tumors and cysts that can compress the nerve;
• hormonal imbalance;
• autoimmune diseases.

If facial nerve paresis is diagnosed in a newborn child, the main cause is birth trauma. Much less often, nerve damage occurs in utero as a result of infection or developmental abnormalities. In an older child, the disease may develop against the background of otitis (since the facial nerve canal originates in the internal auditory canal) or during chickenpox (the facial nerve is exposed to the varicella-zoster virus).

If symptoms of paresis (paralysis) of the facial nerve are recorded, the doctor is faced with the task of finding the causes of this pathology, since it may be concomitant with a serious disease (tick-borne borreliosis, stroke, tumor). But in most cases, the exact reasons remain unknown.

Types of disease

Facial nerve palsy is divided into two types:

• peripheral;
• central.

The first is the most common; it was its symptoms that were described at the beginning of the article. Other signs that accompany the disease:

• swelling of the cheeks when pronouncing vowels (sail syndrome);
• rolling the eye upward when trying to close it (lagophthalmos);
• pain symptoms in some areas of the face, behind the ear and in the ear, back of the head, eyeball;
• impaired diction;
• saliva leaking from the corner of the lips;
• drying of the oral mucosa;
• increased sensitivity to sounds, ringing in the ears;
• hearing loss;
• decreased taste sensitivity;
• symptoms of eye damage on the affected side: lacrimation or, conversely, drying out of the mucous membrane.

In the mild stage, peripheral paresis of the facial nerve is sometimes difficult to establish. To do this, they perform a series of tests: they close their eyes and evaluate how difficult it was to do it (one eye can be closed with effort), they stretch out their lips with a tube, frown their forehead, and puff out their cheeks.

Central paresis affects the lower part of the face - one (it is opposite to the lesion) or both.

Its main symptoms:

• weakening of the muscles of the lower facial part;
• hemiparesis (partial paralysis of half the body);
• preservation of the eye and muscles of the upper facial part;
• unchanged taste sensitivity.

Central paresis mainly occurs due to or secondary to stroke.

Diagnostic procedures

Treatment of the disease should begin as soon as it is detected. Sometimes paresis of the facial nerve can go away on its own, but in which cases this will happen is difficult to predict.

The symptoms of the disease are quite clear, but before treatment, you must try to determine the reasons that caused the paresis (paralysis). In some cases, elimination of the underlying disease leads to restoration of the function of the facial nerve (this can happen, for example, with a brain tumor). For this purpose, tomography (computer or magnetic resonance imaging) is performed.

In addition, an examination of reflexes on an electroneuromyograph should be prescribed. The procedure allows you to evaluate the speed of impulses passing through the fibers, their number, as well as the location of the lesion. One way to determine the degree of paresis (paralysis) is to conduct electrogustometry.

This procedure is performed using an electroodontometer. An anode is applied to the front of the tongue, the electrodes are located 1.5 cm from the midline. The current strength is gradually increased until the patient registers a sensation of sour or metallic taste.

Paresis therapy

Treatment in the acute period is aimed at relieving swelling and inflammation and improving microcirculation. For these purposes the following is used:

• corticosteroids;
• diuretics;
• antiviral drugs (if the disease occurs against the background of herpes or chickenpox);
• antibiotics (with the development of paresis during infection, otitis media).

Gymnastics and massage can be prescribed no earlier than the third day from the onset of the disease and only under the supervision of a doctor, since independent treatment and improper use of techniques threatens the appearance of contractures and synkinesis.

1. The phenomenon of contracture consists of increased muscle tone with pain on the affected side and twitching of the facial muscles. There is a feeling of tightening of the face.
2. Synkinesis - movements that appear simultaneously with the main ones. This may include wrinkling the forehead or raising the corner of the mouth when closing the eyes. Either raising the ears or flaring the wings of the nose when closing the eyes with effort, etc.

These complications appear, as can be learned from medical histories, in 30% of all cases of facial nerve paresis. If this happens, massage and physiotherapy are temporarily canceled and the muscles are given rest.

Principles of gymnastics and massage

Therapeutic gymnastics consists of certain techniques. It could be:

• puffing out the cheeks (alternating, simultaneous);
• snorting, pronunciation of the letter “p” with a delay at the initial stage of movement;
• manual assistance when performing movements (closing eyes, wrinkling the forehead, etc.), which is performed by a specialist.

One of the recovery methods is post-isometric muscle relaxation, which is alternate short-term isometric work of the muscles and their passive stretching afterwards. This type of gymnastics is performed only under the supervision of a doctor, since it has many nuances in its implementation, failure to do which can lead to complications.

The main massage is carried out from the inside of the mouth, which allows you to define the muscles and increase blood circulation in them. In addition, acupressure is performed, since classic massage can lead to muscle strain.

During the recovery period, drugs of group B and alpha-lipoic acid, UHF, phonophoresis are also prescribed.

If the lesion is severe, treatment should be aimed at preserving the eye on the affected side of the face. Drops are used to eliminate and prevent dry mucous membranes, but if the eyelid does not droop at all, this threatens the development of keratopathy and blindness. Doctors can sew the eyelids together and insert implants into the upper eyelid to force it to droop. Currently, the injection of botulinum toxin is popular, which lasts 2-3 weeks. Injections are also effective in combating contractures and can be used for aesthetic facial correction in the future.

During the acute period of the disease, it is not recommended to treat the affected side of the face mechanically, using treatment methods such as massage and gymnastics. At home, you need to use a patch that will fix the weakened muscles on the sore side of the face. Your doctor will show you how best to do this.

Features of the course of the disease and treatment in childhood

A disease in children that is secondary in nature (that is, another disease is the cause of its occurrence) is usually accompanied by pain in the parotid region. In some cases, pain and discomfort may be experienced in various parts of the face and back of the head, depending on the location of the nerve damage.

In a child, paresis of the facial nerve usually goes away faster than in an adult.. In this case, complications may be completely absent or their degree may be minimal. Symptoms of the disease in childhood are more likely to regress on their own than in adults. However, it is necessary to treat paresis, since there is no guarantee that it will go away without therapy.

In a newborn who has suffered nerve damage during childbirth, in addition to visual signs, damage to some reflexes is noted: palatine, search, sucking, proboscis. A complication that occurs with this pathology in an infant is difficulty or complete inability to suck on the mother’s breast. In this case, feeding is carried out from a bottle with a lightweight nipple.

Therapy

Treatment for paresis begins in the maternity hospital according to the standard regimen. In some cases, doctors do not use corticosteroids, since their use in infancy can lead to complications.

A child with damage to the facial nerve often suffers from hyperacusis - it is necessary to protect him from loud sounds and not use rattles.

After the maternity hospital, treatment for paresis continues on an outpatient basis: during the recovery period, massage and physiotherapy can be prescribed. At home, parents have access to therapeutic exercises, which can be used to induce reflexes in the child.

1. The palmo-oral reflex is caused by pressing the parent's fingers on the middle of the child's palm: the baby's mouth opens slightly.
2. To trigger the proboscis reflex, you need to lightly touch the baby’s lips with your finger: his lips should stretch into a tube.
3. The search reflex is caused by stroking the baby's cheek near the corner of the lips, after which the baby moves his mouth towards.
4. The sucking reflex is formed thanks to the pacifier.

Also, at home, parents continue treatment with medications prescribed by the doctor. Massage, heating and any other influences should not be carried out independently - only in a clinic with a specialist. This will avoid the appearance of contractures and synkinesis.

If the pathology at birth is diagnosed as congenital, surgical treatment is indicated.

So, paresis of the facial nerve is a pathological condition that occurs acutely and is characterized by weakening of the muscles of one side of the face (peripheral paresis) or the lower facial part (with the central type). The causes of this phenomenon often remain unclear, but they may include tumors, infections, neurosurgical interventions, and in newborns, birth trauma. Treatment of the disease begins with medication from the first day to avoid complications. During the recovery period, massage and therapeutic exercises can be added.