Facial nerve paresis: types and methods of treating the disease. Paresis, paralysis and neuropathy of the facial nerve Treatment of facial paresis with medications

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 from the localization 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 be entrusted only 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.

Facial paresis – neuritis, that is, inflammation and swelling of the facial nerve. Neuritis of infectious (herpes virus, rubella) and non-infectious nature. Paresis can occur in acute or chronic conditions, against the background of diabetes mellitus, or in ischemic disease due to impaired blood supply to the facial nerve.

Predisposing factors include hypothermia, hypertension, atherosclerosis, multiple sclerosis, dental surgery, and facial trauma.

In paresis, it often occurs as a result of birth, especially when used.

Symptoms of facial paresis

Facial palsy most cases affect one side of the face. Numbness of the facial muscles occurs, which causes
difficulty in facial expressions, drooping of one eyelid, impaired production of saliva and tear fluid.

Difficulty eating, taste disturbances, dry eyes, and increased sensitivity to sounds may occur. Speech becomes difficult and there is no facial expression on the affected side. All this causes not only a significant disruption of normal daily functions, but also leads to emotional suffering and a deterioration in the patient’s social life.

Treatment

Most facial nerve neuropathies have a favorable prognosis. Full recovery occurs in 75% of patients, but after three months of paresis, recovery time decreases.

Treatment of facial nerve paresis is strictly individual. In mild cases, a simple medical treatment and a course of massage are sufficient. Restoration of nerve function occurs slowly, up to six months or longer, often there is a need for drug treatment and physiotherapeutic procedures, and occasionally surgical intervention is required.

Drug treatment includes corticosteroid hormones, which have a powerful anti-inflammatory effect, and antiviral drugs in the case of a viral nature of the disease. Vitamin therapy is based on the use of B vitamins (“Neurovitan”, “Neurobeks”, “Milgama”). If necessary, artificial tears or moisturizing gels for dry eyes are used.

Physiotherapy, massage, and special exercises for the facial muscles help prevent long-term paresis. Patients are taught relaxation techniques and biofeedback to relieve pain and tension.

Surgical intervention is possible in cases where no improvement is visible from conservative therapy after 2-3 months of treatment. Decompression of the nerve in the bone canal, suturing of the nerve, its plastic surgery, neurolysis, and corrective operations for contractures of facial muscles are performed.

We continue to get acquainted with neurological diseases. And today talk about facial nerve paresis. The disease develops in a matter of days. The resulting asymmetry on one side of the face does not change a person’s appearance for the better. Timely treatment measures will help to quickly cope with the disease. Let's sort it out in order.

What is facial nerve palsy?

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 from the localization of the lesion.

Most often, the cause of paresis is colds of the upper respiratory tract, but there are also several other factors that provoke the disease, which we will discuss further.

The average age of a neurologist's patients with this disease is about 40 years, both men and women suffer from the disease equally often, and the disease develops in childhood.

The facial nerve refers to the nerves responsible for the motor and sensory function of the muscles of the face. As a result of its defeat, nerve impulses do not pass through in the required volume, the muscles become weakened and can no longer perform their main function to the required extent.

The facial nerve is also responsible for the innervation of the lacrimal and salivary glands, taste buds on the tongue, and sensory fibers of the upper layer of the face. With neuritis, as a rule, one of its branches is involved in the pathological process, so the symptoms of the disease are noticeable only on one side.

What symptoms can you use to recognize facial nerve paresis?

Symptoms of facial nerve paresis are divided into basic and additional.

The main symptoms include: tilting of the face to one side, partial immobility of some part of the face, a condition in which a person cannot close one eye. Also, complete immobility of the eyebrows, cheeks, or the corners of the mouth drooping downwards is often observed; often a person suffering from facial nerve paresis can be recognized by difficulty speaking.

Additional signs of the presence of facial nerve paresis include constant dry eyes or, conversely, excessive lacrimation. Almost complete loss of taste, as well as increased salivation. A person may become irritable, loud noises will get on his nerves, and the corners of his mouth will involuntarily droop.

Where are the roots of all diseases?

Our world is diverse and complex for some, but simple and great for others. The ability to behave, to subordinate thoughts to one’s will, to manage one’s condition in different situations, to launch the correct biochemical processes, allows a person to have strong energy and strong immunity, and therefore resistance to any diseases.

The integrity of the body begins to collapse with psycho-emotional factors that affect us every day. If a person knows how to cope with them, processing any emotional surges towards a positive shift forward for himself, he will be able to react easily to any uncomfortable situation, remain in good health and, moreover, develop his energy potential.

Otherwise, under the influence of a crazy pace of life, stressful situations at work, at home or on the road, a negative energy charge begins to accumulate, gradually destroying a person’s energy shell.

First, this affects a person’s psychological health; later, the destruction moves to the physical level, where internal organs begin to suffer and various sores appear.

What is the cause of facial paresis and what factors contribute to its development?

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 damage and secondary damage that progresses 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:

• polio
• pathogenic activity of the herpes virus
• mumps
• respiratory pathologies of the upper airways
• head injuries of varying severity
• nerve fiber damage due to otitis media
• damage to the nerve fiber during surgery in the facial area
• syphilis
• tuberculosis

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

• multiple sclerosis
• ischemic stroke
• hypertensive crisis
• diabetes.

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

The following types of paresis are distinguished:

Peripheral paresis

As a rule, this type of paresis begins with severe pain behind the ear or in the parotid area. One side is affected; upon palpation, the muscles are flaccid, and their hypotonicity is noted.

The disease develops under the influence of inflammation, which leads to swelling of the nerve fibers and their compression in the narrow channel through which they pass. Peripheral paresis developing according to this etiology is called Bell's palsy.

Central paresis

With this form of the disease, the muscles located in the lower part of the face are affected, the forehead and eyes remain in their normal physiological position, that is, the patient easily wrinkles the frontal folds, the eye functions fully, closes without a gap, and no change in taste is noted.

On palpation, the muscles at the bottom of the face are tense, and in some patients there is bilateral damage. The cause of central paresis of the facial nerve is ongoing damage to the neurons of the brain.

Congenital paresis

This lesion of the facial nerve accounts for approximately 10% of cases of the total identified number of patients with this pathology. For mild and moderate forms, the prognosis is favorable; for severe cases, one type of surgery may be prescribed.

Congenital anomaly of the facial nerve must be distinguished from Moebius syndrome; with this pathology, lesions of other nerve branches of the body are also recorded.

How to recover from facial nerve paresis with Tibetan medicine?

Rapid restoration of the body using Tibetan methods occurs thanks to methods of external and internal influence. Everything that can contribute to rapid recovery is taken into account. Lifestyle and nutrition also play an important role here.

We already know that the “Wind” constitution is responsible for the nervous system. And since the occurrence of this disease is closely related to disruption of the passage of nerve impulses, it means that in order to calm the disease it is necessary to restore the harmony of the wind in the body. This is achieved precisely with the help of external and internal influence.

Methods of external influence used for paresis are aimed at resuming the passage of nerve impulses to muscle structures, normalizing the psycho-emotional state, eliminating congestion and stimulating the body’s own immune forces to resist the disease. The procedures are prescribed by the doctor, taking into account the medical history and characteristics of the patient’s mental state.

The main external influences include the following procedures:

• Moxibustion therapy
• Stone therapy
• Tibetan massage
• Vacuum therapy
• Hirudotherapy
• And others.

In combination with herbal medicine, these procedures provide a tremendous healing effect and allow you to quickly relieve pain and alleviate the condition.

Properly selected herbal remedies have an immunomodulatory, antibacterial and anti-inflammatory effect, harmonizing the state of the body’s internal systems.

An integrated approach is the basis of Tibetan medicine. External influence by the above procedures leads to the following:

• Relieves inflammation and swelling
• Pain syndrome is quickly eliminated
• Reduces compression of the damaged nerve bundle
• Blood supply is normalized
• Stagnation is eliminated
• Nerve tissue is restored
• Normal muscle activity returns
• Facial expressions are restored
• Increases immunity

Tibetan medicine has helped many patients regain lost health. Even in those cases when ordinary doctors refused the patient, saying that he could no longer be helped, Tibetan medicine helped.

Not because she has some kind of magic pill, but because she has enormous knowledge about human nature and its interaction with this world. This experience has been accumulated over thousands of years and is now quickly gaining popularity due to its amazing results.

Without chemicals, antibiotics, painful procedures and surgeries, we manage to get people back on their feet, significantly improving their condition.

People also come to us to prevent diseases. Relax, unload your emotional state, raise your vitality and restore your energy.

After complex procedures, a person gains harmony with himself and the outside world for a long time. He simply glows with love, energy and life.

Therefore, if you have any health problems, come, we will help you.

Health to you and your loved ones!

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

General information

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

This is the most common lesion of the peripheral facial nerve.

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

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 there is local hypothermia in the ear and neck area or insufficient blood supply (ischemia) to 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 the right side of the face.
• 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, it is assumed that there is a need for the existence of an additional factor that provokes the reactivation and multiplication of the virus. Viruses of infectious mononucleosis, mumps, RNA-containing enteroviruses (Coxsackie), influenza and polio viruses are also considered potential pathogens.
• Lymphogenic. It is 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 the thickness of the nerve column, which is about 70% of the cross-sectional area of ​​the canal, 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 damage to the facial nerve, but the factors causing the disease vary from case to case (anatomically narrow fallopian canal or stylomastoid foramen, abnormalities of the vessels that feed the nerve, metabolic disorders). Features of the immune response are also considered a predisposing factor.
• Ischemic (vascular). Various factors cause disturbances in vascular tone and provoke a tendency to spasms in the vertebral or external carotid artery system. 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 of the 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.
• Stage 3, during which late recovery is observed. The duration of this stage (3-4 months) is associated with incomplete and slow restoration of myelin (when a nerve is compressed, degenerative changes primarily affect 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 symptom is observed (in the absence of closed eyelids, on one side the eyeball is turned upward and a white stripe of the sclera is noticeable).

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.

In a patient, pain due to neuritis of the facial nerve can be felt in the area behind the 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:

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

There is also loss or decreased taste sensitivity, which does not affect the 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, is difficult to treat and is accompanied by the development of contractures, and complete recovery is 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 of the disease is accompanied by 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 facial neuritis has a clear clinical picture, the 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 perform other similar actions 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.

In Bell's palsy, according to radiography performed according to Schüller-Mayer, in 84% of patients a pneumatic (with a large number of cells) type of structure of the mastoid process is detected. 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, laboratory tests are also used, which make it possible to detect a slight increase in the amount of protein in the cerebrospinal fluid (CSF) in 1/3 of cases.

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

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 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

Therapeutic measures carried out for Bell's palsy are designed to:

• 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).

Early facial neuritis (days 1–10) is recommended to be treated 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.

Simultaneously with hormonal drugs, it is recommended to use:

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

In the presence of pain and inflammation, 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);
• in the 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 the back of the hand).
• 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 cathode galvanization of the nerve exit site - 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 the tongue in the 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. In this case, attention is paid to breathing exercises, which are of 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;
• the area of ​​the eye sockets (the gaze is directed downwards, the healthy eye is closed, and the sick eye is slightly covered with the palm of the hand);
• 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;
• moving 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 the trigeminal nerve on the affected side and the facial nerve on the healthy side are involved in the pathological process.

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 in severe forms of neuritis and include:

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

Facial neuritis has been reported to be associated with an increased risk of stroke.

Prevention

Prevention of neuritis of the facial nerve consists of preventing hypothermia and injuries, adequate treatment of 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

Facial nerve paralysis(facial paralysis or Bell's palsy) is a sudden weakness of the facial muscles resulting from damage to the facial nerve.

In this condition, muscle movement on one side of the face is usually impaired.

The patient's smile may become distorted, and one eye may be closed.

Bell's palsy, according to American experts, occurs in 20-30 people per 100,000 population. Facial paralysis is equally common in both men and women. The disease can occur at any age, the average age of patients is 40 years.

The exact cause of Bell's palsy is unknown. Paralysis occurs as a result of inflammation of the facial nerve, which controls numerous facial muscles. This disease may be a reaction to previous viral infections.

For most people, facial paralysis is a temporary problem. The condition usually improves after a few weeks, and full recovery occurs after a few months. In a small percentage of people, symptoms remain for life. Facial paralysis may recur.

Causes of facial paralysis

Viral infections that are associated with Bell's palsy:

Herpes (herpes simplex virus).
. Chickenpox and herpes zoster (Varicella zoster virus).
. Acute respiratory viral infections (adenovirus).
. Infectious mononucleosis (Epstein-Barr virus).
. Cytomegalovirus infection (CMV).
. Infection caused by the Coxsackie virus.
. Influenza (type B virus).
. Rubella.

Risk factors

Pregnant women (during the 3rd trimester or immediately after childbirth).
. Patients who often suffer from viral infections.
. Elderly people with weakened immune systems.

Some patients with recurrent episodes of facial paralysis have a family history of the disease. In these cases, a genetic tendency to Bell's palsy is suspected.

Symptoms of facial paralysis

Symptoms may include:

Rapidly developing weakness or paralysis of one half of the face.
. Difficulty in facial expressions, skewed smile.
. Increased sensitivity to sound on one side.
. Drooping of one eyelid.
. Pain in the ear on the affected side.
. Jaw pain
. Headache.
. Impaired production of saliva and tear fluid.
. Taste disturbance.

When should you see a doctor?

Complications of facial paralysis

Irreversible damage to the facial nerve with long-term consequences - symptoms of paralysis may last a lifetime.
. Improper restoration of nerve fibers, which leads to involuntary muscle contractions (synkinesis). For example, a person smiles, but at the same time his eye closes.
. Partial or complete blindness from the side of the eye that does not close. The inability to close the eye leads to dryness and damage to the cornea - the protective membrane of the eye.

Diagnosis of facial paralysis

If the cause of your symptoms is not clear, your doctor may order the following tests:

Electromyography (EMG). This test will confirm the nerve damage and determine its severity. EMG evaluates the electrical activity of facial muscles in response to stimulation, and also measures the speed of electrical impulses along nerve fibers.
. Head scan. X-rays, CT scans, and magnetic resonance imaging may be needed to find the cause of the compression of the facial nerve. Such causes may be head tumors or skull fractures.

Treatment of facial paralysis

There is no single treatment that would suit all patients. The doctor may suggest medications or physical therapy, depending on the situation. In rare cases, surgical treatment may be necessary.

1. Drug treatment:

Corticosteroid hormones such as prednisolone. These substances have a powerful anti-inflammatory effect. They will relieve inflammation of the facial nerve, which will help the patient regain control of the muscles. These drugs work best if given in the early days of illness.
. Antiviral drugs such as acyclovir (Zovirax) or valacyclovir (Valtrex). These medications stop the reproduction of viruses that may cause illness. This treatment is prescribed only in cases of severe paralysis.

2. Physiotherapy.

Paralyzed muscles may gradually shorten, causing permanent damage. Physiotherapy, massage and special exercises for the facial muscles will help prevent long-term consequences.

3. Surgical treatment.

In the past, decompression surgery was widely used in the West, which relieves pressure on the inflamed nerve from surrounding tissue (bone). Today, Western experts do not recommend such operations because they are associated with a high risk of damage to the facial nerve and irreversible hearing loss. In rare cases, plastic surgery is recommended to correct minor complications of Bell's palsy.

Protecting eyes that the patient cannot close. In these cases, it is imperative to use artificial tears or moisturizing gels, because without blinking, the eyes can dry out and become inflamed. During the day, you should wear goggles to protect from wind and dust, and at night, be sure to wear a bandage.
. Over-the-counter pain relievers. Aspirin, ibuprofen, paracetamol, or naproxen can help you manage the pain. These drugs are usually well tolerated and are therefore available in pharmacies without a doctor's prescription. Consult your pharmacist or doctor about any restrictions on their use.
. Apply moist heat. Another useful remedy is a piece of cloth soaked in warm water. Sometimes this helps relieve facial pain.

Alternative treatments:

Relaxation techniques. Learning some yoga and meditation techniques can help relieve pain and tension.
. Acupuncture, or acupuncture. An acupuncturist uses hair-thin needles that are inserted into specific reflex points on the body. This may provide relief from pain.
. Biofeedback technique. This method is based on practicing control over your body with the help of thoughts. The method requires long and hard training on a special computer, but in the end it allows you to regulate pain and improve control of your muscles.
. Vitamin therapy. Some experts recommend vitamin B6, B12, and the trace element zinc to treat nerve damage. In post-Soviet countries and European countries, officially approved drugs based on B vitamins are available (Neurorubin, Neurovitan, Neurobex, Milgama, etc.).

Konstantin Mokanov