Facial paralysis - causes, symptoms and treatment. Facial paralysis or sudden weakening of facial muscles

Facial expressions, facial sensitivity (superficial), perception of tastes and sounds. It consists of two branches, but the lesion most often affects only one of them. Therefore, signs of paresis are usually observed only on one side of the face.

Paresis facial nerve: causes

Most often, paresis develops as a result of hypothermia or previous colds. Sometimes paresis can be otogenic, occurring due to nerve damage due to inflammation of the ear (mastoiditis, otitis media) or during surgery. IN in rare cases paresis of the facial nerve becomes a consequence of tuberculosis, mumps, syphilis or polio. Damage can also occur as a result of trauma to the skull.

Facial nerve paresis: symptoms at different degrees of severity

The pathological process may have different degrees gravity. In mild cases, the patient can perform actions on the affected side of the face such as wrinkling the forehead, closing the eyes, and raising the eyebrows. Of course, these manipulations are difficult, but they are still possible. The mouth barely tilts to the healthy side. If the severity of paresis is moderate, the patient cannot close his eyes completely. When you try to wrinkle your forehead or move your eyebrow, you can see some movements, but they are very minor. When facial nerve paresis occurs severe degree, the patient cannot perform any movements on the affected side of the face. The pathological process can be acute (lasting no more than two weeks), subacute (lasting up to four weeks), chronic (lasting more than four weeks).

Facial nerve paresis: characteristic signs

With unilateral paresis of the facial muscles, the affected side becomes like a mask: wrinkles on the forehead (if any) and nasolabial folds are smoothed out, the corner of the mouth droops. When a person tries to close his eyes, complete closure does not occur, that is, a gap remains. But such signs do not appear immediately. At first, the patient will only feel numbness in the ear area, and only then, after a day or two, paresis develops. Also pathological process accompanied by loss taste sensations on the tongue on the side that is affected, dry mouth or, conversely, drooling, decreased hearing or, conversely, its aggravation, dry eyes or lacrimation.

Facial nerve paresis: diagnosis

To make a correct diagnosis, you will need to be examined by a therapist, neurologist and otolaryngologist. The main doctor in this case is a neurologist, who will prescribe necessary treatment it will be he. An examination by an otolaryngologist is necessary to exclude the possibility that the existing condition is a complication of pathology of the throat, nose or ear. The therapist gives an opinion on general condition patient's health. To determine the degree of paresis, electroneuromyography is performed. In addition, the nature of the pathological process is revealed.

Facial nerve paresis: treatment

It should be said that therapy must be started as quickly as possible, otherwise there is a risk of permanent paralysis. Also, treatment may be ineffective if the nature of the paresis is traumatic or otogenic. For treatment, vasodilators, anti-inflammatory and decongestant drugs, and antispasmodics are used. If there is pain, analgesics are additionally prescribed. Subsequent therapy is aimed at regenerating the affected nerve fibers and preventing muscle atrophy. For this purpose, physiotherapy and drugs that improve metabolism are prescribed. If conservative therapy is powerless, they resort to surgical intervention, during which the nerve is sutured, its plastic surgery is carried out, and in case of contraction, the facial muscles are corrected.

Facial nerve paresis childhood is mainly infectious or traumatic injury. A special type of paresis occurs in newborns. This is formed as a result of difficult childbirth, with long standing heads in bony pelvis mother, prolonging the period of pushing, applying forceps to the head while pushing and pressing the branches of the nerve, their hypoxia and dysfunction are formed. Such paresis is difficult to immediately recognize, and by the time it is detected, the situation may be irreversible or advanced. In children, paresis in the area of the facial nerve usually affects only one side, which leads to slight or pronounced asymmetry of the face (depending on the level of damage to the nerve branches and the severity). With paresis, the face looks distorted, the affected half has little mobility.

There are many reasons for the development of paresis. The main ones among children include hypothermia, infectious pathologies, autoimmune pathology, hormonal changes, strong pain near the nerve and nerve injury. In childhood, such lesions are usually reversible; in most children, the lesion goes away without a trace; the severity ranges from mild to moderate to severe. In mild cases, facial asymmetry is not visually detected; paresis is visible only when the muscles are tense. With moderate severity, minor deviations in the halves of the face are visually detected, intensifying with crying and screaming. In severe cases, one half of the face is almost completely immobilized.

Symptoms

Manifestations of paresis are noticeable to parents; these are palpebral fissures of different widths, on the side of the injury the eyes do not close tightly, and tears may leak. When feeding, the child does not close his mouth tightly on the affected side, milk may flow out of the mouth, he cannot suck effectively, and cries. During wakefulness, tears or mucus may flow from the nose on the affected side, facial expressions are disproportionate, the face is asymmetrical, and the corner of the mouth droops down. Older children with paresis have difficulty eating and opening their mouths wide, chewing and talking.

When palpating the affected area, pain may occur in the area of the lymph nodes, along the nerve branches, forehead, cheek and lips, dryness of the eyes and nasal passage, the tongue may partially paralyze, it deviates to the side when protruding, and taste sensations change.

Diagnosis of facial nerve paresis in a child

The basis of diagnosis is external manifestations and the baby’s inability to perform certain tests - he cannot stretch his lips into a tube, cannot wrinkle his forehead, open and close both eyes at once, raise or lower his eyebrows to the affected side, smile, stick out his tongue evenly. The exact determination of the level of nerve damage and the extent of the pathology are determined with special, topical diagnostics. For this purpose, electroneuromyography is used.

Complications

If the pathology is recognized in a timely manner, there are no health consequences; almost all children recover without complications. With advanced paresis, atrophy of facial muscles, impaired taste perception, speech disorders, facial asymmetry and cosmetic defects.

Treatment

What can you do

Parents can independently use thermal procedures in the treatment of paresis in the area of the facial nerve - a compress with a warm diaper, a bag of warm salt or sand, a boiled egg. It is necessary to protect the child from the bright sun and strong auditory irritations, and create a darkened and quiet atmosphere. It is necessary to carry out special gymnastics with the child according to his age. It is performed on newborns based on innate reflexes, and on older children based on active movements. It is important to stimulate the child to show facial expressions, talk to him and encourage him to copy your movements.

What does a doctor do

In order to relieve swelling in the area of the affected nerve, drugs for dehydration and drugs to improve local blood circulation in the area of the nerve are used. The effectiveness of treatment increases in combination with physiotherapy, stimulation of nerve function, drugs to restore trophism of the nerve trunk, drugs to activate protective forces body, vitamins. Physiotherapy is included in treatment from the very first days and a Sollux lamp is used, UHF in the affected area, and then the use of ultrasound and electrophoresis, massotherapy and the use of passive gymnastics to prevent muscle atrophy.

Prevention

The basis for the prevention of paresis in newborns is careful management of childbirth using gentle techniques for pushing. In older children, this is the prevention of infections, injuries to the face and ear area, exacerbations of herpes infection, severe hypothermia. Parents need to strictly monitor the condition of the facial muscles and consult a doctor at the slightest deviation from the norm.

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Bell's palsy (facial neuritis) is a peripheral lesion of the facial nerve that occurs for an unknown reason ( idiopathic form paralysis) and is characterized by dysfunction of facial muscles. It develops suddenly and appears in most cases on one side of the face.

ICD-10	G51.0
ICD-9	351.0
DiseasesDB	1303
MedlinePlus	000773
eMedicine	emerg/56
MeSH	D020330

General information

Mentions of neuritis of the facial nerve are found in the works of Avicenna, but he was the first to describe this type paralysis in 1821 by Scottish anatomist and physiologist Sir Charles Bell.

This is the most common lesion peripheral part facial nerve.

Bell's palsy is observed annually in 16-25 people per 100,000 population, that is, on average, it occurs once every 60-70 years of life of each person.

The disease can appear at any age and does not depend on gender. It is more often observed in people weakened by influenza or acute respiratory infections, with diabetes or during pregnancy.

Neuritis of the facial nerve in children is observed with equal frequency in girls and boys. The prevalence of the disease is 5-7 cases per 10,000.

The number of cases is higher during the cold season.

Forms

Based on the presence or absence of infection, facial nerve neuritis is distinguished:

Primary. Occurs when local hypothermia of the ear and neck area or insufficient blood supply(ischemia) of the nerve in the presence of problems with blood vessels.
Secondary. It is provoked by the presence of infection (type I herpes virus, otitis media, eustachitis, mumps, etc.).

Depending on the affected area, Bell's palsy can be:

Left-handed. In this form, the facial nerve on the left side is affected.
Right-handed. Affects only right side faces.
Double-sided. This form is rare in Bell's palsy (23% of cases), so bilateral facial palsy in most cases is associated with other diseases.

Depending on the course of the disease, there are:

acute stage, which lasts no more than 2 weeks;
subacute period, the duration of which does not exceed 4 weeks;
chronic stage, which lasts longer than 4 weeks.

Reasons for development

The cause of Bell's palsy has not been definitively established. Currently, there are arguments in favor of several theories of the etiology of facial neuritis:

Infectious. According to this theory, acute neuritis of the facial nerve develops as a consequence of a general or local infection. The theory is confirmed by the number of patients who developed Bell's palsy after a viral infection (60% of all cases of the disease). Presumably the cause of the disease is herpes simplex virus type I, since in 77% of cases of paralysis in patients, reactivation of this virus was detected in the knee node (located at the bend of the facial canal). Since HSV-1 is widely represented in the population and its presence in the geniculate ganglia was detected in healthy subjects, and the effectiveness of antiviral drugs does not have sufficient evidence, suggest the necessity of existence additional factor, provoking reactivation and reproduction of the virus. Viruses are also considered potential pathogens infectious mononucleosis, mumps, RNA-containing enteroviruses (Coxsackie), influenza and polio viruses.
Lymphogenic. Based on the vulnerability of the facial nerve located in the fallopian canal - the fallopian canal located in the pyramid of the temporal bone narrows in some places, and makes up about 70% of the area cross section canal, the thickness of the nerve column does not decrease. In this case, cervical lymphadenitis resulting from inflammatory processes causes disturbances in regional lymph circulation, prevents the outflow of lymph from the tissues surrounding the facial nerve and contributes to the occurrence of mechanical pressure on the nerve trunk. According to this theory, neuritis of the facial nerve is considered as tunnel syndrome.
Hereditary predisposition based on descriptions of familial cases of neuritis. There are isolated descriptions of the autosomal dominant type of inheritance of familial forms of lesions of the facial nerve, but the factors causing the disease vary from case to case (there are anatomically narrow fallopian canal or stylomastoid foramen, abnormalities of the vessels that supply the nerve, disorders metabolic processes). Features of the immune response are also considered a predisposing factor.
Ischemic (vascular). Various factors cause disruption of vascular tone and provoke a tendency to spasms in the vertebral or external system. carotid artery. Spasms cause ischemia of the nerve trunk, its subsequent swelling and damage in a narrow place of the bone canal. Compression of the facial nerve occurs due to collagen fibers concentrically enveloping the nerve trunk. As a result of compression, swelling appears, which contributes to compression lymphatic vessels and veins Thus, the swelling worsens, and degeneration of nerve fibers develops in the dense bone canal.

Factors that provoke the development of Bell's palsy include:

reactivation of herpes simplex virus (type I);
draft and other factors contributing to hypothermia;
arterial circulation disorders;
injuries that usually occur on the outer part of the skull (possibly damage to the bones of the skull);
developmental anomalies;
impaired metabolism;
respiratory diseases;
immunity disorders;
lymphoma or brain tumor.

Neuritis of the facial nerve is also possible as a result of anesthesia of the lower alveolar nerve by the dentist.

Pathogenesis

The pathogenesis of Bell's palsy has been discussed by physicians since the end of the 18th century, but the mechanism of development of the disease has not yet been fully established, since the causes of this type of paralysis have not been clarified.

It is known that neuritis of the facial nerve occurs when there is compression in the narrow bony canal of the facial nerve, and this compression provokes swelling of the nerve, entrapment and ischemia.

There is also dilation of the vessels that supply blood to the facial nerve. Sometimes mononuclear infiltration and nerve atrophy are detected in the lesion.

During neuritis of the facial nerve, there are 4 stages that reflect the dynamics and pathogenesis of the disease:

Stage 1, in which symptoms gradually increase. Lasts from 48 hours to 10 days and corresponds to the development of edema, acute ischemia and nerve compression.
Stage 2, in which early recovery occurs. Lasts about a month and is characterized by regression of edema and active restoration of function.
3rd stage, during which it is observed late recovery. The duration of this stage (3-4 months) is associated with incomplete and slow recovery myelin (when the nerve is compressed primarily degenerative changes concern the myelin sheath). It may be accompanied by contracture (contraction) of the facial muscles on the affected side of the face, which indicates gross changes in the facial nerve.
Stage 4, which is characterized by the presence of residual phenomena of paralysis, contractures and synkinesis as consequences of neuritis of the facial nerve. This stage is observed in patients with minor spontaneous or treatment-induced recovery over a long period (from 4 months).

Symptoms

Bell's palsy causes sudden stiffness of the face on one side. Tension and inability to control half of the face are accompanied by its asymmetry.
On the affected side:

the nasolabial fold is smoothed;
folds on the forehead disappear (they remain on the healthy half);
the eyelids are wide open, there is no way to close the eyelids tightly;
irritation of the conjunctiva and dryness of the cornea may occur;
Possible lacrimation when eating.

When trying to activate the facial muscles, a skewing of the face in the healthy direction is typical due to a sharply lowering corner of the mouth and a smoother skewing of the nose.

When trying to close the eyelids, Bell's sign is observed (in the absence of closed eyelids on one side eyeball turned upward and a white stripe of sclera is visible).

Symptoms of the disease also include:

Weakness of the facial muscles of the affected side, which reaches a maximum 48 hours after the first signs of neuritis appear. It is manifested by the inability to bare teeth, puff out cheeks, as well as the absence of facial folds on the affected side when trying to frown or raise the eyebrows upward.

The patient may feel pain due to facial nerve neuritis in the area behind auricle(occurs 1-2 days before the development of paralysis) or in the area of the temporal bone at the site of the mastoid process.

Depending on the degree of nerve damage, it is possible:

appearance painful sensitivity to perceived sounds due to increased auditory sensitivity (hyperacusis);
appearance hypersensitivity(hyperesthesia) in the ear area.

There is also loss or decreased taste sensitivity, without affecting posterior region(1/3) of the tongue.

Facial neuritis is in some cases accompanied by a slight increase in the number of cells in the cerebrospinal fluid (mild pleocytosis).

There may be difficulties with eating and diction, as patients try to use only the healthy side.

The acute period of the disease is accompanied by the development of compensatory hypertonicity of the facial muscles of the healthy side.

The recurrent course of neuritis of the facial nerve, which is observed in 3.3 - 13% of cases, is more severe, difficult to treat and is accompanied by the development of contractures, and full recovery rarely observed.

Bilateral Bell's palsy is considered an intermediate form between bilateral facial paralysis itself and the recurrent course of the disease, since symptoms of paralysis usually occur on each side after a certain time interval (cross-recurrent form). This form the disease is accompanied cervical lymphadenitis, the presence of serious vegetative-vascular pathologies, arterial hypertension or hypotension.

Neuritis of the facial nerve (symptoms and treatment) largely depends on which part of the nerve is affected by the pathological process.

Diagnostics

Since neuritis of the facial nerve is distinguished by its bright clinical picture, diagnosis is usually based on the patient's examination and medical history.

During the examination, the doctor asks the patient to frown, puff out his cheeks, close his eyes and do other similar actions, allowing to determine the degree of damage to the facial muscles. Neuritis of the facial nerve is accompanied by a sail symptom (when exhaling, there is a passive swelling of the cheek on the affected half), when closing the eyes, Bell's symptom is revealed, and weakness of the entire affected half of the face is observed (with a stroke and brain tumor, weakness of the lower part of the face is observed mainly).

In order to assess the degree of damage to the facial nerve, in case of a recent disease (up to 3 months), the K. Rosier scale is often used, which consists of 4 degrees of severity of paralysis.

The F.M. method is also used. Farber, taking into account changes in the degree of eyebrow raising and reduction, lip extension, eye closing, the presence of the brow reflex and the corneal reflex before and after treatment. This method allows you to assess the severity of the disease and the effectiveness of treatment for neuritis of any age.

In 1985, the Committee on Facial Nerve Disorders approved the six-level House-Brackmann Facial Nerve Grading Scale, which is used in cases of incomplete facial nerve repair to assess:

degree of muscle weakness;
symmetry;
the presence of synkinesis;
the presence of facial contractures.

Since similar symptoms are observed in other diseases (supranuclear lesions of the facial nerve, fractures), radiography, CT and MRI are performed to exclude such pathologies.

With Bell's palsy, according to radiography performed according to Schüller-Mayer, pneumatic (with big amount cells) type of structure of the mastoid process. In half of the cases, this type of structure extends to the top of the petrous part of the temporal bone and causes a local narrowing of the lumen of the fallopian canal due to the protruding walls of individual cavities. The same structure can be identified by tomography performed according to Stenvers.

For differential diagnosis are used and laboratory research, which make it possible to identify in 1/3 of cases cerebrospinal fluid(cerebrospinal fluid) a slight increase in the amount of protein.

The functions of the facial nerve are assessed using electroneuromyography (EMG), which, when conducting research in the acute period, makes it possible to find out:

whether the facial nerve paresis is central or peripheral;
affects individual branches of the nerve or its trunk;
what type of lesion is observed (axonopathy, demyelination, mixed process);
prognosis for recovery of the facial nerve.

The first EMG (examination of the facial nerve and blink reflex on both sides) is recommended to be carried out in the first 4 days of the disease, the second - 10-15 days after the moment of paralysis, the third - after 1.5 - 2 months. If necessary, additional studies are carried out on an individual basis.

During the EMG study, distal latency is assessed (the speed with which the impulse is conducted from the angle lower jaw), the amplitude of the M-response (depending on the synchrony and amount of activation of the muscle motor units caused) and the speed with which the impulse is carried along the nerve.

If on days 5-7 from the onset of the disease the first two indicators are within normal limits, the prognosis is favorable for damage of any severity.

The increased latency indicates the process of demyelination, but the observed preservation of the normal M-response amplitude (or the presence of 30% compared to the healthy side) indicates the possibility of recovery within 2 months.

An M-response amplitude of 10 to 30% indicates a fairly good, but longer recovery (from 2 to 8 months).

The amplitude of the M-response, which is less than 10% compared to the healthy side, with the speed of impulse conduction along the facial nerve differing by 40% from the indicators of the healthy side, indicates an incomplete and prolonged restoration of the functions of the facial muscles.

The fibrillation potential detected at 2-3 weeks indicates the presence of a process of axonal degeneration. IN in this case the prognosis is unfavorable - there is a high probability of developing contractures.

Facial neuritis must be distinguished from middle ear or mastoid infections, chronic meningeal infections, Ramsay Hunt syndrome, Lyme disease, and multiple sclerosis.

Treatment

Performed for Bell's palsy therapeutic measures called upon:

increase blood and lymph circulation in the affected part of the face;
improve the conductivity of the facial nerve;
restore the functions of facial muscles;
prevent the development of muscle contracture.

The maximum result of treatment is observed when it is started in a timely manner (about 72 hours after the onset of the first symptoms).

Neuritis of the facial nerve early stage(days 1–10) it is recommended to treat with glucocorticoids, which reduce swelling in the fallopian canal. Most often, prednisone is prescribed, which is taken at a dose of 60-80 mg per day for the first 5 days, and then the dose is gradually reduced until complete withdrawal after 3-5 days. Dexamethasone for neuritis of the facial nerve is used at a dose of 8 mg per day for 5 days. The drug is discontinued within a week. Glucocorticoids are taken simultaneously with potassium supplements. Hormonal drugs in most cases (from 72 to 90%) lead to significant improvement or recovery, and contractures do not develop.

At the same time with hormonal drugs recommended use:

antivirals (effective in treating herpes with Zovirax or Acyclovir);
antioxidants (alpha lipoic acid);
diuretics (glycerol, furosemide, triampur);
vasodilators (complamin, a nicotinic acid, theonicol);
B vitamins.

In the presence of pain syndrome And inflammatory process analgesics are prescribed.

Since neuritis often takes a recurrent course in childhood, treatment of facial neuritis in children includes:

glucocorticoid therapy (prednisolone is used at 1 mg per kg per day for 7–10 days);
V acute period preparations of low molecular weight dextran and dehydrating drugs (L-lysine escinate, Lasix), which are administered parenterally;
vasoactive drugs (actovegin, trental);
neurometabolic drugs (berlition, espalipon, thiogamma);
B vitamins.

Neuritis of the facial nerve during pregnancy usually occurs in the first trimester, as well as after the birth of the child. For treatment, a short course of corticosteroids, vitamins B1 and B12, massage, physiotherapy, and possible use of dibazole and amidopyrine are prescribed.

Treatment of Bell's palsy at the initial stage of the disease includes treatment with the following position:

When sleeping, it is recommended to lie on the affected side.
Throughout the day, sit at least 3 times for 10 minutes, tilting your head to the painful side with support on your hand (the hand rests on the elbow, and the head on back side brushes).
Try to restore the symmetry of the face with the help of a tied scarf (the muscles on the healthy side are pulled up from the bottom towards the affected side).

Physiotherapy for neuritis of the facial nerve is also used to accelerate nerve regeneration and restore its conductivity. To do this, non-contact heat (Minin lamp) is used in the first week, and after the 5th day of the disease the following are prescribed:

Thermal procedures on both sides of the face. It is possible to use paraffin, ozokerite and mud applications.
Ultrasound with hydrocortisone in the mastoid area.

In most cases, acupuncture has a good effect, but acupuncture for neuritis of the facial nerve is not carried out simultaneously with physiotherapeutic procedures. Functions begin to be restored after 2-3 procedures, and the course is 10 procedures.

From the second week of the disease, massage and exercise therapy begin, and by the end of the 2nd week, applications with galantamine, proserine and dibazol, and phonophoresis using hydrocortisone are used. The use of anticholinesterase drugs is not always justified (with a long course of neuritis, it contributes to the development of contracture). At later stages of the disease, galvanic half masks according to Bergonier are used.

Exercise therapy for facial nerve neuritis should include a gradually increasing load.

Therapeutic exercises for neuritis of the facial nerve are performed in front of a mirror. It can be performed after thermal procedures. If there are difficulties in reproducing specified movements on the affected side, it is possible to use galvanization of the nerve exit site with a cathode - the passage of current facilitates the reproduction of facial movements. Exercises for neuritis of the facial nerve are performed:

in a sitting or standing position;
after muscle relaxation (especially on the healthy side);
for the healthy and diseased side at the same time - so that the movements are as symmetrical as possible.

Gymnastics for neuritis of the facial nerve on the healthy side is performed with limited range of motion. On the affected side, movements are carried out using the hand. The patient should 5-10 times:

wrinkle your forehead;
close eyes;
frown;
suck in air through your nose;
wink with each eye in turn;
make a movement with your nose, depicting a feeling of displeasure;
bare teeth;
smile from the corner of your mouth (grin);
pull the cheeks into the oral cavity;
puff out your cheeks;
move the lower jaw to the side;
make movements with your tongue oral cavity;
rinse your mouth with air;
rinse your mouth with warm water;
stretch your lips into a “tube”;
whistle;
pronounce the letters B, P, M, X, C;
pronounce vowels.

Facial gymnastics for neuritis of the facial nerve is performed twice a day between general strengthening exercises. At the same time, attention is paid breathing exercises having great importance in the presence of speech disorders.

Facial massage is also effective for neuritis of the facial nerve, which is recommended to be done with superficial light movements before performing exercises.

Massage for facial neuritis includes:

forehead area;
area of the eye sockets (gaze is directed downwards, healthy eye closed, and the patient is slightly covered with the palm);
wings of the nose and parotid area;
perioral area and chin area (movements are performed from the middle of the mouth to the corner of the jaw);
the front surface of the neck;
head tilts;
movements of the head in a circle (not performed by older people).

After approximately 2.5 months, if recovery is incomplete, lidase and biostimulants are prescribed, and if contractures appear, anticholinesterase drugs and stimulants are discontinued.

In case of congenital pathology or complete rupture of the facial nerve (trauma), surgical treatment is indicated.

Biofeedback for neuritis of the facial nerve does not provide significant improvements (according to observational data), but does not have a negative effect.

Eye care is also necessary, which includes:

instilling artificial tear fluid into the eyes every 2 hours;
wearing glasses and putting a damp patch over the eye;
using a special eye lubricating ointment at night.

Forecast

The prognosis of Bell's palsy in most cases is favorable - about 75% recover completely, and the presence of complications is associated with concomitant pathology (the presence of herpes, otitis or mumps).

Neuritis of the facial nerve is accompanied by the development of contracture in 20 - 30% of cases.

Unfavorable prognostic signs include the presence of:

complete facial paralysis;
proximal level of the lesion (manifested by hyperacusis, dry eye);
behind the ear pain;
diabetes mellitus;
severe degeneration of the facial nerve (EMG results).

The prognosis is unfavorable for illness lasting more than 3 weeks (no noticeable improvement), and for patients who become ill after 60 years of age.

For children, the prognosis is generally favorable, but there is a risk of developing a recurrent form of the disease if involved in the pathological process trigeminal nerve on the affected side and the facial nerve on the healthy one.

Possible complications

The consequences of neuritis of the facial nerve in the form of contractures occur 4-6 weeks after the onset of the disease, if there is no timely and adequate treatment and there are concomitant pathologies.

Possible complications of the disease occur when severe forms neuritis and include:

synkinesis, which occurs when nerve fibers grow incorrectly, which causes involuntary movement of some muscles while trying to use others;
irreversible damage to the facial nerve;
partial or total loss vision, which is caused by dry eyes due to the inability to close the eyelids.

According to some reports, facial neuritis is associated with increased risk stroke.

Prevention

Prevention of neuritis of the facial nerve consists of preventing hypothermia and injuries, adequate treatment ear diseases and other infectious diseases.

In the acute period of the disease, the prevention of overstretching of tissues and muscles is fixation of facial tissues with adhesive plaster strips.

Massage for neuritis of the facial nerve

This article talks about symptoms of facial paresis in newborns. Describes the causes, diagnosis, treatment (including surgery), consequences, prognosis and prevention of the disease.

One of possible complications birth process for a child maybe facial nerve paresis. The facial nerve moves the facial muscles and is responsible for the first search reflexes (sucking). Damage during childbirth to this nerve is caused by its passage in a narrow canal, which increases the risk of paresis due to prolonged compression nerve fibers.

Facial nerve paresis is characterized by immobilization of the muscles on the affected side.

Types of facial nerve paresis

Facial nerve paresis is divided into:

Central paresis;
Peripheral paresis;
Congenital.

Peripheral paresis is more a common complication during childbirth due to local compression of the facial nerve itself. More peripheral paresis called Bell's palsy.

Manifests:

Central paresis occurs as a consequence of more dangerous birth injuries, accompanied by brain damage, stroke and manifests itself:

Weakening muscles of the lower face;
Hemiparesis not only faces, but also torsos;
Often are affected both sides of the face;
Upper Part the face and eyes retain their function and are not affected by symptoms;
No violations taste.

Congenital paresis facial nerve occurs when there is an abnormality of the facial nerve.

Ask your doctor about your situation

Severity

1st degree. Manifests light current, slight asymmetry of the face with preservation of eye closure (difficulty), frowning eyebrows, the corner of the mouth is lowered, the sucking process is disrupted;
2nd degree. Characterized by lagophthalmos. When performing functional diagnostic tests (smile, frown, close the eyes), the child does not complete them completely or does not perform them at all. These tests are carried out taking into account age, that is, the newborn does not yet understand human speech to complete the task, so they are carried out when the child is crying or sleeping and can spontaneously smile.
3rd degree. Manifests severe course. Symptoms increased. Strong asymmetry face, the eye does not close, diagnostic tests are positive (not performed), difficulty chewing and speaking (almost impossible).

Causes of facial nerve paresis

The most common reasons:

Symptoms of facial paresis

Symptoms:

Muscle weakness(hypotonicity) in the area of innervation of the facial nerve on one or both sides;
Ear pain, behind the ear;
Tearing or drying out of the mucous membrane of the eyeball;
Violation mother's breast sucking;
Leakage milk from the mouth;
Increased sensitivity to loud sound;
Tearfulness;
Eyelids open, lagophthalmos from the side of the nerve lesion.

Symptoms develop acutely over two weeks. The subacute phase lasts for a month. A chronic phase diagnosed when paresis remains untreated for more than a month.

Diagnosis of the disease

Diagnostic methods:

Conduct objective research(functional diagnostic tests: smiling, wrinkling the forehead, sucking, stretching the lips with a tube, carried out at rest or while screaming);
Consultation with other specialists to exclude pathologies and tumors of the face and ear;
Electromyoneurography to study the speed of nerve impulses;
CT scan;
Magnetic resonance imaging(to exclude brain damage);

Treatment of facial nerve paresis

Treatment of damage (paresis) of the facial nerve in a newborn is a gradual process.

Parents need to be patient and follow all the specialist’s recommendations:

Carry out gymnastics follows immediately after diagnosis, it is characterized by the implementation of innate reflexes aimed at moving the facial muscles.
For example, during pressing the fingers to the baby’s lips, the lips stretch into a tube, and a proboscis reflex occurs; when you touch the skin of the cheek near the lips, the baby begins to look for the breast with his lips, thereby causing physical activity muscles, when you press the center of the baby's palm, he opens his mouth.
Also positive The effect is the use of a pacifier.

Massage:

Held symmetrically on both sides of the face.
The massage is worth it carry out to a specialist.
Technique massage is to prevent atrophy of the facial muscles with the temporary impossibility of their movement.
Massage begins by kneading the neck muscles. At the same time, they tilt their heads in different directions.
All massaging movements are performed symmetrically and along the outflow lymphatic system, but the lymph nodes are not exposed to the massage area.
If the child begins to act up, this indicates pain in the pressure area. In this case, the massage should be carried out using light and superficial techniques.

Treatment at home

Treatment of facial nerve paresis at home is possible only after therapy and prescribed treatment by a specialist.

learn lung techniques, but regular massage;
conduct daily therapeutic physical exercises;
give medications prescribed by a neurologist.

Surgical interventions

Surgical treatment of facial nerve paresis in newborns is carried out for:

Congenital anomalies of the development of the facial nerve, its exit hole, skull bones and other anomalies;
Neoplasms, which were a consequence of the occurrence of paresis;
Full nerve rupture.

The operation facilitates restoration of facial expressions. It is carried out during the first months of the child’s life so that the muscles do not atrophy and the nerve can move them.

When a nerve is ruptured, it is sutured. And when congenital pathologies, carry out autotransplantation. That is, a healthy nerve is taken from the child’s leg and sewn into the affected area of the facial nerve. The unaffected branches of the facial nerve are connected to it. In this case, only one facial nerve controls the muscles.

Notice earlier after surgery previous illness almost impossible. The movement of the muscles of the entire face is restored, and surgical intervention The only thing that can remind me is the scar behind the ear.

With early diagnosis and removal of the tumor, a compressed nerve resumes its function completely.

In case of a severe facial defect, cosmetic surgery.

Consequences

Without treatment for facial paresis, the child may suffer a number of complications:

If impossible closing the eye, blindness occurs;
At average and severe disease causes the inability to eat food. The child cannot suck, and the injected liquid may flow out of the slightly open mouth;
Synkenesia(a friendly movement of muscles, for example, when trying to close an eye, a wrinkling of the forehead occurs);
Symptoms make it impossible for the child to eat, sleep normally, and also painful sensations lead to tearfulness and neurological diseases;
Incorrect nerve restoration;
Irreversible nerve damage;
Further Difficulties arise in the child’s social adaptation in child care institutions and schools.

Forecast

The outcome of facial nerve paresis in a newborn is more favorable than in an adult. Also, the occurrence of complications with timely treatment is minimized. Often a disease with mild degree currents, passes on its own.

But, in order to avoid contractures and other complications, you must always consult a doctor and carry out treatment immediately after diagnosis.

Also, the prognosis of the disease depends on the internal psychological mood in family. With a gentle, caring attitude of parents towards the child, he quickly resumes the work of facial muscles, copying the facial expressions of mom and dad. He also feels the love and care of people close to him and calms down, improvement comes faster.

Enough rarely a long and persistent course of the disease occurs. Basically, this indicates aplasia of the facial nerve nucleus.

Sometimes there is isolated hypotonicity of the depressor anguli oris muscle. This manifests itself when embryogenesis is disrupted, that is, it is congenital anomaly.

Prevention of facial nerve paresis:

Apply in time to the maternity hospital for assistance in childbirth, and doctors, together with midwives, prevent paresis of the facial nerve of the newborn that occurs during childbirth;
Avoid viruses and infectious diseases during pregnancy. Also try to avoid infection of the newborn itself after birth;
Avoid hypothermia newborn;
Identify in time and treat accompanying illnesses, especially otitis media.

Conclusion

Subject to preventive measures, is decreasing risk of facial paresis in newborns. That's why to the expectant mother you need to be responsible not only for your health, but also take care of preventing possible diseases and complications after childbirth.

May require some procedures or rehabilitation. He is the seventh of twelve cranial nerves. Every person has a facial nerve on each side of their face.

Symptoms

Problems can occur due to paralysis, weakness, or spasmodic contractions of the facial muscles. You may also experience dry eyes or mouth, a change in taste on the affected side, or even excessive tearing or drooling. However, one of these symptoms does not necessarily mean there is a problem with the facial nerve. The doctor needs to conduct a thorough examination to make a diagnosis. Symptoms can range from mild spasms to complete paralysis of one side of the face.

Video about the facial nerve

Causes of facial nerve damage

There are many causes of dysfunction of the facial nerve:

trauma, for example birth injury, skull fractures, injuries to the middle ear, face or surgical injuries;
diseases nervous system, including stroke;
shingles, facial or ear infection (Hunt syndrome);
tumors including neuroma, schwannoma, cholesteatoma, parotid gland tumor and glomus tumor;
toxins from alcoholism or poisoning carbon monoxide;
Bell's palsy, this condition is sometimes associated with diabetes or pregnancy.

Diagnostics

Causes range from unknown to life-threatening. Sometimes, to solve a problem you need special treatment. Therefore, it is necessary to find out why it appeared. Specific tests include:

hearing test: They are carried out to determine the condition of the auditory nerve. The middle ear acoustic reflex can identify the part of the facial nerve that supplies the motor nerve fibers of one of the muscles in the middle ear;
balance test: will help you find out if it is connected auditory nerve with a problem;
tear test: Loss of the ability to produce tears can help diagnose the location and extent of the lesion;
taste bud test: Loss of taste at the tip of the tongue can help diagnose the location and extent of the lesion;
salivation test: Changing the amount of saliva production can help diagnose the location and extent of the lesion;
imaging studies: These tests help determine the presence of infection, tumor, bone fracture, or other defects. These studies usually include CT and MRI scans;
electrical stimulation test: stimulation electric shock checks whether he is able to contract muscles. It can be used to assess disease progression. For example, if the test reveals the same response on both sides of the face, function will return in 3-6 weeks without significant deformity.

Bell's palsy and its symptoms

This is paralysis of unknown cause. This diagnosis is made when it is impossible to identify other causes. Although it was believed that the cause of the disease was viral infection, this has not been proven.

The disease usually goes away on its own and is not life-threatening. There is no age or race predisposition, but the disease is slightly more common in pregnant women. In general, the incidence of the disease increases with age. Children under 13 years of age are less likely to develop Bell's palsy than older children.

The exact mechanism of Bell's palsy is unknown, but the proposed mechanism involves the following steps:

initial viral infection (herpes);
the virus remains in the nerve for a period of several months to several years;
the virus is reactivated;
the virus multiplies and moves further;
the virus infects surrounding cells, causing inflammation;
the immune system responds to cellular inflammation, causing inflammation and subsequent facial paralysis;
the course of the disease and recovery depend on the degree and volume of the lesion.

Typical symptoms include:

acute, unilateral paralysis of the facial muscles;
pain in the tongue, neck, ear, face;
in most cases, nerve damage is preceded by a viral disease;
some patients have a family history of Bell's palsy;
In a few patients, both sides of the face are affected;
Hearing sensitivity may change.

Treatment of facial paralysis

For treatment of this disease no special medicines. Previous diseases that led to disruption of the facial nerve are treated, taking into account their characteristics. Steroid medications (corticosteroids) are the best treatment. When steroids and antiviral drugs (acyclovir) are used simultaneously, patients recover faster.

Although physical therapy and electrotherapy do not have significant benefits, facial exercises can help avoid contraction of the affected muscles. Surgical decompression has mixed reviews. Some doctors recommend decompression within 1-2 weeks of onset severe symptoms. However, there is a risk of hearing loss with this operation.

Treatment of eye problems due to facial nerve dysfunction

Patients experience difficulty closing their eyes because... the muscles that close the eyes do not work. If the cornea of the eye becomes very dry, serious complications can occur.

Treatment consists of:

wearing special glasses to prevent dust from getting into your eyes;
closing the eye with a finger to maintain moisture;
artificial tears or ointments to maintain moisture;
if muscle function is not fully restored, blepharorrhaphy may be required.

Surgical methods of treatment

Possible surgeries to restore function include:

restoration or transplantation: The facial nerve regenerates at a rate of 1 mm per day. When trimmed or removed, direct microscopic restoration is the best option;
moving: Often the hypoglossal or other facial nerve may be connected to another. For example, the patient may learn to move the face by moving the tongue;
moving muscles: The temporalis muscle or masseter muscle can be moved down and connected to the corner of the mouth, allowing the face to move;
muscle transplant: muscles in the legs can be used to restore volume and function of the facial muscles;
auxiliary procedures on the eyelids or oral cavity: In addition to the above operations, a brow lift or correct treatment improve the prognosis.
Prevention

At one time it was believed that exposure to cold air or strong wind increases the risk of developing Bell's palsy. It is now known that this was just a delusion. In most cases, the causes of facial nerve dysfunction are unknown, and it is difficult to determine factors that should be avoided. A healthy lifestyle that reduces the risk of diabetes, cancer or infections can help prevent this problem.