Treatment of paralysis facial nerve represents a difficult problem for both the doctor and the patient. This potentially disabling disease can have many causes, so a detailed understanding of the differential diagnosis and available methods treatment.

For optimal cosmetic and functional results all patients with facial paralysis treatment should be provided taking into account the individual characteristics of the disease with the participation of a team of various specialists.

Frequency of occurrence facial paralysis depends on its etiology. More detailed information is provided in the following articles on the site - we recommend using the search form on home page site.

A) Classification of facial paralysis. A reliable method for assessing facial nerve function is the House-Brackmann scale. It is not applicable to patients with facial synkinesis. Other scales have also been proposed that assess the degree to which paralysis affects the physical and mental state of the patient.

b) Anatomy of the facial nerve. The facial nerve enters the temporal bone through the internal auditory canal and then follows the bony fallopian canal. Most often, compression and paralysis of the nerve due to various inflammatory processes occur in this segment of the nerve. After emerging from the stylomastoid foramen, the facial nerve passes through the parenchyma of the parotid salivary gland, so in the preauricular region the nerve is protected by gland tissue.

Then, within its thickness, the facial nerve divides into five main branches, which leave the gland deeper from the superficial muscular aponeurotic system (SMAS). Anterior to the parotid gland, the distal branches of the nerve communicate with each other, so here the fibers facial muscles can be innervated by several nerves at once.

Educational video of the anatomy of the facial nerve and the projection of its branches

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V) Congenital causes of facial paralysis:

1. Birth trauma. During childbirth, several factors can contribute to injury to the facial nerve with subsequent paralysis. These include the use of obstetric forceps, birth weight more than 3.5 kg, first pregnancy. The provoking factor is compression of the fetus as it passes through the birth canal. Under these conditions, the facial nerve is extremely susceptible to injury from stretching, and it takes time to restore normal function.

In general, the prognosis is extremely favorable; 90% of children experience complete restoration of facial nerve function without any surgical or pharmacological interventions. IN in rare cases When there is a high risk of nerve rupture, surgical exploration may be required.

2. Mobius syndrome. Moebius syndrome, first described in the 19th century, is characterized by combined paralysis of the facial and abducens nerves, which may be caused by underdevelopment of the peripheral part of the nerves or insufficient functioning of the nuclei of the brain stem. Sometimes there is damage to other cranial nerves. Clinically, there is a violation of the mobility of facial muscles; it is difficult for patients to display any emotions on their faces.

Other symptoms and signs include incomplete lip closure, drooling, decreased self-esteem, and social isolation. All these factors aggravate the general condition. In patients with this syndrome, free muscle tissue transplantation is successfully used to restore the function of facial muscles. It is highly advisable to carry out surgical treatment before starting school to prevent psychological trauma, which a child can receive due to insults from peers at a very early stage in his life.

3. Melkersson-Rosenthal syndrome. Melkersson-Rosenthal syndrome is characterized by a triad of recurrent facial nerve paresis, facial swelling, and folded tongue. In the treatment of exacerbations, glucocorticosteroids and anti-inflammatory drugs are used. There is no consensus on how to treat and prevent facial paresis. Some descriptions of individual cases provide information about decompression of the facial nerve (opening the bony walls of its canal to prevent compression of the nerve as swelling increases), according to which the long-term prognosis for restoration of nerve function turns out to be more favorable when using such a fairly aggressive treatment tactic.

4. Hemifacial microsomia. The group of hemifacial microsomia includes a number of congenital developmental anomalies, which are based on underdevelopment of one half of the face. The syndrome is characterized by a deficiency of soft tissue on one side of the face, underdevelopment of the lower and upper jaws, and the external ear. In the presence of combined facial nerve paresis, surgery for it can be performed simultaneously with craniofacial reconstruction of the jaws and ear. Particularly useful in restoring facial symmetry and the patient's ability to smile is the use of free muscle grafts, one of the additional effects of which is to add volume to the facial area.

Course of the prepared facial nerve.
Temporal part: 1 - meatal segment; 2 - labyrinth segment; 3 - drum segment; 4 - mastoid segment.
Extratemporal part: 5 - temporal branches; 6 - zygomatic branches; 7 - temporofacial portion;
8 - buccal branches; 9 - cervical branches; 10 - marginal mandibular branch; 11 - neck part; 14 - extratemporal part.
Other structures: 12 - duct of the parotid gland; 13 - parotid gland.

G) Infectious causes of facial paralysis:

1. Bell's palsy. Bell's palsy is also known as idiopathic facial palsy. However, recent evidence suggests that most cases of Bell's palsy are caused by a virus. herpes simplex. The incidence is about 30 cases per 100,000 people. Paralysis usually develops within 24-72 hours. It may be accompanied by pain around the ear, decreased taste, and decreased hearing on the affected side. And although in the vast majority of patients, nerve function gradually returns to normal, some of them continue to have limited mobility of the facial muscles, which is often combined with periodic aberrant twitching (syncinesia).

In the acute phase of the disease, glucocorticosteroids and antiviral drugs can be successfully used to improve the recovery of nerve function. In some cases where the electrical activity of the nerve is significantly reduced during the first two weeks (see examination section below), surgical decompression of the facial nerve canal should be considered. If restoration of nerve function has not occurred and synkinesis persists, a rehabilitation option that has a chance of success is chemical denervation of the nerve (palsy) using botulinum toxin A followed by an intensive course of physical therapy.

2. Hunt syndrome. Hunt's syndrome (herpes zoster oticum) occurs when the Varicella zoster virus (human herpes virus 3) is reactivated in the area of ​​the facial nerve. Other symptoms include ear pain and the formation of vesicles (zoster oticus). Other symptoms may also occur: hearing loss, tinnitus, dizziness, nausea and vomiting, which are believed to occur due to irritation of the vestibulocochlear nerve, located near the facial nerve in the thickness temporal bone. And although there are no randomized controlled studies who assessed the effectiveness various methods Treatment for this rare pathology, a combination of corticosteroids, antiviral drugs and analgesics can be successfully used to suppress inflammation of the facial nerve.

This treatment regimen is based on experience with the treatment of facial paralysis (corticosteroids), as well as Herpes zoster lesions in other parts of the body (which are treated with antiviral drugs). In Hunt syndrome, the prognosis for restoration of facial nerve function is poor. After resolution of the infectious process, patients often continue to experience chronic neuralgia (pain).

3. Otitis media and mastoiditis. Otitis media and mastoiditis are acute inflammation of the mastoid process, which in rare cases (less than 1%) can lead to facial paralysis. It is believed that nerve damage is caused by swelling of the surrounding tissue and exposure to bacterial toxins. Successful treatment consists of timely recognition and eradication of infection, which includes the use of antibiotics wide range actions and myringotomy with the installation of a ventilation tube to obtain material for culture. In some cases of mastoiditis, mastoidectomy (removal of the affected mastoid tissue) is indicated. If all of the above measures are performed, the prognosis for restoration of nerve function is favorable.

4. Cholesteatoma. Cholesteatoma is a slowly growing cystic formation of epithelial origin, which over time causes destruction of surrounding tissues with their compression and the appearance of lesions chronic inflammation. The incidence of facial paralysis with cholesteatoma reaches 3%. Timely diagnosis and surgical removal cholesteatomas are necessary for the successful elimination of compression of the facial nerve that develops against the background of chronic inflammation and infection. Unfavorable prognostic signs include the spread of cholesteatoma to the apex of the pyramid (deep part of the temporal bone) and untimely surgical treatment. Patients who receive early surgical treatment are most likely to regain facial nerve function.

5. Lyme disease. Lyme disease is caused by the pathogen Borrelia burgdorferi, which enters the human body through the bite of a tick infected with the microorganism. TO typical symptoms and signs of the acute stage of the disease include headache, weakness, fever and chronic migratory erythema (a characteristic skin rash that occurs at the site of a tick bite). And although concomitant damage to the facial nerve can occur in 11% of cases, its function is completely restored in 99.2% of patients. Lyme disease should always be kept in mind when treating patients living in endemic areas when symptoms appear in summer time after tick bites. On the website of the US Centers for Disease Control and Prevention you can find a map that shows the frequency of occurrence of the disease in different US states. To confirm the diagnosis and start antibacterial therapy antibody level determination is required. Treatment is carried out in accordance with the recommendations of the Infectious Diseases Society of the United States.

6. Other. A number of other infectious diseases can manifest as dysfunction of the facial nerve. These include HIV infection, tuberculosis, infectious mononucleosis and others. In most cases, these diseases are accompanied by a number of other symptoms, for correct setting When making a diagnosis, the doctor must be extremely wary. When carrying out differential diagnosis, it is necessary to take into account the patient’s medical history and the presence of relevant risk factors. The basis of treatment is correctly selected pharmacotherapy, except in cases where mastoiditis is detected as a result of additional examination. In this case, a mastoidectomy is performed to eradicate the infection and reduce swelling around the nerve.

d) System and neurological causes facial paralysis. These include autoimmune diseases, diabetes, sarcoidosis, Guillain-Barre syndrome, multiple sclerosis and others. In rare cases, these diseases manifest as isolated facial paralysis. In most cases, with timely diagnosis and fast start adequate treatment can restore nerve function.

e) Traumatic causes facial paralysis. Head and skull injuries are one of the most common causes of acquired facial paralysis. If the injury was blunt and there are no fractures or soft tissue injuries, the integrity of the facial nerve is preserved and its function is likely to be restored. If nerve damage is suspected (penetrating injury to the skin and soft tissues of the face), immediate surgical revision of the wound is required to restore the integrity of the nerve. Under ideal conditions, surgery should be performed within three hours of injury while the distal fragment can be stimulated to allow identification of the nerve during surgery.

At combination of facial skeleton trauma With a fracture of the temporal bone, damage to the facial nerve occurs in 10-25% of cases. Depending on the relationship of the fracture line to the longitudinal axis of the temporal bone, the following types of fracture are distinguished: longitudinal (80%), transverse (10%) and mixed (10%). Facial nerve paralysis is more often observed with transverse (50%) fractures rather than longitudinal (20%). Full recovery nerve function is most often observed with delayed development. On the contrary, in 50% of cases of acute paralysis, recovery is extremely poor. Often, due to existing extensive injuries to the facial area and other emergency conditions, diagnosis and assessment of facial nerve function is not carried out in a timely manner. However, delayed surgery, which can be performed even several months after the injury, still has a reasonable chance of restoring or improving the function of the facial muscles.

Iatrogenic facial nerve damage may occur during operations on facial tissues, the skull, or during intracranial interventions. The choice of treatment method depends on the extent of nerve damage. In severe cases, restoring the integrity of the nerve is impossible, which is why it is necessary to resort to other methods.

e) Tumors as a cause of facial paralysis. Removal of tumors that penetrate the facial nerve or are located in close proximity to it often requires significant exposure to the nerve, which may result in its partial or complete transection. The most common tumors affecting the facial nerve include acoustic neuroma (vestibular schwannoma), glomus tumors, facial neuroma, and parotid carcinoma. If during the operation the integrity of the facial nerve was preserved, careful monitoring of its condition is required in the postoperative period. To clarify the prognosis, electrical stimulation of the nerve can be performed at the end of the operation. Corticosteroids are not usually used in this situation because several studies have clearly shown their lack of effectiveness in this setting. After surgery, electromyography (EMG) can be used to assess the process of reinnervation of the facial muscles.

Depending from the recovery stage(as well as individual patient preferences and difficulties), several simple techniques can be used to ensure eyelid closure, facial asymmetry, and complete lip closure.

and) Possible complications. If the integrity of the facial nerve has been successfully restored (or was not damaged initially), resolution of the paralysis depends on the regeneration of axons and their growth into the facial muscles. With pathological regeneration, there may be a change in the direction of the axons, or their branching to many fibers at once. As a result of this process, synkinesis occurs, which are involuntary twitches. facial muscles during their contraction.
Other possible complications of facial paralysis include severe dryness. eyeball with subsequent keratopathy, incomplete closure of the lips with the flow of saliva, constant biting of the cheek.

Facial nerve paresis is a disease of the nervous system that develops over a few days completely unexpectedly for the patient. The disease is immediately noticeable - asymmetry of muscles occurs on one half of the face, which changes a person’s appearance not in better side. Most often, the cause of paresis is colds of the upper respiratory tract, but there are several other factors that provoke 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.

Facial nerve paresis

The disease is not related to rare diseases nervous system, approximately 20 people are identified for every 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, and the disease develops in childhood.

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

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

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

Paresis of the facial nerve is also recorded in children; this disease is especially common in schoolchildren. The cause of paresis in childhood is the flu, otitis, and the herpes virus can influence its occurrence.

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

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

You can suspect paresis of the facial nerve in a newborn baby by the drooping corner of the lip on one side or by disturbances during 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 manifest themselves in various behavioral attacks and interfere with getting enough sleep 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 twitching and muscle contractions. about the disease.

Types of facial nerve paresis

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

Peripheral paresis

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

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

Central paresis

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

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

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

Congenital paresis

This lesion of the facial nerve accounts for approximately 10% of cases of the total identified number of patients with this pathology. With mild and average shape The prognosis is favorable; in severe cases, one type 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.

Causes of pathology

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

• In 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 past respiratory diseases of the upper respiratory tract. Hypothermia of the head can occur while sitting under air conditioning or when traveling in a vehicle 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 considered to be the negative impact of the herpes virus; the development of paresis due to tuberculosis, syphilis, mumps and polio is possible.

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

The motor and sensory function of the facial nerve can be impaired by dental procedures and trauma.

Symptoms and manifestations

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

In the absence of the necessary nerve impulse, symptoms primarily manifest themselves in the inability to perform facial movements.

Facial nerve paresis is divided into an acute stage, lasting up to 2 weeks, and a subacute phase lasting up to one month.

If the disease is not cured within a month, then they already talk about chronic stage diseases.

The following manifestations are noticeable on the affected side:

• Smoothing of the nasolabial fold.
• The corner of the mouth is downturned.
• The eyelids are wide open, and when they close, lagophthalmos is observed - a light, visible strip of sclera remains.
• 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 or, on the contrary, lacrimation appears. A noticeable secretion of tears occurs when eating and chewing food.
• The patient cannot extend his lips, and food may leak out of the half-open half of the mouth.
• In the first days of the disease, there is an exacerbation of hearing - pain appears with loud sounds.
• Before the development of all symptoms, there is a sharp pain behind the ear.
• An attempt to wrinkle the forehead ends in failure - the skin of this area remains completely smooth.

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

• Mild degree. The asymmetry of the face is not very pronounced - there may be a slight distortion of the mouth on the affected side, the patient can, with difficulty, frown the eyebrow muscles, and completely close the eye.
• Paresis of moderate severity lagophthalmos is already manifested, minor movements are noted in the upper half of the face. When asked to perform lip movements or puff out a cheek, their incomplete execution is noted.
• Severe degree of paresis manifests itself as a pronounced asymmetry - the mouth is noticeably skewed, the eye on the affected side almost does not close. Simple movements in which facial muscles should participate are not performed.

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Diagnostics

An experienced doctor’s clinical signs of paresis do not raise doubts when making a diagnosis. Additionally, an examination by an ENT doctor is necessary to exclude pathology of the ear parts. Tests and examinations are prescribed to identify and exclude the underlying causes of the disease.

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

This examination allows us to identify the location of the damage that has occurred, its degree and the severity of the ongoing pathological process.

Treatment

Facial nerve paresis is a disease in which the chances of complete relief from the disease depend on when the patient sought qualified help.

When the process occurs chronically, it is almost completely impossible to restore the innervation of the nerve and the person may forever be left with noticeable facial asymmetry.

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

How to treat paresis of the facial nerve in a particular case is decided by the attending physician.

Drug 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 tablets of analgesics and antispasmodics. They use Ketorol, Baralgin, Spazgan.
• Decongestants – Triampur, Furosemide.
• Corticosteroids are prescribed for moderate to severe paresis. The use of Prednisolone is necessary to quickly relieve swelling and inflammation.
• It is necessary to use vasodilators - Complamin, drugs nicotinic acid.
• If the patient’s anxiety level is high, a positive effect is achieved more quickly after prescribing sedatives - Relanium, Sibazon. Under the influence of these medications, the patient calms down and at the same time, muscle spasm is partially relieved.
• Courses of vitamins, especially group B, are necessary.
• If the eyes are affected, drops of artificial tears are prescribed - their use moisturizes the mucous membrane and prevents the addition of a secondary infection that develops when it dries out.
• Symptomatic treatment is prescribed based on secondary signs of the disease.

Surgical treatment

Surgical treatment is indicated for complete rupture of the nerve, which often occurs with injuries, and for congenital anomalies. The effectiveness of operations is observed only if it is carried out during the first year of the disease; subsequently, 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 desired location on the face, and nerve branches from the healthy, unaffected side are sutured to it.

Thus, facial expressions are subsequently controlled by one facial nerve; after the operation, no noticeable changes are observed on the facial skin - only a scar behind the ear remains.

Physiotherapy

During the first week, paresis of the branches of the facial nerve can be treated with the help of Solux, a special lamp for light therapy. In the future, UHF, phonophoresis with medicines, paraffin therapy is indicated.

Physiotherapy may vary depending on the stage of the process and the changes that occur 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 and depressive symptoms are especially noticeable in people with high self-esteem. If sedatives do not help restore your usual state of mind, then you need to consult a psychotherapist.

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

Homeopathy and acupuncture

For treatment homeopathic remedies must be handled with caution - tightening more than effective therapy can permanently disfigure a person's face.

In homeopathy, many preparations are made from 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 removing acute symptoms diseases. One of the homeopathic medicines indicated for use in paralysis, paresis and neuroses is Gelsemium.

Acupuncture is also widely used for treatment.

Folk remedies

Together with the main treatment of the disease, you can use folk remedies that help restore muscle activity.

• A mixture of tinctures of motherwort, calendula, hawthorn and peony helps to normalize the state of the nervous system. Take 50 ml of tinctures, mix, add 25 ml of Corvalol and three tablespoons of liquid honey to the resulting liquid. The healing tincture is drunk before bed, a teaspoon at a time, for three months. Then they take a break for two months and conduct another course of treatment.
• Warming up with heat - sand or table 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. The prerequisites for the appearance of auditory neuritis are numerous factors. Most often, the lesion occurs on one side.

Gymnastics

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

The following sets of exercises can be used at home:

• It is necessary to develop eyebrows, for this they are raised and frowned. Exercises can be done at any free time.
• Inflate the cheek on the affected side with air. It is advisable to create external resistance by pressing on the cheek area with your fingers.
• They curl their lips into a tube and try to pull them forward.
• The eyes are opened wide several times and closed tightly.

The attending physician may recommend a set of gymnastic exercises depending on the identified pathology. It is recommended to combine gymnastics with massage - the effect of both 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 the paresis; if it is an injury or an oncogenic tumor, then muscle atrophy may develop.

Muscle contracture is observed in cases where the patient sought help after 2-3 months from the onset of the disease. When a contracture occurs, the face looks like a mask, and asymmetry is 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 completely restore facial movements. If the defect is noticeable, cosmetic surgery is performed.

Prevention

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

The video provides additional visual information about facial nerve paresis:

G51 Lesions of the facial nerve

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 compression 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 of the disease per 100 thousand 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 the winter.

According to prognostic data, the functioning of the facial muscles is completely restored in most cases. This happens over 3-6 months. In 5% of patients, innervation is not restored, and in 10%, re-damage to 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, but the disease is often caused by infectious viral pathologies:

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

In addition, the trigger for the development of facial nerve paralysis can be 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 media or sinusitis.

Risk factors

Pathogenesis

The facial nerve is the VII paired cranial nerves, which control the facial muscles responsible for speech production, facial expressions and chewing. Paralysis of this nerve can occur as a result of an inflammatory process, which leads to spasm arterial vessels with stagnation of blood flow in capillary network. The capillaries become permeable, the tissues around them swell, and compression of the venous and lymphatic vessels occurs. This provokes disruption 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. The nerve trunk increases in size, and the transmission of nerve impulses through it deteriorates. When the brain sends a command to the muscles to perform a certain action, they do not receive it and do not respond. This explains the characteristic manifestations of the disease - the inactivity of some facial muscles.

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Symptoms of facial paralysis

In any case, facial paralysis begins acutely, with sharp deterioration condition.

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

• soreness behind auricle, giving in occipital region or front part;
• pain in the eye on the affected side.

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

Subsequent symptoms are more pronounced:

• facial symmetry is disrupted;
• the affected side attracts attention by the lack of emotionality and facial expressions;
• on the affected side you can observe a drooping corner of the mouth, a smoothed nasolabial fold, and the absence of frontal folds;
• violation of facial symmetry intensifies during the patient’s attempts to speak, smile, cry;
• upper eyelid on the affected side it does not close completely, but the eye looks up;
• liquid food and drinks are not retained in the mouth and spill out from the affected side of the mouth; the function of chewing and swallowing is not impaired;
• while chewing, the patient, without feeling her own cheek, can bite it from the inside;
• the mucous membrane dries out, salivation often decreases (sometimes it happens the other way around);
• speech function is impaired due to the inactivity of certain areas of the lips and oral cavity;
• the eye on the affected side is half-open or fully open, the blinking function is impaired, the mucous membrane dries out (less often it happens the other way around - excessive tearing);
• there is a violation taste sensations on the affected side of the tongue;
• hearing on the affected side is enhanced, sounds are perceived louder than usual.

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

• A lesion in the area of ​​the cerebral cortex responsible for the function of the facial nerve is manifested by paralysis of the facial muscles of the lower part of the face, nerve and muscle twitching. At the same time, when smiling, symmetry is visually restored.
• Damage to the nucleus of the facial nerve is accompanied by nystagmus, the inability to wrinkle the skin on the forehead, and numbness. skin on the sore side, muscle twitching of the palatine and pharyngeal area. Sometimes there is a unilateral coordination disorder of the entire body.
• Damage to the facial nerve inside the cranium and the inner part of the temporal bone is characterized by paralysis of facial expressions, salivary glands. You may notice signs such as thirst, changes in hearing function, and drying of the ocular mucosa.

Forms

• Congenital facial paralysis is associated with improper formation of the brain during fetal formation. This type of paralysis is characterized by one or bilateral mask-like facial expression on the affected side, a drooping 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 “sail” sign). The most severe form of congenital facial palsy is Moebius syndrome.
• Peripheral facial palsy is the result of a disorder motor function nerve trunk. The pathology is accompanied by asymmetry and complete immobility of the muscles of the affected part of the face. The patient's affected eye often does not close, except in cases of damage to the orbicularis muscle, when symmetrical closing of the eyes is possible.
• Central facial palsy is the result of pathological changes in the cerebral cortex. Causes may include diseases affecting the corticonuclear pathways adjacent to the facial nerve. Most common location central paralysis- This is the lower part of the face. The disease is manifested by involuntary muscle movements - a kind of tic, as well as convulsive attacks.

Complications and consequences

The 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 give up further rehabilitation. If the paralysis is not treated, very unpleasant complications can arise.

1. Muscle atrophy is the thinning and weakness of muscles due to prolonged dysfunction and disruption of tissue trophism. This process considered irreversible: atrophied muscles do not recover.
2. Facial contractures – loss of muscle elasticity on the affected side, muscle spasms, spastic shortening of muscle fibers. Visually, the affected side of the face seems to tighten, the eye squints.
3. Facial muscle tics and spastic twitching represent a violation of the conduction of impulses along the nerve. This condition is also called hemispasm or blepharospasm.
4. Associated movements - synkinesis - arise as a result of a 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: while chewing food, the patient produces tears, or when squinting the eye, the edge of the lips rises.
5. 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 facial paralysis

The diagnosis of facial paralysis is made by a neurologist. Usually this happens during the first examination of the patient, but in some cases it may be necessary additional research. Most often, diagnostics are used to clarify the causes of paralysis.

• First of all, the patient is prescribed tests - for example, general analysis blood will indicate the presence of inflammation. Signs of the inflammatory process will be: increased ESR, leukocytosis, decreased number of lymphocytes.
• Instrumental diagnostics may include the following procedures:

1. MRI is a type of examination using magnetic field and obtaining layer-by-layer images. Thanks to magnetic resonance imaging, it is possible to identify tumor processes, vascular disorders, inflammatory changes meninges, cerebral infarction.
2. CT is a type of X-ray examination that can also detect such probable causes of the disease as tumors, post-stroke conditions, disorders of perinuclear blood flow, consequences mechanical damage brain.
3. The electroneurography method helps determine the speed of passage of a nerve impulse. Results this study help in determining the inflammatory process, damage to the nerve branch, muscle atrophy.
4. 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 performed with stroke, Ramsay-Hunt syndrome, with inflammatory processes in the middle ear or mastoid process, with Lyme disease, with temporal bone fractures, with damage to the nerve trunk by carcinomatosis or leukemia, with chronic meningitis, with tumor processes, osteomyelitis, multiple sclerosis, as well as with Guillain-Barré syndrome.

Difference between central and peripheral facial palsy

Some difficulties sometimes arise in differentiating central and peripheral facial palsy.

First of all, attention is paid 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 central localization of paralysis is assumed.

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

From practice, distinguish between central and peripheral paralysis The facial nerve is quite difficult, 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 for facial paralysis begins.

Glucocorticoids
	Directions for use	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 ulcers, dizziness, increased blood pressure.	The drug is not prescribed for systemic fungal infections.
Dexamethasone	At the onset of the disease, 4-20 mg of the drug is administered intramuscularly up to 4 times a day.	Nausea, cramps, headache, weight gain, allergies, flushing of the face.	The drug is discontinued gradually due to the risk of withdrawal syndrome.

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

Physiotherapeutic treatment

Physiotherapy is used as an auxiliary, but mandatory therapeutic method with facial paralysis. It is possible to prescribe the following physiotherapeutic procedures:

• UHF is the heating of tissue using an electric field, which leads to an improvement in trophic processes, relieving swelling and inflammation. The duration of one UHF session is about 10 minutes. Treatment course usually consists of about 10 sessions, which are carried out every day, or 3-4 times a week.
• UV irradiation of the affected part of the face can be applied starting from approximately 6 days from the onset of the disease. Ultraviolet light 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 lasts about 10 minutes. The course can be short (3-5 procedures) or standard (10-15 procedures).
• Electrophoresis with dibazole, vitamins, proserine represents the effect of certain doses electric current, with the help of which the drug manages to penetrate the affected tissues. The duration of one electrophoresis session is about 20 minutes. Treatment duration is from 10 to 20 sessions.
• Diadynamic currents help restore muscle function by causing spastic contraction. At the same time, swelling is relieved and nerve fibers are restored. Treatment is usually long-term: recovery may require from 10 to 30 procedures.
• Applications with paraffin or ozokerite accelerate the regeneration process and promote speedy recovery. The application is applied for 30-40 minutes. Approximately 15 procedures may be required to restore nerve supply to facial nerve palsy.

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

Massage treatments for facial paralysis

Massage for facial paralysis is considered very effective, but it is carried out without 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 therapeutic massage from facial paralysis?

• The massage procedure begins with warming up and kneading the neck muscles, using slow bends and rotations of the neck;
• then massage the occipital region, thereby enhancing 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 central line to the periphery;
• Massaging the localization of lymph nodes should be avoided;
• massage the inside of the cheek using the thumb;
• at the end of the procedure, the neck muscles are massaged again.

The massage procedure should last no more than 15 minutes. Total course duration – up to complete cure patient.

Special gymnastics

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

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

• the patient raises and lowers his eyebrows;
• frowns;
• looks down as far as possible, while closing his eyes;
• squints;
• moves eyeballs in a circle;
• smiles with pursed lips;
• raises and lowers the upper lip, showing the upper row of teeth;
• lowers and raises lower lip, showing the lower dentition;
• smiles with an open mouth;
• presses his chin to his chest and snorts;
• moves nostrils;
• tries to puff out his cheeks, alternately and simultaneously;
• takes in air and blows it out, pursing his lips into a “tube”;
• tries to whistle;
• sucks in cheeks;
• lowers and raises the corners of the lips;
• lifts the lower lip onto the upper one, then places the upper lip on the lower one;
• makes movements with the tongue 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 recovery from facial paralysis. Homeopathic remedies should not be the mainstay of therapy, but they can enhance the effects of other treatments. Next - in more detail about the medications that homeopaths offer to alleviate the condition of facial paralysis.

• Traumeel C is an injection drug in ampoules. Usually 1-2 ampoules are prescribed 1 to 3 times a week in the form intramuscular injections. Duration of therapy is at least 1 month. Possible combined use with Traumeel ointment and tablets.

The drug rarely causes allergies, but redness and slight swelling may occur at the injection site. IN similar situation Consultation with a doctor is recommended.

• Nervoheel is homeopathic medicine, which improves the functioning of the nervous system, promotes functional renewal of nerve fibers, 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 is continued 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 normal.
• Girel is a drug that is used for facial paralysis, 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.
• Valerianaheel is a sedative that can be used for neuroses, neuropathy, and neurasthenia. Reception this drug can serve as an excellent prevention of relapses of facial paralysis. The drug is prescribed 15 drops from ½ glass clean water, three times a day for half an hour before meals. Continue taking for 20-30 days.

Surgical treatment

The doctor may resort to surgery if drug treatment does not have the expected effect within 9 months. It is not worth prescribing an operation before this date, since medications can still have a positive effect. If more than 1 year passes, then it is already pointless to carry out surgical treatment, since by this time the atrophic changes muscle tissue that cannot be restored.

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

To summarize, we can highlight the following situations with facial paralysis in which the help of a surgeon may be needed:

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

How is the operation performed?

• If the facial nerve is compressed, the intervention is carried out as follows:

1. an incision is made behind the ear;
2. the place where the nerve exits the stylomastoid foramen is identified;
3. the outer wall of the hole is expanded with special devices;
4. stitches are placed.

General anesthesia is used for the operation.

• To stitch together a 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 trimmed for the best fusion;
3. the ends are sewn together immediately or first passed along a different, shorter path;
4. In some cases, a nerve transplant from another area of ​​the body, such as a lower limb, may be necessary.

The operation is quite complicated, but the rehabilitation period is usually short.

Traditional treatment

1. It is useful to apply compresses made from elderberry-based puree. The berries are steamed and ground, 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 regular consumption of dates with milk, which are eaten three times a day, 6 pieces each. Duration of treatment – ​​1 month.
3. Collected into the oral cavity warm water, to which a few drops of valerian tincture are added. Keep the medicine in your mouth without swallowing for 3-4 minutes.
4. Take mumiyo in the morning, afternoon and at night, 0.2 g, for 10 days. After another 10 days, the dose is repeated. Usually three such courses are enough for cure.

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

1. Take 100 g of sage herb, pour 1 glass hot water and insist overnight. Drink 1 tsp. between meals, washed down with milk.
2. An equivalent mixture is prepared from valerian rhizome, oregano herb, yarrow and mistletoe. Prepare an infusion at the rate of 1 tbsp. l. mixture per glass of water. Drink the medicine 100 ml three times a day 20 minutes before meals.
3. Prepare an equal mixture of mint, lemon balm, oregano, thyme, mistletoe, and motherwort. Pour 1 tbsp. l. mixture of 200 ml of boiling water, infuse for an hour and take 100 ml twice a day between meals.
4. eat right, avoid strict diets, eat enough plant foods;
5. 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;
6. maintain your immunity, harden yourself, take air baths;
7. Massage your face periodically, morning and night, using light stroking movements.

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Facial nerve paresis- This is a disorder in the functioning of the nervous system, in which the performance of the facial muscles is impaired. In most cases, the symptoms of the disease appear on one side.

The cause of the pathology is injury to the trigeminal nerve, which leads to disruption of the transmission of nerve impulses. The patient can independently determine paresis of the facial nerve due to pronounced symptoms.

Paresis of the facial nerve can be an independent disease or a symptom of other pathological processes that occur in the patient’s body. The disease develops with idiopathic or secondary lesions.

The occurrence of facial nerve paresis is diagnosed when the head is hypothermic. The disease develops against the background of:

• Syphilis;
• Poliomyelitis;
• Tuberculosis;
• Mumps.

With the pathogenic activity of the herpes virus, a pathological process occurs in patients. It develops against the background of otitis media, which affects the nerve fiber. Common cause diseases are respiratory diseases. The disease is observed with head injuries that have varying degrees of severity. If surgical intervention is performed incorrectly in the facial area, this leads to the development of pathology.

Facial nerve paresis is diagnosed when blood circulation in the facial part is impaired. This pathological process develops in diabetes mellitus. Patients with are at risk. The disease appears in people after a hypertensive crisis. It is diagnosed against the background of ischemic stroke. The appearance of pathology is observed after dental operations.

There are various causes of facial nerve paresis, which are recommended to be identified in order to prescribe effective treatment for the pathology.

Types of pathology

Facial nerve paresis is divided into several types in accordance with the characteristics of the pathological process. It could be:

• Innate. This form of facial nerve paresis occurs in extremely rare cases. If the pathology is mild or moderate severity, then treatment is carried out using massage and gymnastics. With the help of these manipulations, blood circulation is stimulated and the functioning of the nerve is restored. In severe cases of pathology, surgery is recommended.

• Peripheral. This facial nerve paresis is diagnosed in most patients, regardless of their age. Patients complain of severe pain behind the ears, which most often manifests itself on one side. Appearance facial paresis diagnosed against the background of an inflammatory process that leads to swelling of the nerve fibers.
• Central. This form of facial paresis is characterized by severe course and difficulties in treatment. With the disease, the muscle structures of the face atrophy, which leads to sagging skin. In this case, there is no damage to the forehead and visual apparatus. The disease occurs when neurons located in the brain are damaged.

Trigeminal nerve palsy is characterized by the presence of several varieties, which are recommended to be identified in order to prescribe effective therapy.

Degrees and symptoms of the disease

With paresis of the facial nerve, patients experience pronounced symptoms. It manifests itself in accordance with the severity of the pathological process, which can be:

• Easy. Facial paresis is characterized weakly severe symptoms. In some cases, a slight distortion of the mouth on the affected side is diagnosed. The patient closes his eyes and frowns with effort.
• Average. With paresis of the facial nerve of this degree, lagophalmos occurs. A person experiences a significant decrease in the mobility of the facial muscles. The patient cannot move his lips or puff out his cheeks.
• Heavy. With facial paresis, pronounced facial asymmetry is observed. Patients' mouths are severely distorted. On the affected side, the organ of vision is not completely closed.

With trigeminal nerve paresis, the appearance of common features. In patients, the nasolabial fold is smoothed and the corner of the mouth is lowered. On the affected side, the eye opens strongly and unnaturally. During the period of eating, food is observed to fall out from the affected side of the mouth.

A sick person cannot wrinkle his forehead much. Patients complain that with paresis of the facial nerve they experience a decrease or complete absence of taste sensations. The disease is accompanied by an exacerbation of auditory function.

In pathology, lacrimation is observed, which intensifies during meals. If you ask a person to form a tube with his lips, he will not be able to do it. Pain syndrome appears behind the ear.

With facial paresis, severe symptoms are observed, which allows the patient to independently determine the disease. When the first signs of illness appear, he should consult a doctor. Only an experienced specialist, after diagnosis, can prescribe effective treatment.

Treatment of the disease

With facial nerve paresis, the diagnosis is made in accordance with its symptoms. The patient is recommended to consult with an otolaryngologist, which will provide the opportunity to exclude pathological processes in the ear. To determine the cause of facial paresis, laboratory blood tests, electromyography, and head scanning are recommended.

The effectiveness of treatment for facial nerve paresis directly depends on the timeliness of the patient seeking medical help. If the disease becomes chronic form, then he will not be able to get rid of facial asymmetry.

Drug therapy

If the patient has a leak acute form pathological process, it is recommended to treat it using medications. The causes of the disease are preliminarily determined, and therapy is aimed at eliminating them. With its help, swelling and inflammation are relieved, and the process of regeneration of nerve cells is activated. Treatment of facial nerve paresis is carried out:

• Analgesics. Drugs are used for severe pain syndrome. Treatment of the disease is carried out with Ketorol, Baralgin, Spazgan.
• Corticosteroids. Medicines in this group are used if the patient has severe or moderate paresis of the facial nerve. Therapy is carried out with Prednisolone, which helps relieve inflammation and swelling in the shortest possible time.
• Decongestant medications. To combat swelling, the use of Triampur or Furosemide is recommended.
• Vasodilator medications. The drugs help restore blood circulation in the area of ​​damage and speed up the treatment process. Patients are recommended to take nicotinic acid or Complamin.
• Sedative medications. Taking the drug is recommended if the patient has high anxiety. It can be eliminated with Relanium or Sibazon. They have a calming effect, which ensures patient relaxation.
• Vitamin and mineral complexes. During the course of the pathological process, patients are prescribed B vitamins.
• Artificial tears. The use of medications is recommended for damage to the visual organs. They are used to exclude the possibility of developing a secondary infection and help moisturize the mucous membrane.

For paresis of the facial nerve, the selection of medications is carried out by the doctor in accordance with the causes and severity of the pathological process.

Surgical intervention

To achieve a high therapeutic effect, surgical intervention is recommended to be performed within 12 months after the onset of the disease. If you delay the operation, this will lead to atrophy of the muscles that the nerve cannot control.

If there is a rupture, the nerve is sutured during surgery. In the case of a congenital form of the pathology, autotransplantation is recommended. During surgical intervention A graft is taken from the patient's leg and sewn into the face. At the next stage, the branches of the nerve are sutured to the healthy area. Thanks to the operation, one nerve will control facial expressions. After surgery, there is only a small scar behind the ear.

Physiotherapy

At early diagnosis pathological process, Sollux, which is a special lamp, is used to treat it. Light therapy is performed using the device. After completing the course, patients are given an appointment UHF, phonophoresis and paraffin therapy.

Acupuncture is characterized by a high effect in the fight against disease. This technique is based on the introduction of special needles into the area of ​​the affected nerve and other acupuncture points on the body. With the help of manipulation, blood circulation in the affected area is improved.

As aid In case of pathology, the use of homeopathy is recommended. The most commonly used drug is Heclesemium. Its use is permitted only after prior consultation with a doctor. otherwise, facial distortion may occur.

With paresis, wide psychotherapy is used. This is explained by the fact that the symptoms of the pathological process negatively affect the psycho-emotional state of a person. This leads to decreased self-esteem and the development of depression. If it cannot be eliminated with the help of sedative medications, the patient is recommended to seek help from a psychotherapist.

To improve muscle function in case of illness, massage is recommended. The use of the technique is allowed only after a week after the onset of the disease. To ensure maximum effectiveness of therapy, it is recommended to consult a specialist. Also for paresis it is allowed self-massage.

Initially, massage the neck and back of the head, and then gradually move on to the face. It is recommended to perform simultaneous massage on the healthy and sore side. Massage is not performed in the area of ​​the lymph nodes. If the patient experiences muscle soreness, a light and superficial massage is recommended. It is recommended to pay special attention to the mastoid process during the manipulation.

It is a serious pathological process that negatively affects a person’s appearance, leading to psycho-emotional disorders. That is why, when the first symptoms of the disease occur, the patient is recommended to seek help from a specialist. Only a doctor, after conducting appropriate examinations, will diagnose correct diagnosis and determine the type of disease. This will allow us to develop an effective treatment regimen taking into account the individual characteristics of the patient and the severity of the disease.

The facial muscles are innervated by the facial nerve; it is also joined by the intermediate nerve, which is responsible for taste sensitivity the anterior part of the tongue, the lacrimal gland and the stapedius muscle. The facial nerve gives a total of 14 branches. When it is affected, there is sudden weakness of the facial muscles. This phenomenon is called “facial nerve palsy.”

It is impossible to name the reasons with one hundred percent probability: we only know about the diseases during or after which the signs and risk factors appeared. Frequent damage to the facial nerve due to external influences is due to a narrow canal: the nerve occupies 40–70% of its area cross section, without changes in thickness even in particularly narrow areas. In some cases, the disease goes away on its own, in others it leaves consequences for life.

In 1821, an article by Charles Bell was published, who described a case of facial paresis. In subsequent works, he supplemented the symptoms of the disease and presented the anatomy and functions of the facial nerve. After some time in the medical world, the term "Bell's palsy" became common for this disorder. But the first person to describe this disease was Avicenna: he not only indicated the clinical symptoms, but also distinguished between peripheral and central paralysis.

Manifestations of paralysis

The symptoms are quite pronounced. These will include:

• weakening of facial muscles and smoothness of skin folds on one part of the face;
• distortion of the mouth;
• incomplete closure of the eyelid;
• swelling of the cheeks when pronouncing vowels;
• upward displacement of the eyeball when trying to close the eyes (Bell's symptom);
• change in diction;
• impaired salivation - saliva begins to leak from the corner of the lips;
• changes in auditory sensations (ringing in the ears, sensitivity to loud sounds, even pain), as well as hearing loss.
• in some cases – a change in taste sensations;
• ear pain due to damage to the tympanic branch.

Due to the fact that the eyeball of the affected side is not completely closed with the eyelid, it dries out (in this case, the localization of the lesion is located before the origin of the large superficial petrosal nerve). At the same time, the eye may constantly water (the lesion is localized in the place that precedes the exit of the stapedius nerve).

Most often, this disease is diagnosed in pregnant women and the elderly.

When people talk about this disease, they often mean its peripheral type (also known as Bell's palsy), since it occurs in most cases. But there is also central facial palsy (supranuclear), in which only the lower muscular part opposite the lesion is affected.

Its main symptoms:

• preservation of the muscles of the upper part of the face (the eye is not covered, the patient is able to wrinkle his forehead);
• consistency of taste sensations;
• sagging muscles of the lower facial part;
• partial paralysis of one half of the body (hemiparesis).

Central paralysis (paresis) often occurs as a consequence of a stroke and, unlike peripheral paralysis, can be bilateral.

Origin of the disease

Possible causes may include:

• cranial trauma;
• inflammation of the brain (meningitis, encephalitis);
• infection (herpes simplex, chickenpox and shingles, cytomegalovirus, ARVI and influenza, coxsackie, Epstein-Bar viruses);
• tick-borne borreliosis;
• neoplasms;
• metabolic and hormonal imbalance(diabetes mellitus, hypothyroidism, uremia, acute deficiency B vitamins);
• stroke, atherosclerosis of cerebral vessels, hypertension;
• genetic predisposition;
• a congenital abnormality of the canal through which the nerve passes.

The doctor’s task is to find the disease due to which paralysis developed, since it may not be an independent illness, but a sign serious illness requiring immediate treatment. This applies, first of all, to the presence of tumors, stroke, borreliosis, and metabolic disorders. However, in 80% of cases the causes of the disease remain unknown.

Severity

When the symptoms are moderate, they speak of paresis (partial paralysis). We list five forms that are distinguished according to the severity of the lesion.

1. The lung is characterized by slight muscle weakness, the ability to close the eye (but with effort), and subtle asymmetry of the mouth.
2. Moderate suggests obvious but not disfiguring asymmetry. At the same time, the eye also closes with effort.
3. In the moderate form, there is severe muscle weakness, and the asymmetry can be disfiguring. There is no movement of the forehead, the eye does not close completely.
4. Severe involves barely defined muscle movements.
5. Not a single movement is recorded with complete paralysis.

Complications and prognosis

Irreversible consequences of the disease can occur in approximately 30% of cases. There may be several of them.

1. Contracture, the symptoms of which are manifested in increased muscle tone of the affected side with pain and rhythmic twitching. The patient experiences a feeling of tightening of the face.
2. Synkinesis - conjugal muscle movements. For example, there may be a raising of the corner of the mouth or a wrinkling of the forehead when closing the eye and vice versa. This disorder occurs due to improper repair of nerve fibers.
3. Partial or total loss vision of an eye that does not close completely.

But the percentage of complete recovery is approximately 50–60% - mainly due to the quality of the received medical care, sometimes the disease goes away on its own. Predict relief from paralysis or probability possible consequences often impossible, doctors name only a few complicating factors that worsen the prognosis:

• severe degrees of paralysis;
• the appearance of contracture or synkinesis;
• damage to the eyeball of the affected side;
• presence of pain;
• prolonged treatment, in which there are no symptoms of improvement;
• old age;
• availability degenerative changes nerve according to examination results;
• the presence of concomitant diseases (for example, diabetes).

Diagnosis and therapy

The doctor relies on visual symptoms of the disease, checks reflexes and refers to instrumental examinations, including electroneuromyography (ENMG) and tomography (MRI or CT). The latter is designed to detect the disease that acted as the cause.

ENMG allows you to assess the condition of muscles and nerve endings, measure the speed and number of impulses passing through the nerves, and determine the location of the lesion. During the procedure, stimulation is carried out using electronic impulses, the response to which is recorded by the device.

ENMG should be prescribed a week after the first symptoms were noted, since the affected trunk of the facial nerve continues to conduct impulses for another 5-6 days.

Possible treatments

Treatment of facial nerve paralysis involves the use of corticosteroids to relieve swelling and inflammation and restore microcirculation. These drugs form the basis of therapy - almost 80% of patients who received them experienced significant improvements in their condition. However, the use of corticosteroids in children is not justified; in most cases they were ineffective and caused side effects.

If it was known that paralysis was preceded by exacerbations of herpes simplex, the appearance of chickenpox and herpes zoster, acyclovir and its derivatives are used. In all cases, it is also prescribed alpha lipoic acid and B vitamins to restore metabolism and damaged structures.

Use of botulinum toxin

If Bell's palsy is diagnosed, the doctor's special attention should be directed to the preservation of the eyeball of the affected side: in severe cases, the patient's eye does not close even during sleep. Eye drops and ointments can only be used to relieve symptoms (dryness and redness), but not to prevent keratopathy. Previously in medical practice the eyelids were sewn together or implants were inserted into the upper eyelid to lower it. Currently, a common method is to administer botulinum toxin injections. The duration of the effect is 2-3 weeks - during this time recovery is possible. If treatment is delayed, repeated administration is used.

By the way, the use of such injections is possible not only to prevent the loss of an eye, but also to improve the aesthetics of facial expression, partially restore functions and combat contractures and synkinesis. The administration of botulinum toxin has been practiced in medicine for more than 30 years to treat diseases that are accompanied by muscle spasms.

In Russia, Botox, Dysport, Lantox, and Xeomin are used. Given the opportunity to choose, doctors give preference to the latter, which is a new generation drug. The absence of hemagglutinating proteins in its composition allows one to avoid consequences.

Other ways

In severe cases, surgery may be indicated, but in lately doctors try to avoid it - because large quantity reported complications. Medicine does not stand still, and we are now aware of the development of new surgical treatments for Bell's palsy (cross-plasty of the nerve, transposition of nerves and muscles). Minimally invasive methods of aesthetic correction are also used: eyebrow lifting with threads, cheek tissue suspension.

In domestic practice, the use of massage, therapeutic exercises and physiotherapy is widespread, but a number of authors doubt the effectiveness of these procedures and provide statistical data that such activities do not have a positive effect. Moreover, they note that their uncontrolled implementation can threaten the appearance of contractures and synkinesis.

Let's summarize. Facial paralysis is a disease that occurs suddenly and is accompanied by weakening of the facial muscles on one side or, in rare cases, only the lower half. The course of the disease may end full recovery or transition to a chronic form with a number of complications. Currently, facial asymmetry is indicated to be corrected using botulinum toxin. Special attention should be paid to preserving the eye on the affected side from the first days of the disease - failure to comply with this requirement can lead to complete blindness.