Facial neuritis: symptoms, diagnosis, treatment

Facial nerve neuropathy is the most acute form of mononeuropathy and is a disease of the nervous system in which, due to the influence of certain factors, damage to the seventh cranial nerve occurs. This nerve controls the movement of the facial muscles and any damage to the nerve results in loss of movement of the facial muscles on the affected side. Damage to the nerve can also affect hearing and taste, since this nerve is also involved in the functioning of the senses. The effectiveness of treatment depends on the severity and cause of the disease.

Information about the disease

The facial nerve is responsible for ensuring the movements of facial muscles, the lacrimal gland, the tensor tympani muscle, and also innervates the anterior two-thirds of the tongue. It leaves the skull in a narrow canal located deep in the temporal bone. The slightest swelling in this area leads to compression of the fibers and the development of corresponding symptoms.

The pathology most often occurs in middle-aged people, who often neglect preventive measures due to the high pace of life. The peak incidence occurs in the cold season, since low temperatures are one of the provoking factors.

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Possible complications

Treatment of facial neuritis cannot be delayed. The later therapy is started, the greater the likelihood of developing complications:

• With a long course of the disease, the patient develops a persistent contracture of the facial muscles on the affected side: the muscles are involuntarily tense, contracted, and involuntary movements are possible. Recovery from such a complication is extremely difficult.
• The appearance of the face can change greatly: immobile muscles create a significant cosmetic defect.
• Persistent disturbances of taste.
• Corneal ulcers, infection, cataract formation, blindness.
• Constant spasm of the muscles of the face or eyelid.

Causes

Depending on the cause, the following forms of facial nerve neuropathy are distinguished:

• idiopathic: the cause of paralysis remains unidentified (the most common variant of the disease);
• infectious: pathology occurs against the background of infectious damage to nerve fibers due to herpes, tuberculosis, mumps, syphilis and some other diseases;
• otogenic: is a complication of inflammation of the middle ear or mastoid process;
• traumatic: neuropathy develops against the background of traumatic brain injury;
• ischemic: the disease is associated with impaired blood flow and decreased oxygen supply to nerve fibers.

The risk of pathology increases significantly in the following situations:

• for metabolic disorders, including diabetes mellitus;
• with advanced forms of arterial hypertension;
• during pregnancy, especially with severe toxicosis.

The triggering factor for the development of pathology is often hypothermia.

Results of surgical treatment of paralysis of facial muscles

The result of these operations (with the exception of static correction) does not appear immediately. As a rule, the result appears after 4-8 months - the first weak movements appear, which gradually intensify with mandatory adherence to the specialist’s recommendations. This is due to the fact that nerves re-grow, according to the literature - up to 1 mm per day. First, sensations appear in the form of “lumbago”, “running goosebumps”, etc. This indicates the growth of the nerve along the nerve fibers. The first movements are quite weak, since the muscles have been without load for a long time, so it takes time for their functional restoration, and it is necessary to constantly load them rationally. Thus, rehabilitation plays a very important key role in the final outcome. And the patient must be prepared for daily exercise and not immediate results.

Symptoms

Symptoms of facial neuropathy make it possible to immediately suspect the disease. Signs arise from the affected nerve. Patients note:

• acute pain: it usually begins in the ear area and gradually spreads throughout the face and begins to radiate to the occipital region;
• intense lacrimation, less often dry mucous membranes of the eyes;
• discomfort or ringing in the ear due to sharp sounds;
• disturbance of the sense of taste in the anterior parts of the tongue.

As the disease progresses, signs of damage to the motor fibers of the nerve appear:

• smoothness of skin folds, especially nasolabial folds;
• swelling of the cheek when exhaling or trying to pronounce a consonant sound;
• lack of complete closure of the eyelids, rotation of the eyeball upward and outward (lagophthalmos);
• leakage of fluid from the corner of the mouth;
• food getting stuck between the gum and cheek when eating;
• limitation of facial expressions: the patient cannot frown or smile.

If the cause of neuropathy is an infectious process, the characteristic signs are accompanied by symptoms of general intoxication:

• high body temperature;
• headache;
• nausea and vomiting;
• weakness.

Diagnostics

Neurological disorders characteristic of facial neuropathy can also occur with other diseases, in particular with stroke. That is why, if any similar symptoms occur, you should urgently consult a neurologist.

Diagnosis of pathology includes:

• collection of complaints;
• taking an anamnesis, during which the doctor clarifies the time and circumstances of the onset of symptoms, records previous and chronic diseases, injuries and other important details;
• neurological examination, during which a specialist checks skin sensitivity, motor function, muscle strength, quality of reflexes, functioning of the central nervous system, etc.;
• tests: general blood and urine analysis, biochemical blood test with mandatory determination of glucose levels, determination of antigens and antibodies to infectious diseases if their presence is suspected;
• X-ray of the chest organs: allows you to diagnose tuberculosis, tumors;
• MRI or CT scan of the brain: helps visualize tumors, areas of acute ischemia, hemorrhages, consequences of injuries and strokes;
• CT scan of the temporal bone;
• electroneuromyography: assessment of the speed of impulse transmission along nerve fibers and muscles, allows you to determine the level of damage and severity of the disease;
• consultations with specialists: therapist, otorhinolaryngologist, endocrinologist, infectious disease specialist, if necessary.

The list of studies can be adjusted depending on the specific clinical situation.

Treatment of facial nerve neuropathy

A combination of drug and non-drug methods is used for treatment. As a rule, doctors prescribe medications from these groups:

• non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, meloxicam, nimesulide, diclofenac and other drugs; necessary to relieve pain and inflammation, eliminate swelling; used for mild to moderate neuropathy;
• glucocorticosteroids: prednisolone, hydrocortisone, dexamethasone; have an anti-inflammatory effect, relieve swelling; used for severe forms of the disease, as well as when NSAIDs are ineffective;
• diuretics: furosemide, lasix; necessary to eliminate tissue swelling;
• vascular drugs: pentoxifylline, nicotinic acid, cavinton; stimulate active blood flow in the affected area, improve tissue nutrition;
• metabolic agents: actovegin; necessary to stimulate metabolism and regenerate damaged structures;
• antiviral and antibacterial agents for the infectious nature of the pathology;
• anticholinesterase drugs: neuromidin, axamon; improve the transmission of excitation from nerve to muscle, help to quickly get rid of paralysis of facial muscles;
• B vitamins: milgamma, combilipen; stimulate nerve regeneration and improve impulse conduction.

If neuropathy has become chronic and muscle paresis has given way to spasm, muscle relaxants are prescribed: mydocalm, carbamazepine, baclofen. They replace anticholinesterase drugs and promote muscle relaxation. If these remedies are ineffective, injections based on botulinum toxin are used.

Drug treatment is complemented by physiotherapy. In the acute period the following are used:

• UHF;
• exposure to alternating magnetic field;
• phonophoresis with hormones.

After one and a half to two weeks from the onset of the disease, these methods are added:

• electrotherapy (diadynamic currents, etc.);
• electrical stimulation of muscles;
• electrophoresis;
• magnetic therapy;
• laser therapy;
• Darsonvalization.

An additional effect is provided by mud applications, therapeutic baths, and acupuncture.

During the acute period it is also recommended:

• sleep only on your side (affected side);
• tie a scarf around your face to prevent stretching of paralyzed muscles;
• carry out muscle taping: tighten the muscles using an adhesive plaster (duration from 30-60 minutes to 2-3 hours);
• tilt your head in the direction of the lesion several times a day and support the muscles with your palm; The duration of the procedure is 10-15 minutes.

After acute inflammation has subsided, it is recommended to perform therapeutic exercises to develop the affected muscles:

• frown and raise your eyebrows;
• open and close your eyes wide;
• widen the nostrils;
• puff out one's cheeks;
• smile with your mouth open and closed;
• stretch out your lips, blow out an imaginary candle, whistle;
• stick out tongue, etc.

The more the patient grimaces, the faster the muscles will recover. During the same period, a light therapeutic massage to stimulate blood circulation is acceptable.

If treatment does not bring effect within 2-3 months, doctors recommend using surgical treatment methods. Two types of operations are used:

• restoration of impulse transmission along the nerve: decompression of the nerve fiber when it is compressed in the canal of the temporal bone;
• reinnervation: replacement of the affected area with a donor nerve (segment of the hypoglossal, phrenic or accessory nerve, as well as healthy branches of the facial nerve);

The choice of a specific treatment method depends on the form of the disease, its cause, severity and level of damage.

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Incidence (per 100,000 people)

Prevention

Compliance with the rules for the prevention of facial nerve neuropathy can reduce the likelihood of pathology occurring. This is especially true if there is an increased risk of developing the disease. Doctors recommend:

• avoid hypothermia and facial injuries;
• observe safety precautions at work to prevent eye damage;
• consult a doctor in time for infections and otitis media;
• control blood sugar levels;
• promptly diagnose and treat chronic diseases.

Treatment at the Energy of Health clinic

Facial nerve neuropathy requires the fastest and most accurate diagnosis and comprehensive, comprehensive treatment. Only in this case can a rapid restoration of impaired functions be achieved. Neurologists at the Energy of Health clinic use the most effective techniques:

• modern drug regimens that affect the cause of the disease and relieve symptoms;
• physiotherapy courses for tissue restoration;
• massotherapy;
• training in facial gymnastics techniques;
• taping the affected areas;
• observation throughout therapy, adjustment of dosages and medications if necessary;
• a full range of measures for quick and complete rehabilitation;
• organization of sanatorium-resort treatment for the most complete recovery.

Advantages of the clinic

The Health Energy Clinic provides each visitor with medical care of the highest level, regardless of his age and reason for visiting. We offer:

• screening diagnostic programs to assess health status;
• accurate and quick diagnosis of obvious and hidden pathologies;
• modern methods of drug therapy, physiotherapy, exercise therapy, massage;
• minor surgical operations within the walls of the clinic;
• course treatment of chronic diseases in comfortable day care wards;
• organization of hospitalization in a specialized hospital if necessary;
• preparation of documents for sanatorium-resort treatment, selection of sanatorium;
• remote consultations with foreign doctors to obtain an alternative opinion;
• modern rehabilitation programs.

Facial nerve neuropathy is a fairly common pathology. To prevent it from leading to irreversible facial asymmetry, contact a specialist as soon as possible. Neurologists at the Energy of Health clinic will always come to the rescue.

Where is surgical treatment for paralysis of the facial muscles performed?

Specialists from the Department of Maxillofacial and Reconstructive Surgery of the Federal State Budgetary Institution NKCO FMBA of Russia, together with the Department of Ear Diseases, have developed and put into practice a unique method of surgical treatment of patients with paralysis of the facial muscles. The first operations on patients with this pathology in Russia were performed by specialists from the Federal State Budgetary Institution NCCO FMBA of Russia - otosurgeon, MD. Hassan Diab and maxillofacial surgeon Ekaterina Orlova.

A healthy person rarely thinks about how important facial expressions are and what role they play in our lives, especially a smile... Smile more often!