Paralysis of the facial nerve

The function of the facial nerve is to ensure the functioning of the musculature of the face. Thanks to this, the nerve becomes possible to transmit mood, smile, screw up, etc.

Paralysis of the facial nerve partially deprives the person of this possibility.

[1], [2], [3]

Epidemiology

Paralysis of the facial nerve happens relatively often. This may be due to its anatomical features: the nerve passes through the narrowed bores of the bones of the facial part of the skull. This becomes the cause of its clamping and subsequent paralysis.

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

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

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

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

[4], [5]

Causes of the paralysis of the facial nerve

The exact cause of paralysis of the facial nerve specialists can not yet be named, but the disease is often caused by infectious viral pathologies:

• herpetic infection;
• chickenpox and shingles;
• adenovirus infections, ARVI, influenza;
• infection with Epstein-Barr virus (mononucleosis);
• defeat of cytomegalovirus;
• defeat by the Coxsackie virus;
• rubella.

In addition, hypothermia, alcohol abuse, hypertension, head trauma (face, ear), brain tumors, dental diseases, diabetes mellitus, atherosclerotic changes in the vessels, severe stress situations, otitis media can become triggers for the development of paralysis of the facial nerve. Or sinusitis.

[6], [7], [8]

Risk factors

Most paralysis of the facial nerve is striking in the following cases:

• during pregnancy or in the postpartum period;
• during the viral epidemics;
• in the elderly, especially under conditions of weak immunity.

Cases of the family type of the disease are described, which suggests that there is a genetic predisposition to the appearance of paralysis of the facial nerve.

[9], [10], [11], [12], [13], [14]

Pathogenesis

The facial nerve is the VII paired cranial nerves, which are subject to the facial muscles responsible for speech reproduction, facial expression and mastication. Paralysis of this nerve can occur as a result of the 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, there is a squeezing of venous and lymphatic vessels. This causes a violation of blood and lymph flow.

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

[15], [16], [17], [18], [19], [20], [21], [22]

Symptoms of the paralysis of the facial nerve

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

Nevertheless, the first signs can be found even at the initial stage of paralysis, 1-2 days before the visual manifestations. It can be the following symptoms:

• soreness behind the auricle, giving to the occipital region or facial part;
• pain in the eye from the side of the lesion.

The first signs are associated with the increasing edema of the nerve column and its gradual contraction.

The following symptoms are already more pronounced:

• the symmetry of the face is broken;
• The affected side draws attention to the lack of emotionality and facial expressions;
• on the affected side, one can observe the lowered corner of the mouth, the smoothed nasolabial fold, and the absence of frontal folds;
• the violation of the symmetry of the face is intensified during the attempts of the patient to speak, smile, cry;
• the upper eyelid on the affected side does not completely close, and the eye looks up;
• liquid food and drinks are not retained in the mouth and poured from the affected side of the oral cavity; the function of chewing and swallowing is not violated;
• during chewing the patient, without feeling his own cheek, can bite her from the inside;
• The mucous membrane dries up, salivation often decreases (sometimes it happens vice versa);
• the speech function is disrupted due to inactivity of certain parts of the lips and oral cavity;
• the eye from the affected side is half open or completely open, the blinking function is broken, the mucous membrane dries up (less often there is, and vice versa - profuse tearing);
• there is a violation of taste sensations from the affected side of the tongue;
• hearing from the affected side is amplified, sounds are perceived louder than usual.

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

• The defeat in the cerebral cortex responsible for facial nerve function is manifested by paralysis of the mimic muscles of the lower part of the face, nervous and muscle twitchings. At the same time, during the smile, the 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 one-sided disorder in the 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 mimicry, salivary glands. You can notice such signs as thirst, changes in the auditory function, drying of the eye mucosa.

Forms

• Congenital paralysis of the facial nerve is associated with an incorrect laying of the brain during the fetal period. This kind of paralysis is characterized by one or two-sided masculine facial expression on the side of the lesion, the lowered corner of the mouth, the open and moist eye-slit. Skin covers on the cheek are smooth, and during exhalation the affected cheek as it inflates (sign of "sail"). The most severe form of congenital paralysis of the facial nerve is Mobius syndrome.
• 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 the patient is often not closed, except in cases of damage to the circular muscle, when it is possible to symmetrically close the eyes.
• Central paralysis of the facial nerve is the result of pathological changes in the cerebral cortex. Causes may include diseases affecting the cortico-nuclear pathways adjacent to the facial nerve. The most frequent localization of central paralysis is the lower part of the face. The disease manifests involuntary movements of the muscles - a kind of teak, as well as convulsive attacks.

[23], [24]

Complications and consequences

Restoration of nerve fibers after paralysis of the facial nerve occurs gradually, significantly slowing down 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 paralysis is not cured, then very unpleasant complications can arise.

1. Muscular atrophy - thinning and weakness of muscles due to prolonged dysfunction and disruption of tissue trophism. This process is considered irreversible: atrophied muscles are not restored.
2. Mimic contractures - loss of muscle elasticity from the affected side, muscle spasms, spastic shortening of muscle fibers. The visually affected side of the face is stretched, the eye squints.
3. Tee of facial muscles, spastic twitching is a violation of conduction of impulses along the nerve. This condition is also called hemispasm or blepharospasm.
4. Associated movements - synkinesias - arise as a result of violation of the isolation of biocurrents in the nerve trunk. As a consequence, excitation spreads to other areas of innervation. An example of associated movements: during chewing food, tears appear in the patient, or when the eye is squinted, the lip of the lips is raised.
5. Inflammation of the conjunctiva or cornea of the eye arises because the patient can not completely cover the eye for a long period of time, which leads to its drying out.

[25], [26], [27], [28], [29], [30]

Diagnostics of the 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, however in some cases additional research may be needed. Most often, the diagnosis is 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: increased ESR, leukocytosis, a decrease in the number of lymphocytes.
• Instrumental diagnostics can include the following procedures:

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

[31], [32], [33], [34],

Differential diagnosis

Differential diagnostics can be performed with stroke, Ramsey-Hunt syndrome, with inflammatory processes in the middle ear or mastoid process, with Lyme disease, with fractures of the temporal bone, with lesion of the nerve trunk with carcinomatosis or leukemia, with chronic meningitis, with tumor processes, osteomyelitis, disseminated sclerosis, as well as Guillain-Barre syndrome.

The difference of the central paralysis of the facial nerve from the peripheral

Some difficulties sometimes arise when differentiating the central and peripheral paralysis of the facial nerve.

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

In this situation, we can talk about a variant with a hemorrhage into the inner capsule: the process proceeds with partial paralysis of the lower part of the nerve and a simultaneous one-sided feeling of weakness in the extremities. Feeling of taste, the allocation of tears and saliva - without violations.

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

[35], [36], [37], [38]

Treatment of the paralysis of the facial nerve

Medications are prescribed immediately after the patient's treatment for medical care. It is with complex medication therapy that the main treatment of paralysis of the facial nerve begins.

Diuretics
	Mode of application	Side effects	Special instructions
Furosemide	Take inside 40 mg in the morning.	Nausea, diarrhea, skin reactions, lowering of blood pressure, dizziness, dry mouth.	Long-term use of the drug is not recommended.
Veroshpiron	Take 50-100 mg in the morning.	Dyspepsia, blocking, headache, drowsiness.	The drug is not compatible with alcohol.

Anti-inflammatory drugs
	Mode of application	Side effects	Special instructions
Nimesulide	Orally at 100 mg in the morning and at night, washing down with water.	Pain in the head, apathy, dyspepsia, heartburn.	Do not use for a long time.
Nurofen	Take inside 0.2-0.8 g to 4 times a day.	Nausea, flatulence.	It is recommended to drink the drug with milk.

Glucocorticoids
	Mode of application	Side effects	Special instructions
Prednisolone	The average dosage is 5-60 mg per day. The drug is taken once a day, in the morning.	Weak muscle, digestive disorders, peptic ulcer, dizziness, increased blood pressure.	The drug is not prescribed for systemic fungal lesions.
Dexamethasone	At the beginning of the disease intramuscularly administered 4-20 mg of the drug up to 4 times a day.	Nausea, convulsions, headache, weight gain, allergies, blood flushes to the face.	The drug is canceled gradually because of the risk of the syndrome of "withdrawal".

Antiviral drugs
	Mode of application	Side effects	Special instructions
Zovirax	Take 200 mg 5 times a day, for 5 days.	Digestive disorders, headache, fatigue, allergic rash.	During treatment with Zovirax, you need to drink plenty of fluids.
Acyclovir	Take 200 mg 5 times a day, for 5 days.	Pain in the abdomen, headache, drowsiness, allergies.	The drug should not be taken for a long time.

Spasmolytic drugs
	Mode of application	Side effects	Special instructions
Spazmol	Take 1-2 tablets up to 3 times a day.	Heart palpitations, lowering of blood pressure, dizziness, allergies.	It is not recommended for glaucoma and prostatic hyperplasia.
Drotaverine	Take 40 to 80 mg three times a day.	Lowering blood pressure, headache, nausea, allergies.	The drug is not prescribed for severe liver and kidney problems.

Neurotropic drugs
	Mode of application	Side effects	Special instructions
Carbamazepine	Take inside 100-400 mg to 3 times a day. Dosage is increased gradually.	Trembling in the limbs, depressive states, anxiety, allergies, digestive disorders.	The drug is not compatible with alcohol.
Diphenine	Take an average of 200-500 mg per day.	Weakness in the muscles, dizziness, upset of the chair, nervousness.	During treatment, the body's need for vitamin D may increase.

Vitamin preparations
	Mode of application	Side effects	Special instructions
Pyridoxine	Enter intramuscularly in an amount of 50 to 150 mg per day.	Sometimes - an allergy, increased isolation of hydrochloric acid in the stomach.	It requires caution in the stomach ulcer and duodenum.
Thiamine	Enter intramuscularly once a day for 25-50 mg. The duration of therapy is 10-30 days.	Allergies, sweating, heart palpitations.	Injections can be painful.

Remedies for cholinesterase
	Mode of application	Side effects	Special instructions
Proserin	Take inside 10-15 mg to 3 times a day.	Nausea, headache, arrhythmia, shortness of breath.	For the duration of treatment it is desirable to abandon driving.
Galantamine	Ingest, in an amount of 8 to 32 mg in three divided doses, washed down with water.	Differences in blood pressure, swelling, thirst, dyspepsia, muscle spasms, urination disorders.	The drug is not prescribed for pathologies of the urinary system.

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

Physiotherapeutic treatment

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

• UHF is the heating of tissues by an electric field, which leads to an improvement in trophic processes, removal of edema and inflammation. The duration of one UHF session is about 10 minutes. The treatment course usually consists of about 10 sessions that take place every day, or 3-4 times a week.
• UVA of the affected part of the face can be used starting from about 6 days after the onset of the disease. Ultraviolet activates the synthesis of hormones, improves the work of immunity, which has a positive effect on recovery. The treatment course can consist of 7-15 sessions.
• DMV therapy is the use of electromagnetic decimeter waves to activate metabolic processes in the affected tissues of the face. The procedure lasts about 10 minutes. The course can be short (3-5 procedures) or standard (10-15 procedures).
• Electrophoresis with dibazol, vitamins, proserin is the effect of certain doses of electric current, by means of which the drug can penetrate into the affected tissue. The duration of one electrophoresis session is about 20 minutes. Duration of treatment - from 10 to 20 sessions.
• Diadynamic currents help to restore the work of muscles, causing their spastic reduction. At the same time, edema is removed and nerve fibers are restored. Treatment is usually lengthy: 10 to 30 procedures may be needed for recovery.
• Applications with paraffin or ozocerite accelerate the process of regeneration and promote a speedy recovery. The application is applied for 30-40 minutes. To restore innervation in paralysis of the facial nerve, it may take about 15 procedures.

After each session of physiotherapy, it is important to protect your 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 with paralysis of the facial nerve is considered very effective, but spend it, bypassing the acute period of the disease. The first massage sessions are prescribed not earlier than one week after the onset of the disease. What is a therapeutic massage from paralysis of the facial nerve?

• massage procedure begins with warming up and kneading muscles of the neck, using slow slopes and rotation of the neck;
• further massage the occipital region, thereby strengthening the lymph flow;
• massage the scalp;
• pass to massage of 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;
• face massaged from the center line to the periphery;
• should avoid massaging the localization of lymph nodes;
• massage the inner part of the cheek with the thumb;
• at the end of the procedure, massage the neck muscles again.

The massage procedure should last no more than 15 minutes. The total duration of the course is up to the complete cure of the patient.

Special gymnastics

Gymnastics with paralysis of the facial nerve consists of a set of exercises to warm up the cervical region and shoulder area. The patient is seated opposite the mirror so that he can see his reflection. This ensures the quality of the exercises performed.

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

• the patient raises and lowers his eyebrows;
• frowns;
• looks as much down as possible while closing his eyes;
• screwed up;
• moves the eyeballs in a circle;
• smiling with clenched lips;
• Raises and lowers the upper lip, showing the upper row of teeth;
• Lowering and lifting the lower lip, demonstrating the lower dentition;
• smiles with open oral cavity;
• He presses his chin to his chest and snorts;
• moves the nostrils;
• tries to inflate his cheeks, alternately and simultaneously;
• collects air and blows it, folding his lips with a "tube";
• tries to whistle;
• draws his cheeks;
• Lowering and lifting the corners of the lips;
• Raises the lower lip to the upper, then the upper one puts on the lower one;
• makes the movements of the tongue with closed and open lips.

If any exercise fails, it is recommended to relax and carry out stroking movements with your fingertips over the affected part of the face.

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

Homeopathic remedies for paralysis of the facial nerve

Homeopathy also offers a number of remedies that will help accelerate recovery in facial paralysis. Homeopathic preparations should not be the basis of therapy, but they can enhance the effect of other treatments. Next - in more detail about the medicines that homeopaths offer to ease the condition with facial nerve palsy.

• Traumeel C is an injectable preparation in ampoules. Usually appoint 1-2 ampoules from 1 to 3 times a week in the form of intramuscular injections. The duration of therapy is at least 1 month. A combined use with Traumeil ointment and tablets is possible.

The drug rarely causes an allergy, but there may be redness and a small swelling at the injection site. In such a situation, a doctor's consultation is recommended.

• Nervocheel is a homeopathic remedy that improves the functioning of the nervous system, promotes functional renewal of nerve fibers, eliminates the effects of stress and fatigue. The drug is taken 1 tablet three times a day, dissolving under the tongue for half an hour before meals. Treatment continues for about 3 weeks. Features of the drug: during the first week of taking Nervocheil, a temporary deterioration of the condition is possible, which is considered a variant of the norm.
• Girel is a drug used for paralysis of the facial nerve, which is a consequence of viral infectious diseases. Hirel take 1 tablet three times a day, dissolving under the tongue. Duration of admission is calculated by the doctor.
• Valerianahel is a soothing remedy that can be used for neuroses, neuropathies, neurasthenia. Reception of this drug can serve as an excellent prophylaxis of relapses of paralysis of the facial nerve. The drug is prescribed 15 drops with ½ cup of clean water, three times a day for half an hour before meals. Continue taking 20-30 days.

Operative treatment

The doctor may resort to surgery if medication does not have the expected effect for 9 months. Before this time, it is not necessary to prescribe an operation, since medicines can still have their positive effect. If it takes more than 1 year, then surgical treatment is already meaningless, because by this time already there are atrophic changes in muscle tissue, which can not be restored.

In most cases, surgical intervention is used for nerve ischemia, which develops due to chronic otitis or after head injuries. Also, the operation is appropriate for a mechanical rupture of the nerve branch.

Summing up, we can distinguish the following situations with paralysis of the facial nerve, which may require the help of a surgeon:

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

How is the operation performed?

• When squeezing the facial nerve, the procedure is as follows:

1. an incision is made behind the ear;
2. the place of the exit of the nerve from the stylophyllary opening is allocated;
3. the outer wall of the hole is widened by special devices;
4. overlapping is applied.

General anesthesia is used for the operation.

• To sew the nerve trunk damaged by a rupture, the following surgical procedures are performed:

1. an incision is made behind the ear;
2. under the skin, the ends of the torn nerve trunk are found, which are cleaned for the best adhesion;
3. the ends are stitched together at once or first passed through a different, shorter path;
4. in some cases, it may be necessary to transplant the nerve from another part of the body, for example, from the lower limb.

The operation is rather complicated, however the rehabilitation period is usually not long.

Alternative treatment

1. It is useful to put compresses of puree based on elderberries. The berries are steamed and grinded, distributed on the surface of a clean cloth and applied as a compress to the affected part of the face for half an hour. The procedure is carried out twice a day.
2. A good effect is expected from the regular use of dates with milk, which eat three times a day for 6 pcs. Duration of treatment - 1 month.
3. They collect warm water into the oral cavity, in which a few drops of valerian tincture are added. Keep the medicine in your mouth, do not swallow, 3-4 minutes.
4. Take mummies in the morning, during the day and at night for 0.2 g, for 10 days. After another 10 days, the reception is repeated. Usually there are three such courses for cure.

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

1. Take 100 g of sage grass, pour 1 glass of hot water and insist for the night. Drink 1 tsp. Between meals, squeezed milk.
2. Prepare an equivalent mixture of the rhizome of valerian, herb oregano, yarrow and mistletoe white. Prepare the infusion at the rate of 1 tbsp. L. Mixture on a glass of water. Drink a medicine in 100 ml three times a day for 20 minutes before a meal.
3. Prepare an equal mixture of mint, melissa, oregano, thyme, mistletoe, motherwort. Pour 1 tbsp. L. Mixture of 200 ml of boiling water, insist for an hour and take 100 ml twice daily between meals.
4. Take 1 tbsp. L. Grass drop caps, pour 200 ml of boiling water and insist for 2 hours. Drink a medicine for 60 ml to 4 times a day.

[39], [40], [41], [42]

Prevention

To prevent repeated relapses of paralysis of the facial nerve, special prevention methods can be used. To do this, it is enough to use the following useful tips:

• Do not allow excessive cooling of the face and head, dress in the weather, avoid drafts;
• Do not ignore the treatment of colds and viral diseases, take appropriate medications in time for the first signs of the disease;
• take care of the nervous system, do not be nervous, avoid unpleasant conversations and scandals;
• properly rest: it is desirable to spend time in nature, swim, engage in active sports;
• eat properly, avoid strict diets, eat enough plant food;
• twice a year, take a course of multivitamin preparations with group B vitamins, which are very necessary for normal operation of nerve cells and fiber conductivity;
• maintain immunity, temper, take an air bath;
• periodically massage your face, in the morning and at night, using light stroking movements.

[43], [44], [45], [46], [47]

Forecast

Most cases of paralysis of the facial nerve self-healing for 1.5-2 months. In elderly patients, such statistics have a less favorable prognosis: paralysis can persist in 40-60% of cases.

It is possible to predict the outcome of the disease, given the degree of nerve damage: the more this lesion is more pronounced, the longer the recovery will be. In severe cases, if the patient is late to seek medical help, signs of the disease may persist for a long time, or for life.

Peripheral paralysis of the facial nerve usually has a more favorable course, in contrast to central lesion.

[48], [49], [50], [51], [52]