Central and peripheral paresis of the face. Facial palsy, or sudden weakening of facial muscles

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

What is facial paresis?

Paresis of the facial nerve is an ailment of the nervous system, characterized by impaired functioning of 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 violation of the transmission of a nerve impulse 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 side of the lesion.

Most often, paresis is caused by colds of the upper respiratory tract, but there are several other factors provoking the disease, which we will talk about later.

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, the development of the disease is also noted in childhood.

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

The facial nerve is also responsible for the innervation of the lacrimal and salivary glands, taste buds on the tongue, 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 are the symptoms of paresis of the facial nerve

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

The main symptoms are: distortion 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 lowering of the corners of the mouth down is often observed, often a person with paresis of the facial nerve can be recognized by difficult speech.

As additional signs of the presence of paresis of the facial nerve, one can distinguish constant dryness of the eyes or, conversely, unmeasured lacrimation. Almost complete loss of taste sensations, as well as increased salivation. A person may become irritable, loud sounds will get on his nerves, and the corners of his mouth will involuntarily drop.

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 state in different situations, to launch the correct biochemical processes, allow 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 daily. If a person knows how to cope with them, processing any emotional jumps in the direction of a positive shift forward for himself, he will be able to easily respond to any uncomfortable situation, remain in good health and, moreover, develop his energy potential.

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

At first, this affects the psychological health of a person, in the future, the destruction passes to the physical level, where internal organs begin to suffer and various sores come out.

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

Paresis of the facial nerve can act in two ways - 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 an idiopathic lesion and a secondary lesion, progressing due to trauma or inflammation.

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

polio
pathogenic activity of the herpes virus
mumps
respiratory pathologies of the upper airways
head injuries of varying severity
nerve fiber damage in 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. Such a violation is often observed in such ailments as:

multiple sclerosis
ischemic stroke
hypertensive crisis
diabetes.

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

There are the following types of paresis:

Peripheral paresis

As a rule, this type of paresis begins with severe pain behind the ear or in the parotid region. One side is affected, on palpation the muscles are flaccid, 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 a normal physiological position, that is, the patient easily wrinkles the frontal folds, the eye functions fully, closes without a gap, there is no change in taste.

On palpation, the muscles at the bottom of the face are tense, in some patients there is a bilateral lesion. The cause of the central paresis of the facial nerve is the 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 number of patients identified with this pathology. With a mild and moderate form, the prognosis is favorable, with a severe one, one of the types of surgery may be prescribed.

A congenital anomaly of the facial nerve must be distinguished from Mobius syndrome, with this pathology, lesions of other nerve branches of the body are also recorded.

How to recover from paresis of the facial nerve with Tibetan medicine?

The rapid recovery of the body in Tibetan ways is due to the methods of external and internal influence. Everything that can contribute to a quick 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 the violation 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 just with the help of external and internal influences.

The methods of external influence used in 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 appointment of procedures is made by the doctor, taking into account the history and characteristics of the mental state of the patient.

The main external influences include the following procedures:

Moxibustion
Stone therapy
Tibetan massage
Vacuum therapy
Hirudotherapy
And others.

In combination with phytotherapy, these procedures give 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 fact that:

Reduces inflammation and swelling
Pain relief quickly
Reduced compression of the damaged nerve bundle
Blood supply normalizes
Stagnation is eliminated
Nervous tissues are restored
Return of normal muscle activity
Restored facial expressions
Immunity increases

Tibetan medicine has helped many patients regain their 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 tremendous knowledge about human nature and its interaction with this world. This experience has been accumulated for thousands of years and is now gaining popularity very quickly due to its amazing results.

Without chemicals, antibiotics, painful procedures and operations, we manage to lift and put people on their feet, significantly improving their condition.

They also come to us for the prevention of diseases. Relax, unload your emotional state, raise your vitality and restore energy.

After complex procedures, a person acquires harmony with himself and the outside world for a long time. It just 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!

Paralysis of the facial nerve leads to disorders of the muscles of the face. Depending on the degree of damage, there is a slight deficit in movement or general muscle relaxation of the affected side of the face. Paralysis can occur at any age, regardless of gender, very often without a clear cause. However, it also happens that this is a complication of pathological processes (for example, infectious diseases, cancer, complications after surgery). The prognosis in the vast majority of cases is good, and treatment ends with complete recovery.

The facial nerve is a VII cranial nerve that can be classified as a mixed nerve, which means that it contains three types of muscle fibers:

sensory
traffic
parasympathetic

Muscle fibers that feed the muscles of the face and neck, as well as the internal muscles of the ear, predominate. On the other hand, sensory fibers supply 2/3 of the front of the tongue, and parasympathetic fibers are responsible for the proper functioning of the glands:

lacrimal gland
sublingual and submandibular gland
glands of the nasal cavity, soft palate and oral cavity

Facial palsy can occur at different levels, and so you can distinguish between:

central facial palsy - damage involves the structure of the brain
peripheral paralysis of the facial nerve - damage occurs on the nerve. It happens much more often than central paralysis.

Bell's palsy accounts for almost 60-70% of all unilateral cases. Paralysis occurs regardless of gender and age. It is also not stated that either side of the face is more likely to be paralyzed.

Other causes of facial paralysis include: The most common form of facial paralysis is a spontaneous lesion of the facial nerve, called Bell's palsy.

ear injury
bacterial infections
intracranial tumors
cooling of the ear area
viral infections - HIV, chicken pox, shingles, mumps, herpes
meningitis
multiple sclerosis
parotid gland tumors
diabetes
mechanical nerve injury, such as during head and neck surgery
otitis media
Guillain-Barré syndrome is an autoimmune disease in which the peripheral nervous system attacks.

Among the factors predisposing to the occurrence of a disorder of the facial nerve, general weakness of the body, fatigue and chronic stress are mentioned.

Diagnosis of the disease

For effective treatment, it is important to distinguish between spontaneous paralysis and disease, and whether the paralysis affects the peripheral or central system.

Differentiation of spontaneous paralysis and paralysis against the background of the disease also uses the observation of the increase in symptoms. The sudden and rapid onset of symptoms is characteristic of spontaneous paralysis, while in the case of ongoing illness, the symptoms gradually increase (from several weeks to several months).

the most commonly used images are magnetic resonance imaging (MRI) and computed tomography (CT) Diagnosis is based on an interview with the patient and a clinical examination that assesses the severity of symptoms. For more accurate testing, additional tests are used:

electromyography - allows you to evaluate the electrical activity of the motor apparatus of muscles based on electrical potentials
electroneurography - evaluates the function of the nerve after stimulation with an electrical stimulus

The type and severity of the disease depends on the location of the nerve damage and the extent of the process in the nerve.

The vast majority of cases are unilateral nerve palsies, and bilateral palsies are rare.

Symptoms that reveal facial paralysis include areas such as sensory, motor, and glandular functions:

complete cancellation (paralysis) or violation (paresis) of facial expressions by half:
wrinkled forehead
raise eyebrows
constriction of the eyelids
falling corner of the mouth
grin
ear pain and its immediate surroundings - the pain is usually located behind the ear
numbness and tingling on the affected side of the face
hypersensitivity of the tongue and taste disorder (mainly within 2/3 of the anterior parts)
impaired secretion of tears
hypersensitivity to auditory stimuli
decreased salivation
removal of the corneal reflector, which is the protective mechanism of the eye, and consists in closing the eyelid when touching the eye.
disturbed deep feeling from the face area

Physiotherapy treatment of facial paralysis

The goal of treatment in the acute phase is to speed up recovery and prevent possible complications. On the contrary, in the chronic phase, the activity focuses on accelerating the regeneration of nerve fibers and preventing muscle atrophy and striving for facial symmetry.

For effective medical rehabilitation, an integrated approach includes pharmacotherapy, physical therapy, kinesitherapy and massage.

The first step in treatment should be prevention, understood as educating patients in daily care and counteracting adverse complications. Attention if eyelid closure does not work. The eye must then be moistened and protected from contamination of the cornea by bonding. Other preventive measures:

supporting the falling corner of the mouth with adhesive tape or a rail
avoiding sudden cooling and drafts
avoiding excessive pressure and stretching of the muscles of the affected side

Kinesitherapy plays a significant role in the recovery process, including facial expressions, massage, and neuromuscular stimulation. The earlier exercises and therapy are performed, the faster the lost functions return.

Facial muscle exercises should be performed in front of a mirror and under the supervision of a physiotherapist. It is recommended to perform the following movements:

wrinkled forehead - both horizontal and vertical
alternating eye closure
eye closure with maximum pressure
nose fold
lowering the eyebrows
smiling with clenched teeth
smiling with open teeth
grin
pulling the corners of the lips on the sides
lowering the corners - a gesture of disgust
protrusion of the tongue of the left and right cheeks
forward and removal of the lower jaw
jaw movement to the side
wide opening of the lips
turning the tongue into a tube
whistling
blowing, blowing straw into a glass of water
pursing the lips while stretching the lips
pronouncing "P" with the resistance of the fingers located at the corners of the mouth
vowel pronunciation: I, O, U, S, E, A

Exercises to learn the correct pattern should be performed with support, avoiding stretching of weakened muscles.

Kinesiology, touching facial paralysis - reduces pain and regulates muscle tone. This is reflected in the improvement of speech and facial symmetry.

Massage in case of paralysis of the facial nerve can be performed on one side or on both sides. It includes classic massage methods - stroking, friction, stroking, vibration, which are aimed at achieving the correct muscle tone, improving the flexibility of muscle fibers and improving blood circulation.

Places for development: * area of the upper and lower lips, * beard, * bridge of the nose, * eyebrows, * cheeks, * round muscle of the mouth, * eye muscle of the eye, * on the forehead.

The last but very important element of physiotherapy is neuromuscular stimulation. Stimulation methods are aimed at activating proprioceptive sensation. In therapy, stronger muscles are often used, which, by irradiation (radiation of muscle tone), stimulate the infected areas. Each therapy is characterized by different methods of work aimed at improving coordination and conscious muscle tightening and loosening. Examples of therapeutic elements:

pressure, interrupted vibration
stretching - contraction
rhythmic stimulation of movement - passively, help and resistance of the therapist
combination of isotonic contractions - uses all types of contractions (concentric, eccentric, static)

physical procedures

Laser biostimulation	Laser biostimulation accelerates the regeneration of nerve fibers, which directly affects the return of muscle function. Stimulation of individual facial nerves is stimulated. Treatment parameters: beam length: 800-950nm, treatment dose 2-9J/cm²
Solar lamp lighting	Sollux lamp exposure (red filter) is mainly used in acute illness. The generated heat allows a stagnant effect and also supports nerve regeneration.
electrical stimulation	Electrical stimulation uses a pulsed current with a triangular shape. The active electrode is the cathode, which stimulates the motor points of the affected muscles. Electrical stimulation should be performed in repetitive rows of about 10-20 pulses.
Magnetotherapy	Both a slowly changing magnetic field and a high-frequency electromagnetic pulsed field (short-wave diathermy) are used. The parameters of the slow magnetic field are induction 5-20Hz, pulse frequency 10-20Hz, sinusoidal pulses. Gradual increase in frequency as therapy progresses to 20 and 50 Hz. The electromagnetic field processing parameters are frequency 80 and 160 Hz, rectangular pulse shape, pulse time 60 µs. Gradual increase in frequency as therapy progresses to 160 and 300 Hz. Treatment using magnetic and electromagnetic fields is characterized by analgesic, anti-inflammatory, vasodilating and angiogenic effects, and also enhances regeneration processes.
Ultrasonic	They are characterized by analgesic and anti-inflammatory effects, and thanks to the "micromassage" a stagnant effect is achieved. Treatment of individual branches of the facial nerve. To obtain a better anti-inflammatory effect, drugs from the group of non-steroidal anti-inflammatory drugs are used. Treatment parameters: dose 0.1-0.3 W/cm².
Galvanizing / iontophoresis	In addition to electrical stimulation, electroplating (cathode current) is also used using a Bergoni electrode. Due to the high sensitivity of facial tissue, low doses are used. Galvanization can be enriched with vitamin B1 (introduced from the negative electrode) or 1-2% calcium chloride (including the positive electrode).

treatment statistics.

Treatment should be carried out as soon as possible, as it affects the consequences of the procedure. In most cases, treatment is effective and the patient returns to normal functioning. However, a key element of treatment is the timing of initiation and patient involvement, and lack of cooperation can be the cause of failure.

The average duration of therapy is about 6 months, during this time:

70% of patients - full recovery of function is registered
15% of patients - a slight deficiency is noticeable
15% of patients - permanent nerve damage found

The absence of conservative therapeutic effects is an indicator for surgical treatment.

Video: Acute neuritis of the facial nerve treatment. Symptoms, causes, 8 ways to relieve pain

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Paresis of the facial nerve is a disease of the nervous system that develops in a few days quite unexpectedly for the patient. The disease is immediately noticeable - there is an asymmetry of the muscles on one half of the face, which changes the appearance of a person not for the better. Most often, paresis is caused by colds of the upper respiratory tract, but there are several other factors provoking the disease. Paresis of the facial nerve can be completely eliminated, provided that the sick person seeks medical help in time and completes the course of therapy.

Paresis of the facial nerve

The disease does not belong to rare diseases of the nervous system; approximately 20 people are detected for every one hundred thousand of the population.

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, the development of the disease is also noted in childhood.

In adults, facial nerve paresis can lead to discomfort, a decrease in self-esteem, a long-term developing disease is often a consequence. Symptoms of the disease may also occur after surgery performed on the middle ear and jaw.

Paresis of the facial nerve is also recorded in children, especially often this disease occurs in schoolchildren. The cause of paresis in childhood is the transferred influenza, otitis media, the herpes virus can affect its occurrence.

With the start of timely treatment of the child, facial expressions are completely restored, on the other hand, if there is no therapy, then children have much more complications. The most severe of them include hearing loss, in some cases, a decrease in visual function is detected.

Newborn children can already be born with paresis of the branch of the facial nerve. There are several reasons for the pathology in this case - birth trauma, applying forceps to the skull, infectious diseases of the mother during the gestation period.

It is possible to suspect paresis of the facial nerve in a newborn child by the lowered corner of the lip on the one hand, by violations in the process of breastfeeding. In mild forms of the disease, it is possible to correct the pathology after professional massage sessions.

- specific conditions that can occur in a person during sleep. They are manifested by various behavioral attacks and interfere with normal sleep in order to restore strength for a new day. This pathology requires mandatory treatment.

One of its manifestations is idiopathic restless legs syndrome, which is characterized by involuntary twitches and muscle contractions. about the disease.

Types of paresis of the facial nerve

Paresis of the facial nerve is usually divided into peripheral and central, the first is detected more often.

Peripheral paresis

Most affected people begin with severe pain behind the ear or in the parotid region. One side is affected, on palpation the muscles are flaccid, their hypotonicity is noted.

Central paresis

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

The schematic photo shows the lesions of various muscles with paresis of the facial nerve:

congenital paresis

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

Causes of pathology

Paresis of the branches of the facial nerve occurs under the negative influence of a variety of reasons.

In the first place is idiopathic, that is, primary paresis, it develops after severe hypothermia of one part of the head or parotid region.
The cause of this form of neuritis is also the transferred respiratory diseases of the upper respiratory tract. Hypothermia of the head can be obtained while sitting under the air conditioner, when traveling in transport with an open window.
In second place among the causes of paresis is otogenic neuropathy - the nerve is affected during otitis media and during operations.
The rarest cause is the negative impact of the herpes virus, it is possible to develop paresis with tuberculosis, syphilis, mumps and poliomyelitis.

For all these reasons, an inflammatory process occurs, and paresis can also develop under the influence of a violation in the blood supply to the face. This occurs with ischemic, a sharp increase in blood pressure, with diabetes mellitus, disseminated.

The motor and sensory function of the facial nerve can be impaired during dental procedures and injuries.

Symptoms and manifestations

The most basic function of the branches of the facial nerve is considered motor, that is, the nerve provides the mobility of the muscles responsible for facial expressions.

In the absence of the necessary nerve impulse, the symptoms primarily manifest themselves in the impossibility of performing facial movements.

Paresis of the facial nerve is divided into an acute stage, lasting up to 2 weeks, the subacute phase lasts up to one month.

If the disease is not cured in a month, then they are already talking about the chronic stage of the disease.

On the side of the lesion, the following manifestations are noticeable:

Smoothing of the nasolabial fold.
The corner of the mouth is down.
The eyelids are wide open, when they are closed, lagophthalmos is observed - a light, visible strip of sclera remains.
The taste sensations on the first third of the surface of the tongue are reduced or completely stopped.
The function of the eyes is impaired - dryness appears or, on the contrary, lacrimation. A noticeable release of tears occurs when eating and chewing food.
The patient cannot stretch his lips, food may flow out of the half-opened half of the mouth.
In the first days of the disease, an exacerbation of hearing is noted - pain appears with loud sounds.
Before the development of all symptoms, there is a sharp soreness behind the ear.
An attempt to wrinkle the forehead ends in failure - the skin of this area remains completely smooth.

In addition, paresis of the facial nerve is usually divided into several degrees.

Easy degree. The asymmetry of the face is not very pronounced - a slight distortion of the mouth on the affected side is possible, the patient can hardly, but can frown the muscles of the eyebrow, completely close the eye.
Paresis of moderate severity already manifested by lagophthalmos, there are slight movements in the upper half of the face. When asked to perform lip movements or puff out the cheek, their incomplete implementation is noted.
Severe degree of paresis manifested by pronounced asymmetry - the mouth is noticeably skewed, the eye on the affected side almost does not close. Simple movements are not performed, in which facial muscles should participate.

In neurology, several types are distinguished, each of which has its own symptoms, severity of manifestations and prognosis. You can read more about them in the article.

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What is typical for the clinic of subarachnoid hemorrhage and how to help a person.

Diagnostics

Clinical signs of paresis in an experienced physician are not in doubt when making a diagnosis. Additionally, an examination by an ENT doctor is necessary to exclude the pathology of the ear departments. Analyzes and examinations are prescribed to identify and exclude the causes that determine the disease.

It is necessary to make sure that paresis is not a consequence of tumors of the facial part of the face and abscesses. If possible, electroneurography is used - the technique is aimed at measuring the speed of a nerve impulse passing through peripheral fibers.

This examination allows you to identify the localization of the resulting damage, its degree and severity of the ongoing pathological process.

Treatment

Paresis of the facial nerve is a disease in which the chances of completely getting rid of the disease depend on when the patient asked for qualified help.

With a chronic course of the process, it is already almost completely impossible to restore the innervation of the nerve, and a person can forever remain with a noticeable asymmetry of the face.

Complete normalization of the structure of nerve fibers occurs in about six months, at which time the patient must undergo a medical course of treatment, sessions of physiotherapy, massage, and do gymnastics.

How to treat paresis of the facial nerve in one case or another is decided by the attending physician.

Medical treatment

In the acute period, the doctor needs to identify the cause of the disease, relieve swelling and inflammation, and take measures aimed at regenerating nerve cells.

Pain relief is achieved by injection or tablet intake of analgesics and antispasmodics. Use Ketorol, Baralgin, Spazgan.
Decongestants - Triampur, Furosemide.
Corticosteroids are prescribed for moderate to severe paresis. The use of Prednisolone is necessary for the rapid removal of edema and inflammation.
It is necessary to use vasodilating drugs - Complamin, nicotinic acid preparations.
With a high level of patient anxiety, a positive effect is achieved faster after the appointment of sedatives - Relanium, Sibazon. Under the influence of these drugs, the patient calms down and at the same time, muscle spasm is partially removed.
Courses of vitamins are needed, especially group B.
In case of eye damage, drops of artificial tears are prescribed - their use moisturizes the mucous membrane and prevents the attachment of a secondary infection that develops when it dries out.
Symptomatic treatment is prescribed based on secondary signs of the disease.

Operational treatment

Surgical treatment is indicated for complete rupture of the nerve, which often occurs with injuries, and with congenital anomalies. The effectiveness of operations is observed only if it is carried out during the first year of the disease, in the future the muscles on the face completely atrophy and the restored nerve will no longer be able to control them.

In case of rupture, the nerves are sutured, and in case of pathology, autotransplantation is possible. The graft is taken from the patient's leg, moved to the required place on the face, and nerve branches are sutured to it from the healthy, unaffected side.

Thus, facial expressions are further controlled by one facial nerve, after the operation, there are no noticeable changes on the skin of the face - only a scar behind the ear remains.

Physiotherapy

For the first week, paresis of the branches of the facial nerve can be treated with the help of solux, a special lamp for phototherapy. In the future, UHF, phonophoresis with drugs are prescribed, paraffin therapy is indicated.

Physiotherapy may vary depending on the stage of the process and the ongoing changes in the course of the disease during its therapy.

Psychotherapy

The resulting distortion of the face does not have the best effect on the patient's psyche, a drop in mood is especially noticeable, depressive symptoms in people with high self-esteem. If sedatives do not help to return the usual mood, then you need to consult a psychotherapist.

In order to prevent a long course of the disease, it is necessary to consult a doctor at the first noticeable changes in appearance. A sick leave is issued for the acute period of the disease, and in the early stages the disease is eliminated quite quickly.

Homeopathy and acupuncture

Treatment with homeopathic remedies should be treated with caution - delaying more effective therapy can permanently disfigure a person's face.

In homeopathy, many drugs are made on the basis of poisonous plants, so their dosage must be strictly observed.

If you decide to use a medicine from this group, then you need to find a qualified specialist and do this only after the acute symptoms of the disease have been removed. One of the homeopathic remedies indicated for use in paralysis, paresis and neurosis is Gelsemium.

Acupuncture is also widely used for treatment.

Folk remedies

Together with the main treatment of the disease, folk remedies can be used to help restore muscle activity.

A mixture of tinctures of motherwort, calendula, hawthorn and peony allows you to normalize the state of the nervous system. 50 ml of tinctures are taken, mixed, 25 ml of corvalol and three tablespoons of liquid honey are added to the resulting liquid. Healing tincture is drunk before going to bed in a teaspoon for three months. Then they take a break for two months and spend another course of treatment.
Warming up with heat - sand or edible salt is placed in dense fabric bags. Before use, heat them to a comfortable temperature and apply to the affected side of the face, hold until cool.
Fir oil, which has a warming effect, can be rubbed into the affected side of the face.

can occur in both adults and children. Prerequisites for the appearance of auditory neuritis are many factors. Most often, the defeat occurs on one side.

Gymnastics

Gymnastic exercises for the face are an important step in restoring the functioning of the facial nerve.

At home, you can use the following sets of exercises:

It is necessary to develop eyebrows, for this they are raised, frowning. Exercises are done in any free time.
Inflate the cheek on the affected side with air. It is desirable to create external resistance by pressing on the cheek area with your fingers.
The lips are folded into a tube and try to pull them forward.
Eyes up to several times open wide and close tightly.

The attending physician may advise a set of gymnastic exercises, depending on the identified pathology. It is recommended to combine gymnastics with massage - the effect of two procedures will be more pronounced.

Consequences and prognosis

A favorable outcome of the disease is observed in those patients who completed the course of treatment on time. The prognosis also depends on the cause of paresis, if it is an injury or an oncogenic tumor, then muscle atrophy may develop.

Muscle contracture is observed in cases where the patient asked for help after 2-3 months from the onset of the disease. With the contracture that has arisen, the face looks like a mask, asymmetry is also noted in the healthy half.

Surgical operations to restore muscle innervation are successful if such treatment is carried out on time. With muscle atrophy, it is not possible to fully restore mimic movements. With a noticeable defect, cosmetic surgery is performed.

Prevention

Since paresis of the nerves on the face often develops with hypothermia, the only preventive measure is to prevent the influence of cold and drafts. They will prevent the development of paresis and timely treatment of otitis media, respiratory diseases.

On the video - additional visual information about paresis of the facial nerve:

G51 Facial nerve disorders

Epidemiology

Facial paralysis is relatively common. This may be due to its anatomical features: the nerve passes through the narrowed openings of the bones of the facial part of the skull. This causes its clamping and subsequent paralysis.

Most often, one branch of the facial nerve is affected, but bilateral paralysis is diagnosed in 2% of patients.

Every year, there are 25 cases of the disease per 100,000 people in the world, and both men and women are equally affected.

The highest incidence rate is observed in the off-season - from autumn to winter, as well as in winter.

According to prognostic data, the work of the facial muscles in most cases is completely restored. This happens over 3-6 months. In 5% of patients, innervation is not restored, and in 10%, re-damage of the nerve is possible after a certain period of time.

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Causes of facial paralysis

Experts cannot yet name the exact cause of facial paralysis, however, the disease is often caused by infectious viral pathologies:

herpetic infection;
chickenpox and herpes zoster virus;
adenovirus infections, SARS, influenza;
defeat by the Epstein-Barr virus (mononucleosis);
defeat by cytomegalovirus;
defeat by the Coxsackie virus;
rubella.

In addition, hypothermia, alcohol abuse, hypertension, head injuries (face, ear), tumor processes in the brain, dental diseases, diabetes mellitus, atherosclerotic changes in blood vessels, severe stressful situations, otitis or sinusitis.

Risk factors

Pathogenesis

The facial nerve is the VII paired cranial nerves, which are subject to the facial muscles responsible for speech reproduction, facial expressions and chewing. Paralysis of this nerve can occur as a result of an inflammatory process, which leads to spasm of arterial vessels with stagnation of blood flow in the capillary network. Capillaries become permeable, tissues around them swell, venous and lymphatic vessels are squeezed. This provokes a violation of blood and lymph flow.

As a result of all these processes, the nutrition of the facial nerve, which is very sensitive to oxygen starvation, worsens. The trunk of the nerve increases in size, the transmission of nerve impulses worsens along it. When the brain sends a command to the muscles for a certain action, they do not receive it and do not react. This explains the characteristic manifestations of the disease - the inactivity of some muscles of the face.

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Symptoms of facial paralysis

Paralysis of the facial nerve in any case begins acutely, with a sharp deterioration in the condition.

However, the first signs can be detected even at the initial stage of paralysis, 1-2 days before the visual manifestations. These may be the following symptoms:

soreness behind the auricle, radiating to the occipital region or the front part;
pain in the eye on the side of the lesion.

The first signs are associated with increasing swelling of the nerve column and its gradual compression.

The following symptoms are more pronounced:

the symmetry of the face is broken;
the affected side draws attention to itself by the lack of emotionality and facial expressions;
on the affected side, one can observe a lowered corner of the mouth, a smoothed nasolabial fold, and the absence of frontal folds;
violation of the symmetry of the face increases during the patient's attempts to speak, smile, cry;
the upper eyelid on the affected side does not close completely, and the eye looks up;
liquid food and drinks are not kept in the mouth and pour out from the affected side of the oral cavity; the function of chewing and swallowing is not violated;
during chewing, the patient, not feeling his own cheek, can bite it from the inside;
the mucous membrane dries up, salivation often decreases (sometimes it happens vice versa);
speech function is disturbed due to the inactivity of certain parts of the lips and oral cavity;
the eye on the affected side is half-open or completely open, the blinking function is impaired, the mucous membrane dries up (less often, and vice versa - profuse tearing);
there is a violation of taste sensations on the affected side of the tongue;
hearing on the affected side is enhanced, sounds are perceived louder than usual.

By evaluating the clinical symptoms of the disease, the doctor can determine which part of the facial nerve is damaged. Depending on this, the following types of facial paralysis are distinguished:

Damage in the area of the cerebral cortex responsible for the function of the facial nerve is manifested by paralysis of the mimic muscles of the lower part of the face, nerve and muscle twitches. At the same time, during a smile, symmetry is visually restored.
The defeat of the nucleus of the facial nerve is accompanied by nystagmus, the inability to wrinkle the skin on the forehead, numbness of the skin on the affected side, muscle twitching of the palatine and pharyngeal zone. Sometimes there is a unilateral disorder of coordination of the entire body.
The defeat of the facial nerve inside the cranium and the inner part of the temporal bone is characterized by paralysis of facial expressions, salivary glands. You can notice signs such as thirst, changes in auditory function, drying of the eye mucosa.

Forms

Congenital facial paralysis is associated with incorrect laying of the brain during the formation of the fetus. This type of paralysis is characterized by one or two-sided mask-like facial expression on the side of the lesion, a lowered corner of the mouth, and an open and moist palpebral fissure. The skin on the cheek is smooth, and during exhalation, the affected cheek seems to swell (a sign of "sail"). Mobius syndrome is the most severe form of congenital facial paralysis.
Peripheral paralysis of the facial nerve is the result of a violation of the motor function of the nerve trunk. Pathology is accompanied by asymmetry, complete immobility of the muscles of the affected part of the face. The affected eye in a patient often does not close, except in cases of damage to the orbicular muscle, when symmetrical closing of the eyes is possible.
Central paralysis of the facial nerve is the result of pathological changes in the cerebral cortex. Causes may be diseases affecting the corticonuclear pathways adjacent to the facial nerve. The most common localization of central paralysis is the lower part of the face. The disease is manifested by involuntary muscle movements - a kind of tic, as well as convulsive seizures.

Complications and consequences

Restoration of nerve fibers after paralysis of the facial nerve occurs gradually, slowing down significantly during periods of stress, intoxication and hypothermia. This creates some difficulties in treatment: for example, many patients simply lose patience and hope and refuse further rehabilitation. If the paralysis is not cured, then very unpleasant complications can arise.

Muscular atrophy is the thinning and weakness of the muscles due to prolonged dysfunction and impaired tissue trophism. This process is considered irreversible: atrophied muscles are not restored.
Mimic contractures - loss of muscle elasticity on the affected side, muscle spasms, spastic shortening of muscle fibers. The visually affected side of the face seems to stretch, the eye squints.
Tick of the facial muscles, spastic twitches are a violation of the conduction of impulses along the nerve. This condition is also called hemispasm or blepharospasm.
Associated movements - synkinesis - arise as a result of a violation of the isolation of biocurrents in the nerve trunk. As a result, the excitation spreads to other areas of innervation. An example of associated movements: while chewing food, the patient releases tears, or when squinting the eye, the edge of the lips rises.
Inflammation of the conjunctiva or cornea of the eye occurs due to the fact that the patient cannot completely close the eye for a long period of time, which leads to its drying out.

Diagnosis of paralysis of the facial nerve

The diagnosis of paralysis of the facial nerve is established by a neuropathologist. Usually this happens already at the first examination of the patient, but in some cases additional studies may be needed. Most often, diagnostics are used to clarify the causes of paralysis.

First of all, the patient is prescribed tests - for example, a general blood test will indicate the presence of inflammation. Signs of the inflammatory process will be: an increase in ESR, leukocytosis, a decrease in the number of lymphocytes.
Instrumental diagnostics may include the following procedures:

MRI is a type of examination using a magnetic field and obtaining layered images. Thanks to magnetic resonance imaging, it is possible to detect tumor processes, vascular disorders, inflammatory changes in the meninges, cerebral infarction.
CT is a kind of X-ray examination, which can also detect such probable causes of the disease as tumors, post-stroke conditions, disorders of the perinuclear blood flow, and the consequences of mechanical damage to the brain.
The method of electroneurography helps to determine the speed of passage of a nerve impulse. The results of this study help in determining the inflammatory process, damage to the nerve branch, and muscle atrophy.
The electromyography method is usually combined with the neurography procedure, determining the quality of intramuscular impulses. This allows you to detect muscle atrophy and contractures.

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Differential Diagnosis

Differential diagnosis can be carried out with a stroke, Ramsey-Hunt syndrome, with inflammatory processes in the middle ear or mastoid process, with Lyme disease, with fractures of the temporal bone, with damage to the nerve trunk by carcinomatosis or leukemia, with chronic meningitis, with tumor processes, osteomyelitis, disseminated sclerosis, as well as Guillain-Barré syndrome.

Distinguishing central facial paralysis from peripheral

Some difficulties sometimes arise in the differentiation of central and peripheral paralysis of the facial nerve.

First of all, attention is drawn to the state of the frontal row of muscles responsible for facial expressions. If they function without changes, and other facial muscles are motionless, then the central localization of paralysis is assumed.

In this situation, we can talk about a variant with hemorrhage into the internal capsule: the process proceeds with partial paralysis of the lower part of the nerve and a simultaneous unilateral feeling of weakness in the limbs. Sensation of taste, secretion of tears and saliva - without disturbance.

From practice, it is quite difficult to distinguish between central and peripheral paralysis of the facial nerve, even for an experienced doctor. Therefore, the maximum possible amount of information about the patient and his disease should be used for diagnosis.

Treatment of facial paralysis

Medicines are prescribed immediately after the patient seeks medical help. It is with complex drug therapy that the main treatment of facial paralysis begins.

Glucocorticoids
	Mode of application	Side effects	special instructions
Prednisolone	The average dosage is 5-60 mg per day. The drug is taken 1 time per day, in the morning.	Muscle weakness, indigestion, peptic ulcer, dizziness, increased blood pressure.	The drug is not prescribed for systemic fungal infections.
Dexamethasone	At the beginning of the disease, 4-20 mg of the drug is administered intramuscularly up to 4 times a day.	Nausea, convulsions, headache, weight gain, allergies, flushing of the face.	The drug is canceled gradually due to the risk of the "withdrawal" syndrome.

Medicines are prescribed only by a doctor. Most often, treatment is carried out in a hospital, since it is very difficult to treat facial paralysis qualitatively at home. In addition, it can lead to various negative consequences.

Physiotherapy treatment

Physiotherapy is used as an auxiliary, but mandatory therapeutic method for paralysis of the facial nerve. Perhaps the appointment of such physiotherapy procedures:

UHF is the heating of tissues using an electric field, which leads to an improvement in trophic processes, the removal of edema and inflammation. The duration of one UHF session is about 10 minutes. The treatment course usually consists of about 10 sessions, which are carried out every day, or 3-4 times a week.
UVR of the affected part of the face can be applied starting from about 6 days from the onset of the disease. Ultraviolet activates the synthesis of hormones, improves the functioning of the immune system, which has a positive effect on recovery. The treatment course may consist of 7-15 sessions.
UHF therapy is the use of electromagnetic decimeter waves to activate metabolic processes in the affected tissues of the face. The procedure takes about 10 minutes. The course can be short (3-5 procedures) or standard (10-15 procedures).
Electrophoresis with dibazole, vitamins, prozerin is the effect of certain doses of electric current, with the help of which the drug manages to penetrate into the affected tissues. The duration of one session of electrophoresis is about 20 minutes. The duration of treatment is from 10 to 20 sessions.
Diadynamic currents help to restore muscle function, causing their spastic contraction. At the same time, edema is removed and nerve fibers are restored. Treatment is usually long-term: recovery may require 10 to 30 treatments.
Applications with paraffin or ozocerite accelerate the regeneration process and contribute to a speedy recovery. The application is applied for 30-40 minutes. It may take about 15 procedures to restore innervation in facial paralysis.

After each session of physiotherapy, it is important to protect the face from drafts and cold, as a sharp temperature drop can aggravate the course of the inflammatory process.

Massage procedures for paralysis of the facial nerve

Massage for paralysis of the facial nerve is considered very effective, however, it is carried out, bypassing the acute period of the disease. The first massage sessions are prescribed no earlier than a week after the onset of the disease. What is a therapeutic massage for facial paralysis?

the massage procedure begins with warming up and kneading the cervical muscles, using slow tilts and rotations of the neck;
then massage the occipital region, thereby increasing the lymph flow;
massage the scalp;
move on to massage the face and temples;
important: massage movements should be light, shallow, so as not to provoke muscle spasms;
it is good to use stroking and relaxing movements;
stroking is carried out along the lymphatic vessels;
the face is massaged from the center line to the periphery;
massaging the localization of the lymph nodes should be avoided;
massage the inside of the cheek with the thumb;
at the end of the procedure, the neck muscles are massaged again.

The massage procedure should last no more than 15 minutes. The total duration of the course is until the patient is completely cured.

Special gymnastics

Gymnastics for paralysis of the facial nerve consists of a set of exercises to warm up the cervical and shoulder regions. The patient is seated in front of a mirror so that he can see his reflection. This guarantees the quality of the exercises performed.

During the lesson, the face should be relaxed. Do 5 repetitions of each of the following exercises:

the patient raises and lowers the eyebrows;
frowns;
looks down as much as possible while closing his eyes;
squinting;
moves eyeballs in a circle;
smiles with pursed lips;
raises and lowers the upper lip, showing the upper row of teeth;
lowers and raises the lower lip, showing the lower dentition;
smiles with an open mouth;
presses his chin to his chest and snorts;
moves the nostrils;
tries to puff out his cheeks, alternately and simultaneously;
takes in air and blows it out, folding his lips with a “tube”;
tries to whistle;
retracts cheeks;
lowers and raises the corners of the lips;
raises the lower lip to the upper, then puts the upper one on the lower;
makes tongue movements with closed and open lips.

Usually the proposed series of exercises is repeated up to 3 times a day.

Homeopathic remedies for facial paralysis

Homeopathy also offers a number of remedies to help speed up the recovery of facial paralysis. Homeopathic remedies should not be the mainstay of therapy, but they can enhance the effects of other treatments. Further - in more detail about the medicines that homeopaths offer to alleviate the condition with paralysis of the facial nerve.

Traumeel C is an injectable drug in ampoules. Usually prescribed 1-2 ampoules from 1 to 3 times a week as intramuscular injections. The duration of therapy is at least 1 month. Combined use with Traumeel ointment and tablets is possible.

The drug rarely causes allergies, but redness and slight swelling may appear at the injection site. In such a situation, it is recommended to consult a doctor.

Nervoheel is a homeopathic remedy that improves the functioning of the nervous system, promotes the functional renewal of nerve fibers, and eliminates the effects of stress and overwork. The drug is taken 1 tablet three times a day, dissolving under the tongue half an hour before meals. Treatment continues for about 3 weeks. Features of the use of the drug: during the first week of taking Nervoheel, a temporary deterioration in the condition is possible, which is considered a variant of the norm.
Girel is a drug that is used for paralysis of the facial nerve, which is a consequence of viral infectious diseases. Girel take 1 tablet three times a day, dissolving under the tongue. The duration of the appointment is calculated by the doctor.
Valerianacheel is a sedative that can be used for neuroses, neuropathies, and neurasthenia. Taking this drug can serve as an excellent prevention of recurrence of facial paralysis. The drug is prescribed 15 drops from ½ cup of pure water, three times a day for half an hour before meals. Continue taking 20-30 days.

Surgical treatment

The doctor may resort to surgical intervention if drug treatment does not have the expected effect for 9 months. Before this period, it is not worth prescribing an operation, since medicines can still have a positive effect. If more than 1 year passes, then it is already meaningless to carry out surgical treatment, since by this time atrophic changes in muscle tissue have already occurred, which cannot be restored.

In most cases, surgery is used for nerve ischemia, which develops as a result of chronic otitis media or after head injuries. Also, the operation is appropriate for mechanical rupture of the nerve branch.

Summing up, we can distinguish the following situations with facial paralysis, in which the help of a surgeon may be needed:

traumatic rupture of the nerve trunk;
ineffectiveness of ongoing drug treatment for about 9 months;
tumor processes.

How is the operation carried out?

When squeezing the facial nerve, the intervention is carried out as follows:

an incision is made behind the ear;
the exit point of the nerve from the stylomastoid foramen is allocated;
the outer wall of the hole is expanded with special devices;
stitches are applied.

General anesthesia is used for the operation.

To suture the damaged nerve trunk, the following surgical procedures are performed:

an incision is made behind the ear;
under the skin, the ends of the torn nerve trunk are found, which are cleaned for the best union;
the ends are sewn together immediately or are first skipped along a different, shorter path;
in some cases, a nerve graft from another part of the body, such as a lower limb, may be needed.

The operation is quite complicated, but the rehabilitation period, as a rule, is not long.

Alternative treatment

It is useful to put compresses from mashed potatoes based on elderberries. The berries are steamed and ground, distributed on the surface of a clean tissue and applied as a compress to the affected part of the face for half an hour. The procedure is carried out twice a day.
A good effect is expected from the regular use of dates with milk, which are eaten three times a day, 6 pcs. The duration of treatment is 1 month.
Warm water is taken into the oral cavity, to which a few drops of valerian tincture are added. Hold the medicine in the mouth without swallowing for 3-4 minutes.
Mumiyo is taken in the morning, afternoon and at night, 0.2 g each, for 10 days. After another 10 days, the reception is repeated. Usually, three such courses are enough for a cure.

In addition, you can use herbal treatment according to the following recipes.

Take 100 g of sage herb, pour 1 glass of hot water and insist overnight. Drink 1 tsp. between meals with milk.
An equivalent mixture is prepared from valerian rhizomes, oregano herbs, yarrow and mistletoe. Prepare an infusion at the rate of 1 tbsp. l. mixture in a glass of water. Drink the medicine 100 ml three times a day 20 minutes before meals.
Prepare an equal mixture of mint, lemon balm, oregano, thyme, mistletoe, motherwort. Pour 1 tbsp. l. a mixture of 200 ml of boiling water, insist for an hour and take 100 ml twice a day between meals.
eat right, avoid strict diets, eat enough plant foods;
twice a year, take a course of multivitamin preparations with B vitamins, which are very necessary for the normal functioning of nerve cells and fiber conductivity;
maintain immunity, harden, take air baths;
periodically massage your face, morning and night, using light stroking movements.

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What is facial paresis? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. V. N. Efimenko, a neurologist with an experience of 41 years.

Definition of disease. Causes of the disease

Paresis of the facial nerve- This is a polyetiological pathological condition, which is manifested by weakness of the facial muscles innervated by the facial nerve. It occurs at various ages, both in adults and in children.

Causes of weakness of the facial muscles:

1. Causes due to damage to the central motor neuron:

stroke (ischemic - 85%, hemorrhagic - 15%);
brain tumors (metastatic or primary, localized in the hemispheres of the brain or its trunk);
brain abscess;

2. Causes due to damage to the peripheral motor neuron:

Bell's palsy;
(may be HIV-associated);
infection caused by the herpes simplex virus;
vasculitis;
sarcoidosis, Behcet's disease, periarteritis nodosa, Sjögren's syndrome,;
: bacterial (pneumococcus, meningococcus, Haemophilus influenza, tuberculosis, borreliosis, syphilis, fungal infections);
fracture of the temporal bone;
temporal bone tumors: metastatic, invasive meningioma;
infections and tumors of the middle ear;
tumors or infections of the parotid gland;
traumatic injuries of the face;
internal rupture of the carotid artery;
the effect of drugs (chemotherapeutic agents);
consequences of installing a cochlear implant;

3. Diseases in which neuromuscular synapses are affected:

myasthenia gravis;
botulism;

4. Diseases that affect the facial muscles:

muscular dystrophy;
myopathy.

Of the most common causes, in 2/3 of cases of paresis of the facial muscles, idiopathic neuropathy of the facial nerve (Bell's palsy) is detected. Infectious lesions of the nerve with the herpes zoster virus may be with Ramsay Hunt syndrome. Of the other infections, neuropathy of the facial nerve can occur with Lyme borreliosis and mumps. In the pontine form of poliomyelitis, the motor nucleus of the facial nerve can be affected. In addition, damage to the facial nerve can be with many systemic infections (syphilis, tuberculosis, HIV infection, and others). With Guillain-Barré syndrome, paresis of the facial muscles is included in the clinical picture of the disease. Bilateral neuropathy of the facial nerve is considered by many authors as an erased form of this syndrome. Involvement of the facial nerve can also occur in systemic connective tissue diseases (periarteritis nodosa, systemic lupus erythematosus, Sjögren's syndrome, and others), as well as sarcoidosis, amyloidosis, etc.

Inflammatory processes in the middle ear can spread to the facial nerve. Recurrent neuropathy of the facial nerve in young individuals may be a manifestation of the Melkerson-Rossolimo-Rosenthal syndrome, which is hereditary in nature with localization in the 9p14 gene.

Among other reasons, one can name a tumor process, for example, damage to the facial nerve with acoustic neuroma, carcinomatosis of the meninges, arachnoid epithelioma of the base of the skull, and others. Traumatic lesions occur with fractures of the base of the skull. Also, nerve damage can occur after operations on the middle ear, pyramid of the temporal bone, salivary gland.

Metabolic disorders in diabetes mellitus can also be manifested by the involvement of the facial nerve with a complex mechanism characteristic of diabetic neuropathies. In older patients, damage to the facial nerve can occur with hypertension, cerebral atherosclerosis and other angiopathy, when small vessels that feed the nerves are involved in the process.

Paresis of the facial muscles can also develop with supranuclear damage to the corticonuclear pathways with focal processes in the hemispheres and brainstem above the nucleus of the facial nerve. There is a so-called "central paresis of the facial nerve." In rare cases, other causes of paresis of the muscles of the face are possible (for example, myasthenia gravis, facial forms of myopathies, and more).

Symptoms of paresis of the facial nerve

It is very important for a practitioner not only to identify the symptoms of damage to the facial nerve, but also to determine the topical (local) level of its damage, which is important for establishing the causes and mechanism of the onset of the disease (etiopathogenesis) and targeted treatment.

Allocate central and peripheral paresis of the facial nerve. Central paresis is different in that it causes weakness of the muscles of only the lower part of the face (smoothness of the nasolabial fold, drooping of the corner of the mouth, and others), while the upper one remains intact (intact). This is due to the fact that the upper part of the nerve nucleus has a bilateral cortical representation. In addition, on the side of paresis, there may be symptoms of damage to the pyramidal tract in the arm and leg (central hemiparesis, hyperreflexia, pathological reflexes, and others).

In all cases of peripheral lesions, the mimic muscles of the face suffer: prosoparesis or prosoplegia occurs (reduction or loss of strength of the facial muscles of the face). The patient on the side of the lesion has a reduced number of folds on the forehead, limited mobility of the eyebrow, the eye does not close completely, and when closing the eyeball moves up (Bell's symptom), the nasolabial fold is smoothed, the cheek “floats” when inflated, it is impossible to whistle, the liquid pours out of the mouth , does not participate in the movement of the subcutaneous muscle of the neck.

The level of nerve damage helps to establish the accompanying symptoms. Most often, the nerve is damaged in the canal of the facial nerve of the pyramid of the temporal bone. At the same time, symptoms of damage to the intermediate nerve (n. intermedius) join prosoparesis.

Scheme of the facial and intermediate nerves (n. Intermedius). 1-5 - levels of nerve damage

Symptoms of nerve damage, depending on the level of damage, are as follows:

when the nerve is damaged in the cerebellopontine angle, symptoms of prosoparesis (VII pair) and hearing loss (VIII pair) occur;
with a high nerve lesion in the canal before departing from it n. petrosus major the patient has prosoparesis in combination with dry eyes, hyperacusis (perception of any sounds as too loud) and a decrease in taste in the anterior 2/3 of the same half of the tongue;
when the nerve is damaged below the origin of the large stony nerve, prosoparesis, lacrimation, hyperacusis and a decrease in taste in half of the tongue are detected;
with damage to the nerve below the discharge n. stapedius there will be prosoparesis in combination with lacrimation and a decrease in taste in the anterior 2/3 of the same half of the tongue;
with damage to the nerve at the exit from the canal after discharge chorda thympani there will be only prosoparesis and lacrimation.

Lachrymation with lesions of the facial nerve can be explained by several reasons. On the one hand, with incomplete closure of the eye, the mucous membrane is constantly irritated, which, while maintaining lacrimal innervation, leads to increased tear formation. On the other hand, when the circular muscle of the eye is relaxed, the lower eyelid is somewhat lowered, and the tear, without falling into the lacrimal canal, pours out through the eyelid.

Ramsey Hunt's neuralgia, which occurs as a result of a herpetic lesion of the geniculate node, is manifested by a combination of paresis of the facial muscles of the face with herpetic eruptions on the tympanic membrane, the skin of the auricle and / or the external auditory canal. Sometimes there is tinnitus and hearing loss.

The Melkerson-Rossolimo-Rosenthal syndrome is characterized by a triad: recurrent angioedema of the face, folded ("geographic") tongue, and peripheral (sometimes recurrent) paralysis of facial muscles.

The pathogenesis of paresis of the facial nerve

Central paresis of the facial nerve occurs due to damage to the fibers of the corticonuclear pathway during processes in the hemisphere or brain stem (stroke, tumor, abscess or trauma).

When a nerve is damaged in the canal of the pyramid of the temporal bone, the pathogenetic mechanisms can be ischemia, edema and compression of the area of the facial and structures of the intermediate nerves in the canal. This is one of the models of compression-ischemic neuropathy. In Guillain-Barré syndrome and multiple sclerosis, autoimmune mechanisms are included in the pathogenesis. In Hunt's syndrome, there may be direct damage to the structures of the nerve by the herpes-zoster virus, which may be the cause of poor recovery of nerve function.

In the pathogenesis of paresis of the facial nerve, a special place is given to traumatic injuries in craniocerebral injuries, which are accompanied by a fracture of the pyramid of the temporal bone, and surgical interventions, for example, neurosurgical removal of the acoustic neuroma or operations on the parotid gland.

Possible damage to small vessels that feed the nerve ( vasa nervorum) in diabetes mellitus, hypertension, vasculitis and vasculopathy. In poliomyelitis, the motor motor neurons of the nucleus of the facial nerve are damaged.

Classification and stages of development of paresis of the facial nerve

Allocate central and peripheral paresis of the facial nerve.

In addition, the disease is divided into primary neuropathy of the facial nerve (idiopathic neuropathy of the facial nerve, Bell's palsy) and secondary neuropathy (with herpes infection, tumors, mesotympanitis, trauma and other processes).

acute period - the first month from the onset of the disease;
subacute period - recovery is delayed by more than 1-1.5 months;
residual effects and complications.

The selected course of illness is important when choosing a method of treatment and rehabilitation (for example, reflexology, electrical stimulation, and others).

Complications of paresis of the facial nerve

Complications in the acute period include damage to the mucous membrane of the eye, especially with high nerve damage in the canal, before the discharge of tear fibers and the development of keratoconjunctivitis.

Late complications include spasmoparesis of facial muscles, the development of pathological synkinesis (involuntary muscle contractions) and the syndrome of "crocodile tears" (lacrimation during meals).

Diagnosis of paresis of the facial nerve

The anamnesis is studied and identification of possible risk factors and suspected causes. For example, the incidence of facial neuropathy is higher in persons suffering from arterial hypertension, diabetes mellitus (approximately 4 times) and in pregnant women, especially in the third trimester (approximately 3.3 times). With idiopathic neuropathy of the facial nerve, there may be indications of hypothermia (riding in transport with an open window, air conditioning, etc.). In addition, it is important to identify concomitant symptoms, such as fever and other infectious manifestations, damage to other organs and tissues, as well as changes in laboratory tests.

The onset of the disease is usually acute, the slow development of symptoms may indicate a tumor process. With Ramsay Hunt syndrome or mastoiditis at the onset of the disease, there may be complaints of pain in the behind the ear region.

A neurological examination makes it possible to distinguish between central paresis of the mimic muscles (mainly the lower part of the face suffers) from the peripheral paresis, and also to clarify the level of nerve damage. To do this, it is necessary to identify concomitant symptoms, such as lacrimation or dry eyes, hyperacusis, decreased taste in the anterior 2/3 of the tongue.

It is necessary to consult an otolaryngologist to exclude inflammatory processes in the ear or pyramid of the temporal bone, as well as herpetic eruptions on the eardrum or in the ear canal. If Lyme borreliosis or another infectious disease is suspected, a consultation with an infectious disease specialist is indicated; if sarcoidosis or tuberculosis is suspected, a consultation with a phthisiatrician is indicated.

Of the laboratory methods, a general blood test is required, as well as a blood test for sugar. Research on Lyme borreliosis in some countries is mandatory for mono- and polyneuropathies. In addition, screening for syphilis and HIV infection is carried out.

MRI of the brain is especially indicated for suspected damage to the brain stem or base of the brain (for example, neurinoma of the cochleo-vestibular nerve). Computed tomography in its diagnostic value is superior to MRI in visualizing fractures of the skull base. The study of cerebrospinal fluid is indicated for symptoms indicating the possibility of meningitis, encephalitis, vasculitis and other diseases.

Electroneuromyography (needle and stimulation), in addition to confirming the diagnosis, is necessary to assess the dynamics of the reinnervation process in the facial muscles.

Treatment of paresis of the facial nerve

The objectives of treatment are aimed at the speedy restoration of the function of the nerve and paretic muscles, as well as the prevention of complications. Treatment should begin as early as possible.

Treatment for idiopathic neuropathy has traditionally been a short course of high-dose glucocorticoids, such as oral prednisolone 1 mg/kg per day for seven days followed by rapid withdrawal. Timely treatment with glucocorticoids increases the frequency of complete functional recovery by 17%.

If a herpes infection is suspected, including Hunt's syndrome, antiviral drugs are prescribed: 200 mg of acyclovir 5 times a day, or 500 mg of valaciclovir 3 times a day, or 500 mg of famacyclovir 3 times a day. With purulent otitis media and mastoiditis, antibiotic therapy is prescribed.

Treatment of paresis of the facial muscles in Guillain-Barré syndrome or multiple sclerosis is carried out in accordance with the recommendations for the treatment of these diseases. In diabetes mellitus, the regulation of carbohydrate metabolism and microcirculation is important.

From non-drug treatment, mimic gymnastics is used. The effectiveness of physiotherapeutic methods and reflexology has not been proven. But in some cases, with a slow recovery, properly performed reflexology speeds up the recovery process.

When the first signs of spasmoparesis or synkinesis appear, it is necessary to cancel anticholinesterase drugs and stimulating methods of physiotherapy. In this situation, thermal facial treatments and muscle relaxation exercises are used, including post-isometric muscle relaxation (PRM) and biofeedback (BFB).

Surgical treatment can be used for congenital narrowness of the fallopian canal and deep paresis of the mimic muscles of the face in the acute period. The effectiveness of the operation is higher when it is carried out in the first two weeks of the disease. Such operations are carried out extremely rarely in specialized centers. Surgical treatment is also carried out with neurinoma of the VIII pair or purulent mastoiditis.

Forecast. Prevention

The prognosis for life is favorable. Approximately in 2/3 cases, especially at a young age, there is a complete recovery of functions. In 13% of cases, minimal residual symptoms persist, in 16% of patients, recovery is incomplete with the development of spasmoparesis and synkinesis. The prognosis is worse for herpetic lesions of the crankshaft (Ramsey Hunt syndrome), as well as in the elderly, in diabetes mellitus, arterial hypertension, in persons with severe mimic muscle paralysis in the acute period, in cases of nerve damage due to operations. The prognosis is also worse for recurrent neuropathy of the facial nerve (for example, with congenital narrowness of the nerve canal or with the Melkerson-Rossolimo-Rosenthal syndrome).

Primary prevention of the disease does not exist. In cases of detection of congenital narrowness of the canal, surgical treatment is possible. It is also justified to prescribe adequate anti-edematous therapy at the very beginning of prosoparesis in Melkerson-Rossolimo-Rosenthal syndrome.

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