Neuropathy of the facial nerve left, right: acute, ischemic

Neuropathy of the facial nerve is a pathological process, as a result of which the innervation and sensitivity of the facial nerve branches is impaired. Statistics say that 75% of all cases of facial nerve neuropathies constitute Bell's paralysis - a one-sided paresis of the facial muscles. This disease occurs regardless of the sex and age of the person, but most often observed in people from 20 to 45 years. This type of affection of the peripheral nervous system is not an independent disease, with the exception of congenital anomalies or disruption of normal intrauterine development.

Paralysis can be one-sided, for example the facial nerve neuropathy on the right. With a bilateral lesion, there is another focus - the neuropathy of the facial nerve on the left. Bilateral lesion is considered the most painful and is hard to tolerate by patients.

[1], [2], [3], [4]

Causes of the neuropathy of the facial nerve

The causes of the neuropathy of the facial nerve are not fully understood. It is proved that acute facial neuropathy is the second link in the pathological process. In the role of the first link or trigger mechanism are:

• craniocerebral trauma, especially trauma of temporal bones, bones of the cranial vault and mastoid process
• surgical interventions (plastic surgery, operations on the mastoid process, etc.)
• viral and bacterial infections (meningitis, meningoephalitis, mumps), complications after SARS, influenza, otitis and mastoiditis.
• Undercooling and prolonged stay in a draft
• aneurysms of the cerebral arteries, acute disturbance of cerebral circulation, in some cases - the consequences of stroke.

[5],

Risk factors

The likelihood of neuritis rises in healthy people if they work in cold conditions, near refrigerators, air conditioners or drafts.

Another no less important factor is the piercing of the face, namely the eyebrows, lower lip or anterior third of the tongue. First, unprofessional puncture can cause trauma to the nerve. Secondly, even the correct puncture does not guarantee complete safety, since inadequate care for the puncture site, contact with insufficiently sterile instruments, dust and dirt can lead to infection with pathogenic microorganisms and cause an acute inflammatory process.

Neuropathy of the facial nerve in children occurs when there is a burdened heredity for this disease. If a history of one of the parents had a case of neuritis, then there is a probability of occurrence in the child.

[6], [7], [8], [9], [10]

Pathogenesis

The pathogenetic mechanism of the development of Bell's paralysis depends on the cause of the onset.

Ischemic neuropathy of the facial nerve occurs on the basis of vessel ischemia, which causes damage to the motor neurons of the facial nerve. This condition is often observed with hypertensive crisis.

Compression ischemic neuropathy of the facial nerve develops as a result of compression of the nerve by nearby structures with subsequent impairment of blood circulation. Bone fragments, bruises, hemostasis and lymphostasis can negatively affect the branches of the facial nerve and disrupt normal functioning.

[11], [12], [13], [14], [15], [16]

Symptoms of the neuropathy of the facial nerve

The main source of unpleasant symptoms is weakness or paralysis of the muscles. Visually observed distortion of facial expressions, asymmetry.

Symptoms of facial neuropathy form a complex, which includes:

1. Acute pain in the area of the affected half of the face.
2. Headache.
3. Impossibility to languish eyelids, the outer corner of the eye and the corner of the mouth are lowered down.
4. Smoothing the folds of the nasolabial triangle and wrinkles on the forehead.
5. Tear, which is replaced by dry eyes, a sense of "sand" in the eyes.
6. Increased intraocular pressure.
7. Salivation (in some cases).
8. Intolerance to noise, bright light.
9. Slurred speech.
10. Loss of taste.

The first signs may appear a day before the neuritis, usually a dull pain in the temporal bone, which is strengthened with active facial expressions. Then the pain passes into the acute, which is felt regardless of the tension of the muscles. In parallel, there are headaches and an inadequate response to external stimuli, such as light and noise.

Peripheral neuropathy of the facial nerve, which occurs as a result of otitis or mastoiditis, can start suddenly on a background of pain and discomfort in the ear.

Diagnostics of the neuropathy of the facial nerve

Primary diagnosis of facial neuropathy includes the collection of anamnesis and general examination. Do not neglect the patient's questionnaire, because information about the type of person's activity, living conditions, heredity and the transferred diseases is the basis for the diagnosis.

In the process of general examination, the evaluation of the level of nerve damage by means of facial tests is carried out. The patient is asked to close his eyes and grin his teeth: on the affected side the eye gap does not close, the corner of the mouth is immovable or slightly mobile.

When trying to inflate the cheeks and keep the air in them, the patient experiences discomfort, the air does not linger. Pulling the lips forward and folding them into the tube is difficult.

Based on these samples, you can determine the extent of the disease.

1. Neuropathy of mild degree is characterized by insignificant mobility of the affected side, eyes are closed completely, eyebrows are mobile. In this case, the nerve function is preserved, but it is weakened.
2. With moderate neuropathy, the patient can not completely close his eyes, while trying to raise an eyebrow can be observed light twitching of the eyelid, the facial muscles react weakly. At this stage, the asymmetry of the face is expressed, it is difficult for the patient to bite his teeth.
3. Severe degree of neuropathy is characterized by minimal mobility of the affected side of the face, the eye is almost not closed, when trying to frown the forehead, smile or raise the eyebrow muscles do not respond. This degree is accompanied by discomfort in the eye area, it is very difficult to chew food and take fluids.

[17], [18]

Differential diagnosis

Differential diagnostics makes it possible to distinguish between damage to the facial nerve and diseases of the trigeminal nerve. It is carried out to clarify the exclusion of other pathologies and clarify the diagnosis.

Instrumental diagnostics includes brain imaging (computed tomography, magnetic resonance imaging), electroneuromyography (to assess muscle activity, frequency and speed of nerve impulse conduction) and ultrasound of the parotid gland.

Laboratory tests of blood and urine are conducted to diagnose the general condition of the body and the presence of metabolic disorders (diabetes). Serological blood tests are prescribed to exclude viral and bacterial infections (herpes, HIV, infectious mononucleosis, cytomegalovirus, etc.).

Treatment of the neuropathy of the facial nerve

Treatment of facial neuropathy is carried out exclusively under the supervision of the attending physician. Self-medication can be ineffective and even dangerous. The absence of timely treatment can lead to complete paralysis, the outcome of which is extremely unfavorable.

After diagnosis and diagnosis, the doctor prescribes complex therapy. The standard of treatment of facial nerve neuropathy includes the use of physiotherapy, medication, massage and facial exercises and acupuncture.

1. Medicines

Prednisolonum  with neuropathy of the facial nerve has anti-inflammatory and anti-edematous effect. The first 2 days prescribe the so-called introductory dose of 20-30 mg (4-6 tablets), after 48 hours apply a maintenance dose of 5-10 mg (1-2 tablets). The course of treatment is determined by the attending physician, on average it is 2-3 weeks. A longer treatment with prednisolone is prescribed in severe cases. Prolonged treatment with adrenal hormones causes a number of side effects, combined under the name of Cushing's syndrome (osteoporosis, headaches, obesity, decreased sexual function, decreased secretion of the gastrointestinal tract and weakening of the defenses of the body).

Berlition  with the neuropathy of the facial nerve is used to normalize the conductivity of the peripheral nerves. The main component of the drug is a vitamin-like substance called alpha-lipoic acid. This component is involved in the oxidation-reduction processes of cells and tissues, has a pronounced antioxidant effect, improves the trophism of the nervous tissue. The drug is produced in tablets and vials for infusions. The average dose is 600 mg (2 tablets) in the morning 30 minutes before meals.

The infusion solution is for intravenous drip. As the solvent used isotonic sodium chloride solution. The drug is administered slowly, for 30 minutes.

Berlition as a whole is well tolerated by patients. With individual intolerance, allergic reactions (skin itching, urticaria), nausea, vomiting, dizziness may occur.

Euphyllin, nicotinic acid, sermion with the facial nerve neuropathy are used as blood circulation correctors and antispasmodics.

Euphyllin  reduces the resistance of blood vessels, which contributes to the normalization of blood flow in the affected areas. It is also used as a diuretic to relieve swelling. Assign tablets for oral administration (0.15 g 2-3 times daily after meals) or solution for intramuscular injection (1 ml 24% solution).

Sermion  is the corrector of cerebral circulation. Assign as a recovery therapy after trauma, stroke, suffered acute and chronic diseases of viral or bacterial etiology. Positively affects cognitive functions and mood, improves transmission in the neuromuscular synapse. The average dosage is 30 mg per day (1 tablet) in the morning 30 minutes before meals or 10 mg (1 tablet) 3 times a day at regular intervals. The course of treatment for this pathology is 2-4 months.

Nicotinic acid  or vitamin PP is part of the enzymes of oxidation-reduction processes. Vit. PP has a wide spectrum of action: dilates blood vessels, improves cerebral and peripheral blood circulation, normalizes carbohydrate metabolism and reduces the concentration of triglycerides in the blood. Used in neuritis of the facial nerve as a supplement to the main treatment.

In the form of tablets, apply the drug at a dosage of 0.1 g 2 times daily with meals. Intramuscularly inject 1ml of 1% solution in the morning and evening. The course of treatment is 1 month.

In diseases of the peripheral nervous system, vitamins of group B (B1, B2, B6) and injections and some fat-soluble vitamins (A and E) in the form of capsules are also used.

• Physiotherapy

Physiotherapeutic treatment is appointed to directly affect the damaged area, which restores blood circulation and improves tissue trophism.

From the very beginning it is recommended to carry out treatment in combination with anti-inflammatory drugs. Electrophoresis with 0.02% dibasol solution has spasmolytic, vasodilating action, improves the functioning and activity of the facial nerve. It is also advisable to prescribe potassium and vitamin B1 for electrophoresis.

To improve the mobility of the face and ease the feeling of muscle tension, electrophoresis is used for the neck-collar zone using sodium oxybutyrate.

Recently, treatment with electromagnetic waves is common. Such electrical stimulation of the facial nerve is prescribed for muscle paralysis.

• Gymnastics

LFK with the facial nerve neuropathy helps improve the blood circulation of the face and neck, accelerates the restoration of normal facial expressions. Gymnastic exercises are conducted in front of the mirror, and weakened muscles are assisted with the help of hands. It is necessary to perform simple movements of the face, such as a smile, folding the lips into a tube, raising the lens, blinking the eyes.

Important! All movements are performed separately from each other. That is, you should not simultaneously smile and raise an eyebrow, otherwise the muscle fibers will remember the combination of these actions and get rid of them will be very difficult even after recovery.

Mimic gymnastics with the neuropathy of the facial nerve should be natural. It is best if, when trying to restore a smile, the patient will listen to something cheerful to form a natural reflex in response to the corresponding stimulus.

• Massage

Massage with the neuropathy of the facial nerve is prescribed after 1.5 - 2 weeks after the onset of the disease. Any mechanical effect is contraindicated in the acute phase, when the patient experiences pain and the inflammatory process persists. Massage is contraindicated in the event that the neuritis has developed on the basis of the spread of infection due to injuries and ENT diseases. Under such circumstances, massage will only exacerbate the situation and cause further spread of the infection.
The purpose of massage is expedient after elimination of the main cause of the disease.

The technique of performing the massage is very simple: light strokes and circular movements clockwise, starting from the neck and ending with the area of the frontal bone. Before carrying out the manipulation, hands must be warmed.

• Acupuncture

Acupuncture in the neuropathy of the facial nerve is performed exclusively by an experienced specialist, taking into account special points on the face and points of projection of the facial nerve. First, the needles are located on the healthy side at the points of "braking". The impact on them has a relaxing effect and helps to get rid of the tension and hypertonic muscles. Further, the needles are located on the affected area at the points of "stimulation". Each zone of the needle is 15-20 minutes. Such a technique "balances" the innervation of the face and contributes to the normalization of impulses along nerve fibers.
Assign 2-4 days after the onset of the disease, provided there is no focus of infection.

Alternative treatment

Treatment of neuropathies with alternative means is carried out after agreement with the attending physician. Neuritis of mild and moderate severity can be successfully treated with the help of the following means.

• Recipe # 1

Make a small bag of dense natural fabric (linen, cotton, chintz). On a dry frying pan pour 400-500 g of salt and warm it well. Salt pour into a bag, tie and put on the affected half of the face. In the day, you must do 3 warm-ups, the latter must be done immediately before bedtime. As practice shows, within 2-3 weeks there should be a significant improvement up to a complete cure.

• Recipe # 2

The natural essential oil of fir 1-2 drops is applied to the face and rubbed lightly with massage movements over the entire affected area. The procedure is carried out in the morning and in the evening, starting from the first day of the disease for a week.

• Recipe # 3

Treatment with the help of special mud masks, which are sold in the pharmacy. They contain a set of natural minerals and trace elements that are beneficial to the facial tissues. The mud is heated to 35-40 degrees and applied to the neuritis area for 20 minutes. The procedure is carried out once every two days.

Herbal Treatment

Herbal properties of herbs help fight not only the effects and symptoms of neuritis, but also the cause of inflammation.

• Recipe # 1

3 tablespoons chopped root of althea pour a glass of boiling water, cover and insist 2 hours. The root is squeezed through gauze, all the liquid is drained into a separate glassware and stored in a closed form in the refrigerator.

Apply heated to 30 degrees infusion. Take inside (a quarter of a glass for half an hour before meals 3 times a day) and externally in the form of a compress (moisten the gauze bandage with warm infusion and apply to the place of neuritis for 20-30 minutes 3 times a day). The course of treatment is 1 month.

• Recipe No. 2

Handful of chamomile flowers pour a glass of warm water and put on a water bath. After 30 minutes, squeeze out the flowers, drain the liquid into a separate bowl. The broth is used for oral administration (half a glass for half an hour before meals 3 times a day), as well as to rinse the mouth (take a decoction in the mouth and keep as long as possible on the side of the neuritis). The course of treatment is 1.5 - 2 months.

• Recipe # 3

3 tablespoons of sage pour a glass of boiling water, insist on the above scheme and drink 100 g 3 times a day for 40 minutes before eating.

All these herbs have a soothing, analgesic, antispasmodic, bactericidal, anti-inflammatory and anti-edematous effect.

Homeopathy

For treatment, the glomerular fighter, magnesium chloride and thuju are used in the form of granules, powders and tinctures.

The glomerular fighter or aconite is prescribed for neuritis and neuralgia of various origin. Chronic neuropathy requires long-term treatment with small doses, while acute neuropathy requires high doses, which are given every half hour until the patient begins to sweat (a sign of a drop in temperature). The plant is poisonous, so tincture should be used under the supervision of a doctor.

Magnesium chloride has an antiallergic, bactericidal, analgesic effect. Magnesium preparations are widely used for the treatment of diseases of the nervous system. Magnesium chloride in the form of a powder is diluted 25 g per 1 liter of water. Adults and children over 5 years of age are prescribed 125 ml 2-3 times a day for 1 month.

Thuya is a good supplement to the basic treatment. In homeopathic pharmacies you can buy thuya granules. The standard dosage is 6-8 granules 30 minutes before meals 3 times a day.

Side effects may occur in case of an overdose. The main symptoms: abdominal pain, nausea, dizziness, darkening in the eyes, allergic rashes. In the presence of the above symptoms, it is necessary to stop taking the drug and immediately call a doctor.

Surgery

Surgically, in particularly difficult cases, the anatomical integrity of the nerve is restored through its suturing, moving, or connecting to another nerve. The main indication for the operation is a tumor of the nerve, a tumor of nearby structures and traumatic damage to fragments of the bone with craniocerebral trauma.

Prevention

Common restorative procedures, balanced diet, moderate exercise and gradual hardening can increase the body's resistance.

Avoid sudden temperature changes, do not overcool, avoid drafts and stay for a long time near the air conditioner in the summer.

Another mandatory item is the timely treatment of diseases of the ear, throat and nose. Treatment should be comprehensive and effective, otherwise a partially cured disease can take a chronic form. Observance of bed rest during illness will not only accelerate recovery, but also prevents complications.

[19], [20], [21], [22], [23], [24], [25]

Forecast

With proper treatment and observance of the recommendations of the attending physician, the prognosis of the facial nerve neuropathy is favorable. It is important to remember that repeated cases of neuropathy are much worse transferred by the body and cause irreversible processes in the nervous and muscular tissues. In order to avoid relapses of the disease, it is important to adhere to prevention.