The facial nerve passes through a narrow canal, which makes it possible defeat for infections, injuries, hormonal imbalances. When this happens, facial nerve paresis (paralysis) occurs, with possible painful sensations. This disease usually involves weakening facial muscles; its symptoms are noticeable: one half of the face “sags”, the folds on it are smoothed out, and the mouth warps to one side. When it is severe, it becomes difficult to cover the eye with the eyelid.

The disease has acute course, develops in a few hours and lasts two weeks (as can be judged from the patient histories), after which the symptoms, under therapeutic effects or on their own, weaken and go away. Treatment should be prescribed from the first days of the onset of paresis to avoid the development of complications.

When doctors talk about paresis, they mean weakened function. Paralysis means its complete loss and absence of voluntary movements.

When does paresis develop?

Basic possible reasons, due to which the disease develops:

• traumatic brain injury;
• infectious diseases (borreliosis, herpes, chicken pox, flu, measles, etc.);
• hypothermia (mainly, infection develops against its background);
• circulatory disorders, stroke;
• otitis;
• neurosurgical treatment;
• inflammation of the brain and its membranes;
• tumors and cysts that can compress the nerve;
• hormonal imbalance;
• autoimmune diseases.

If facial nerve paresis is diagnosed in a newborn child, the main cause is birth trauma. Much less often, nerve damage occurs in utero as a result of infection or developmental abnormalities. In an older child, the disease may develop against the background of otitis (since the facial nerve canal originates in the internal auditory canal) or during chickenpox (the facial nerve is exposed to the varicella-zoster virus).

If symptoms of paresis (paralysis) of the facial nerve are recorded, the doctor is faced with the task of finding the causes of this pathology, since it may be concomitant with a serious illness ( tick-borne borreliosis, stroke, tumor). But in most cases, the exact reasons remain unknown.

Types of disease

Facial nerve palsy is divided into two types:

• peripheral;
• central.

The first is the most common; it is its symptoms that were described at the beginning of the article. Other signs that accompany the disease:

• swelling of the cheeks when pronouncing vowels (sail syndrome);
• rolling the eye upward when trying to close it (lagophthalmos);
• pain symptoms in some areas of the face, behind the ear and in the ear, back of the head, eyeball;
• impaired diction;
• saliva leaking from the corner of the lips;
• drying of the oral mucosa;
• increased sensitivity to sounds, ringing in the ears;
• hearing loss;
• decreased taste sensitivity;
• symptoms of eye damage on the affected side: lacrimation or, conversely, drying out of the mucous membrane.

IN mild stage Peripheral facial nerve palsy is sometimes difficult to establish. To do this, they perform a series of tests: they close their eyes and evaluate how difficult it was to do it (one eye can be closed with effort), they stretch out their lips with a tube, frown their forehead, and puff out their cheeks.

Central paresis affects the lower part of the face - one (it is opposite to the lesion) or both.

Its main symptoms:

• weakening of the muscles of the lower facial part;
• hemiparesis (partial paralysis of half the body);
• preservation of the eye and muscles of the upper facial part;
• unchanged taste sensitivity.

Central paresis is mainly due to or secondary to stroke.

Diagnostic procedures

Treatment of the disease should begin as soon as it is detected. Sometimes paresis of the facial nerve can go away on its own, but in which cases this will happen is difficult to predict.

The symptoms of the disease are quite clear, but before treatment, you must try to determine the reasons that caused the paresis (paralysis). In some cases, elimination of the underlying disease leads to restoration of the function of the facial nerve (this can happen, for example, with a brain tumor). For this purpose, tomography (computer or magnetic resonance imaging) is performed.

In addition, an examination of reflexes on an electroneuromyograph should be prescribed. The procedure allows you to evaluate the speed of impulses passing through the fibers, their number, as well as the location of the lesion. One way to determine the degree of paresis (paralysis) is to conduct electrogustometry.

This procedure is performed using an electroodontometer. An anode is applied to the front of the tongue, the electrodes are located 1.5 cm from the midline. The current strength is gradually increased until the patient registers a sensation of sour or metallic taste.

Paresis therapy

Treatment in the acute period is aimed at relieving swelling and inflammation and improving microcirculation. For these purposes the following is used:

• corticosteroids;
• diuretics;
• antiviral drugs (if the disease occurs due to herpes or chickenpox);
• antibiotics (with the development of paresis during infection, otitis media).

Gymnastics and massage can be prescribed no earlier than the third day from the onset of the disease and only under the supervision of a doctor, since self-treatment and incorrect use of techniques threatens the appearance of contractures and synkinesis.

1. The phenomenon of contracture consists of increased muscle tone with pain on the affected side and twitching facial muscles. There is a feeling of tightening of the face.
2. Synkinesis - movements that appear simultaneously with the main ones. This may include wrinkling the forehead or raising the corner of the mouth when closing the eyes. Either raising the ears or flaring the wings of the nose when closing the eyes with effort, etc.

These complications appear, as can be learned from medical histories, in 30% of all cases of facial nerve paresis. If this happens, massage and physiotherapy are temporarily canceled and the muscles are given rest.

Principles of gymnastics and massage

Therapeutic gymnastics consists of certain techniques. It could be:

• puffing out the cheeks (alternating, simultaneous);
• snorting, pronunciation of the letter “p” with a delay of initial stage movements;
• manual assistance when performing movements (closing eyes, wrinkling the forehead, etc.), which is performed by a specialist.

One of the recovery methods is post-isometric muscle relaxation, which is alternate short-term isometric work of the muscles and their passive stretching afterwards. This type of gymnastics is performed only under the supervision of a doctor, since it has many nuances in its implementation, failure to do which can lead to complications.

The main massage is carried out from the inside of the mouth, which allows you to define the muscles and increase blood circulation in them. In addition, acupressure is performed, since classic massage can lead to muscle strain.

IN recovery period also prescribe drugs of group B and alpha-lipoic acid, UHF, phonophoresis.

If the lesion is severe, treatment should be aimed at preserving the eye on the affected side of the face. Drops are used to eliminate and prevent dry mucous membranes, but if the eyelid does not droop at all, this threatens the development of keratopathy and blindness. Doctors can sew the eyelids together and insert implants into the upper eyelid to force it to droop. Currently, the injection of botulinum toxin is popular, which lasts 2-3 weeks. Injections are also effective in combating contractures and can be used for aesthetic facial correction in the future.

IN acute period diseases, it is not recommended to treat the affected side of the face mechanically, using treatment methods such as massage and gymnastics. At home, you need to use a patch that will fix the weakened muscles on the sore side of the face. Your doctor will show you how best to do this.

Features of the course of the disease and treatment in childhood

A disease in children that is secondary in nature (that is, another disease is the cause of its occurrence) is usually accompanied by pain in the parotid region. In some cases, pain and discomfort in different parts of the face and back of the head, depending on the location of the nerve lesion.

In a child, paresis of the facial nerve usually goes away faster than in an adult.. In this case, complications may be completely absent or their degree may be minimal. Symptoms of the disease in childhood are more likely to regress on their own than in adults. However, it is necessary to treat paresis, since there is no guarantee that it will go away without therapy.

In a newborn who has suffered nerve damage during childbirth, in addition to visual signs, damage to some reflexes is noted: palatine, search, sucking, proboscis. A complication that occurs with this pathology in an infant is difficulty or complete inability to suck on the mother’s breast. In this case, feeding is carried out from a bottle with a lightweight nipple.

Therapy

Treatment for paresis begins in the maternity hospital according to the standard regimen. In some cases, doctors do not use corticosteroids because their use infancy may result in complications.

A child with damage to the facial nerve often suffers from hyperacusis - it is necessary to protect him from loud sounds and not use rattles.

After the maternity hospital, treatment for paresis continues on an outpatient basis: during the recovery period, massage and physiotherapy can be prescribed. Available to parents at home therapeutic exercises, with the help of which reflexes are evoked in a child.

1. The palmo-oral reflex is caused by pressing the parent's fingers on the middle of the child's palm: the baby's mouth opens slightly.
2. To trigger the proboscis reflex, you need to lightly touch the baby’s lips with your finger: his lips should stretch into a tube.
3. The search reflex is caused by stroking the baby's cheek near the corner of the lips, after which the baby moves his mouth towards.
4. The sucking reflex is formed thanks to the pacifier.

Parents also continue treatment at home medications which are prescribed by a doctor. Massage, heating and any other influences should not be carried out independently - only in a clinic with a specialist. This will avoid the appearance of contractures and synkinesis.

If the pathology at birth is diagnosed as congenital, surgical treatment is indicated.

So, facial nerve paresis - pathological condition, which occurs acutely and is characterized by weakening of the muscles of one side of the face (peripheral paresis) or the lower facial part (with the central type). The causes of this phenomenon often remain unclear, but they may include tumors, infections, neurosurgical interventions, and in newborns, birth trauma. Treatment of the disease begins with medication from the first day to avoid complications. During the recovery period, massage and therapeutic exercises can be added.

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 a rare disease of the nervous system; approximately 20 people are diagnosed for every hundred thousand people.

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, and sensory fibers of the upper layer of the face. With neuritis in pathological process As a rule, one of its branches is involved, 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 a long-term 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, application of forceps to the skull, infectious diseases 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

For most people who get sick, it starts 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 transferred respiratory diseases 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.
• Most rare cause The herpes virus is considered to have a negative effect, and paresis may develop due to tuberculosis, syphilis, mumps and polio.

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 increases 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 speak of the chronic stage of the disease.

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 medium degree gravity 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 for quick removal swelling and inflammation.
• It is necessary to use vasodilating drugs - Complamin, nicotinic acid preparations.
• At high level patient’s anxiety, 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 trauma, 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 medications are prescribed, and 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 a long course of the disease, it is necessary to consult a doctor at the first noticeable changes in appearance. For the acute period of illness, sick leave is issued, and for early stages the disease is eliminated quite quickly.

Homeopathy and acupuncture

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

In homeopathy, many 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 sand is placed in dense fabric bags. table salt. Before use, heat them to a comfortable temperature and apply to the affected side of the face, hold until cool.
• You can rub it on the affected side of the face fir oil, which has a warming effect.

can occur in both adults and children. Prerequisites for the appearance auditory neuritis There are numerous factors involved. 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.

Can be used at home the following complexes exercises:

• 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

Favorable outcome 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:

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

Definition of disease. Causes of the disease

Facial nerve paresis- this is a polyetiological pathological condition, which is manifested by weakness of the facial muscles innervated by the facial nerve. It occurs at different ages, both in adults and children.

Causes of weakness of the facial muscles:

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

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

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

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

3. Diseases that affect neuromuscular synapses:

• myasthenia gravis;
• botulism;

4. Diseases that affect the facial muscles:

• muscular dystrophy;
• myopathies.

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

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

Other reasons include a tumor process, for example, damage to the facial nerve due to neuroma auditory nerve, carcinomatosis of the meninges, arachnoid epithelioma of the skull base and others. Traumatic lesions occur with fractures of the base of the skull. Nerve damage can also occur after operations on the middle ear, pyramid of the temporal bone, and salivary gland.

Metabolic disorders in diabetes mellitus can also manifest as involvement of the facial nerve with complex mechanism characteristic of diabetic neuropathies. In older patients, damage to the facial nerve may occur with hypertension, cerebral atherosclerosis and other angiopathy, when the process involves small vessels that supply the nerves.

Paresis of the facial muscles can also develop with supranuclear damage to the corticonuclear pathways during focal processes in the hemispheres and brain stem above the nucleus of the facial nerve. The so-called “central paresis of the facial nerve” occurs. IN in rare cases Other causes of facial muscle paresis are also possible (for example, myasthenia gravis, facial forms of myopathies, etc.).

Symptoms of facial paresis

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

There are central and peripheral paresis of the facial nerve. Central paresis is different in that it causes weakness of the muscles of only the lower part of the face (smoothness of the nasolabial fold, drooping corner of the mouth, etc.), while the upper part remains intact (undamaged). This is due to the fact that upper part the nerve nuclei have bilateral cortical representation. In addition, there may be symptoms of damage on the side of the paresis pyramid path in the arm and leg (central hemiparesis, hyperreflexia, pathological reflexes and others).

In all cases of peripheral damage, the facial muscles are affected: prosoparesis or prosoplegia occurs (decreased or loss of strength of the facial muscles). In the patient on the affected side, the number of folds on the forehead is reduced, the mobility of the eyebrow is limited, the eye does not close completely, and when closing the eyeball moves upward (Bell's symptom), the nasolabial fold is smoothed, when inflated, the cheek “swells”, it is impossible to whistle, liquid pours out of the mouth , the subcutaneous muscle of the neck is not involved in movement.

The level of nerve damage helps to determine associated symptoms. Most often the nerve is damaged in the canal of the facial nerve of the pyramid of the temporal bone. In this case, prosoparesis is accompanied by symptoms of damage to the intermediate nerve (n. intermedius).

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

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

• when the nerve in the cerebellopontine angle is damaged, symptoms of prosoparesis (VII pair) and hearing impairment (VIII pair) occur;
• with high damage to the nerve in the canal before it leaves it n. petrosus major the patient has prosoparesis in combination with dry eyes, hyperacusis (perception of any sounds as too loud) and decreased taste in the anterior 2/3 of the same half of the tongue;
• when the nerve is damaged below the origin of the greater petrosal nerve, prosoparesis, lacrimation, hyperacusis and decreased taste on half of the tongue are detected;
• with damage to the nerve below the origin n. stapedius there will be prozoparesis in combination with lacrimation and decreased taste in the anterior 2/3 of the same half of the tongue;
• when the nerve is damaged at the exit from the canal after its departure chorda thympani There will only be prosoparesis and lacrimation.

Tearing due to damage to the facial nerve can be explained by several reasons. On the one hand, when the eye is not completely closed, the mucous membrane is constantly irritated, which, while maintaining lacrimal innervation, leads to increased tear production. On the other hand, when the orbicularis oculi muscle relaxes, the lower eyelid droops somewhat, and the tear, without getting into tear duct, pours out through the eyelid.

Ramsay Hunt's neuralgia, which occurs as a result of herpetic lesions of the geniculate ganglion, is manifested by a combination of paresis of the facial muscles with herpetic rashes on the eardrum, skin of the auricle and/or external auditory canal. Sometimes there is tinnitus and hearing loss.

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

Pathogenesis of facial nerve paresis

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

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

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

Possible defeat small vessels, feeding the nerve ( vasa nerve) for diabetes mellitus, hypertension, vasculitis and vasculopathies. Poliomyelitis causes damage to the motor neurons of the facial nerve nucleus.

Classification and stages of development of facial nerve paresis

There are central and peripheral paresis of the facial nerve.

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

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

The identified courses of illness are important when choosing a method of treatment and rehabilitation (for example, reflexology, electrical stimulation and others).

Complications of facial nerve paresis

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

TO late complications include spasmoparesis of facial muscles, the development of pathological synkinesis (involuntary muscle contractions) and “crocodile tears” syndrome (lacrimation while eating).

Diagnosis of facial nerve paresis

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

The onset of the disease is usually acute; slow development of symptoms may indicate a tumor process. With Ramsay Hunt syndrome or mastoiditis, at the onset of the disease there may be complaints of pain in the post-auricular area.

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

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

From laboratory methods it is necessary general analysis blood, as well as a blood sugar test. Testing for Lyme borreliosis in some countries is mandatory for mono- and polyneuropathies. In addition, screening for syphilis and HIV infection is carried out.

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

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

Treatment of facial nerve paresis

Treatment goals are aimed at speedy recovery functions of the nerve and paretic muscles, as well as the prevention of complications. Treatment should begin as early as possible.

For idiopathic neuropathy, treatment traditionally uses a short course of glucocorticoids in high doses, for example, oral prednisolone 1 mg/kg per day for seven days, followed by rapid withdrawal. Timely treatment with glucocorticoids increases the rate of full functional recovery by 17%.

If you suspect herpes infection, including for Hunt syndrome, antiviral drugs are prescribed: 200 mg of acyclovir 5 times a day, or 500 mg of valacyclovir 3 times a day, or 500 mg of famaciclovir 3 times a day. At purulent otitis and mastoiditis, antibacterial therapy is prescribed.

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

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

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

Surgical treatment can be used for congenital narrowness of the fallopian canal and deep paresis of the facial muscles in the acute period. The effectiveness of the operation is higher when performed in the first two weeks of the disease. Such operations are performed extremely rarely in specialized centers. Surgical treatment is also performed for neuroma VIII pairs or purulent mastoiditis.

Forecast. Prevention

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

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

References

• 1. Autoimmune diseases in neurology // Ed. Zavalishina I.A., Piradova M.A., Boyko A.N. and others. Clinical guidelines. - T. 1. - M.: ROOI “Human Health”, 2014. - 400 p.
• 2. Autoimmune diseases in neurology // Ed. Zavalishina I.A., Piradova M.A., Boyko A.N. and others. Clinical guidelines. - T. 2. - M.: ROOI “Human Health”, 2014. - P. 4-76.
• 3. Biller H. Practical neurology: T. 2. Treatment // Transl. from English - M.: Med. lit., 2005. - pp. 169-177.
• 4. Biller H. Practical neurology: T. 1. Diagnostics // Transl. from English - M.: Med. lit., 2008. - pp. 198-206.
• 5. Duus P. Topical diagnosis in neurology. Anatomy. Physiology. Clinic // Per. with him. - M.: IPC “VAZAR-FERRO”, 1996 P. 120-128.
• 6. Clinical recommendations. Neurology and neurosurgery //Under. ed. E.I. Guseva, A.N. Konovalova, A.B. Hecht. - M.: GEOTAR-Media, 2008. - P. 211-220.
• 7. Treatment of diseases of the nervous system // F. Lehmann-Horn, A. Ludolf / Transl. with him. / Ed. O.S. Levina. - M.: MEDpress-inform, 2005.- P. 330-355.
• 8. Neurology // Ed. M. Samuels / Trans. from English - M.: Praktika, 1997. - 640 p.
• 9. Nikiforov A.S., Gusev E.I. Private neurology: training manual. - M.: GEOTAR-Media, 2008. - P. 327-332.
• 10. Fedorenko N.A. Restorative treatment methods. - M.: Eksmo, 2008. - P. 613-617.
• 11. Ramsey MJ, DerSimonian R, Holtel MR, Burgess LP. corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis // Laryngoscope. - 2000. - Vol. 110 (3 Pt 1). - P. 335-341.
• 12. Adour KK, Ruboyianes JM, Von Doersten PG et al. Bell’s palsy treatment with acyclovir and prednisone compared with prednisone alone: ​​a double blind, randomized, controlled trial // Ann. Otol. Rhinol. Laryngol. - 1996. - Vol. 105. - P. 371-378.
• 13. Axelsson S, Lindberg S, Stjernquist-Desatnik A. Outcome of treatment with valacyclovir and prednisone in patients with Bell’s palsy // Ann. Otol. Rhinol. Laryngol. - 2003. - Vol. 112. - P. 197-201.
• 14. Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG. Surgical management of Bell’s palsy // Laryngoscope. - 1999. - Vol. 109. - P. 1177-1188.
• 15. Peitersen E. The natural history of Bell’s palsy // Am. J.Otol. - 1982. - Vol. 4. - P. 107 -111.

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, acute respiratory viral infections, 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 of arterial vessels with stagnation of blood flow in the 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, paralysis of the facial nerve begins acutely, with a sharp deterioration in the condition.

However, the first signs can be detected even at the initial stage of paralysis, 1-2 days before 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;
• the upper eyelid on the affected side does not close completely, and 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 disturbance in 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, numbness of the skin on the affected 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 skull and the inner part of the temporal bone is characterized by paralysis of facial expressions and 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 paralysis is the result of a violation of the motor function of the 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 refuse 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 is considered irreversible: atrophied muscles are not restored.
2. Facial contractures – loss of muscle elasticity on the affected side, muscle spasms, spastic shortenings 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. This usually happens during the first examination of the patient, but in some cases additional studies may be necessary. Most often, diagnostics are used to clarify the causes of paralysis.

• First of all, the patient is prescribed tests - for example, a general blood test will indicate the presence of inflammation. Signs of the inflammatory process will be: increase in ESR, leukocytosis, decreased lymphocyte count.
• 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 fractures of the temporal bone, 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, it is quite difficult to distinguish between central and peripheral facial paralysis, 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 a comprehensive drug therapy 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 ulcer, 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 tissues using electric field, which leads to improvement of trophic processes, reduction of 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 facial tissues. 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 medicine manages to penetrate the affected tissue. 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, since a sharp temperature change 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 for 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. The total duration of the course is until the patient is completely cured.

Special gymnastics

Gymnastics for facial paralysis consists of a set of warm-up exercises cervical spine 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 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 – injectable 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 a homeopathic medicine that improves the functioning of the nervous system, promotes functional renewal of nerve fibers, and eliminates the effects of stress and overwork. The drug is taken 1 tablet three times a day, dissolving under the tongue half an hour before meals. Treatment 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 infections. 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 surgical treatment is already pointless, since by this time atrophic changes have already occurred muscle tissue, which cannot be restored.

In most cases surgery used for nerve ischemia that develops as a result of 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 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 skin the ends of the torn nerve trunk are discovered, 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, however rehabilitation period, as a rule, does not last long.

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 of hot water and leave 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 food;
5. twice a year, take a course of multivitamins with B vitamins, which are very necessary for normal operation nerve cells and fiber conduction;
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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Description:

The facial nerve is characterized by a relatively acute development of dysfunction of the facial muscles. At the same time, on the affected side there are no folds in the forehead, the nasolabial fold is smoothed, and the corner of the mouth is lowered. The patient cannot wrinkle his forehead, frown his eyebrows, close his eye (“hare eye”), puff out his cheek, whistle, or blow out a burning candle. When teeth are bared, a lack of movement on the affected side is revealed, and slower and less frequent blinking occurs here. On the side of the muscle paralysis, salivation is increased, saliva flows from the corner of the mouth. When the peripheral parts of the nerve are damaged, facial pain is often observed, which may precede the development of paralysis of the facial muscles. Depending on the level of nerve damage movement disorders may be combined with taste disorders on the front half of the tongue and increased hearing. A hare's eye is often combined with impaired lacrimation (dry conjunctiva), which can lead to the development.
The onset of the disease is acute, then during the first 2 weeks the condition begins to improve. The lack of restoration of movements of facial muscles within a month is alarming regarding the possibility of the development of irreversible changes in the nerve. At the same time unfavorable symptom is the development of keratitis (due to drying of the conjunctiva of the eye on the side of paralysis) and paralyzed muscles (the nasolabial fold is emphasized, as a result of contraction of the orbicularis oculi muscle, the palpebral fissure narrows, tic-like twitching of the facial muscles is observed).

Symptoms:

Damage to the motor portion of the facial nerve leads to peripheral paralysis of the innervated muscles - the so-called. peripheral paralysis n.facialis. In this case, facial asymmetry develops, noticeable at rest and sharply increasing with facial movements. Half of the face on the affected side is motionless. The skin of the forehead, when trying to wrinkle it into folds on this side, does not gather, and the patient is unable to close his eyes. When you try to close your eyes, the eyeball on the affected side turns upward (Bell's sign) and a strip of sclera becomes visible through the gaping palpebral fissure (hare's eye). In the case of moderate paresis of the orbicularis oculi muscle, the patient is usually able to close both eyes, but cannot close the eye on the affected side, while leaving the eye on the healthy side open (eyelid dyskinesia, or Revillot's sign). It should be noted that during sleep the eye closes better (relaxation of the muscle that lifts the upper eyelid). When the cheeks are puffed out, the air comes out through the paralyzed corner of the mouth, the cheek on the same side “sails” (sail symptom). The nasolabial fold on the side of the muscle paralysis is smoothed, the corner of the mouth is lowered. Passive lifting of the corners of the patient's mouth with fingers leads to the fact that the corner of the mouth on the side of the lesion of the facial nerve rises higher due to decreased muscle tone (Russetsky's symptom). When you try to bare your teeth on the side of the paralyzed orbicularis oris muscle, they remain covered with your lips. In this regard, the asymmetry of the oral fissure is roughly expressed; the oral fissure is somewhat reminiscent of a tennis racket, with the handle turned towards the affected side (racket symptom). A patient with paralysis of the facial muscles caused by damage to the facial nerve experiences difficulty while eating; food constantly falls behind the cheek and has to be removed from there with the tongue. Sometimes there is biting of the mucous membrane of the cheek on the side of paralysis. Liquid food and saliva may leak from the corner of the mouth on the affected side. The patient also experiences a certain awkwardness when talking. It is difficult for him to whistle or blow out a candle.

Due to paresis of the orbicularis oculi muscle (paretic lower eyelid), the tear does not completely enter the lacrimal canal and flows out - the impression of increased lacrimation is created.

For neuropathy of the facial nerve late period Contracture may appear with the face pulled to the healthy side.

After peripheral paralysis of the n.facialis, partial or incorrect regeneration of damaged fibers, especially vegetative ones, is possible. The surviving fibers can send new axons to the damaged parts of the nerve. Such pathological reinnervation can explain the occurrence of contractures or synkinesis in the facial muscles. Imperfect reinnervation is associated with crocodile tears syndrome (paradoxical taste-tear reflex). It is believed that secretory fibers for the salivary glands grow into the Schwann membranes of degenerated damaged fibers that originally supplied the lacrimal gland.

Causes:

Peripheral paralysis of the facial nerve develops under the influence of cooling, infection and some other factors; spasm of the vessels of the facial nerve occurs, which leads to its swelling and a discrepancy between the diameters of the facial nerve and its canal.

Treatment:

For treatment the following is prescribed:

It is advisable to carry out treatment in a hospital setting. Treatment tactics depend on the cause, period of the disease, and the level of nerve damage. At infectious cause For the disease, semi-bed rest is recommended for 2-3 days, anti-inflammatory therapy is used. In the early stages of the disease, treatment with hormones - corticosteroids (prednisolone and its analogues) is effective. Due to swelling of the nerve and pinching of it in the bone canal, diuretics (furosemide, diacarb, triampur) are used. Regardless of the cause of neuropathy, medications are prescribed that improve blood circulation in the nerve (nicotinic acid, complamin). To prevent dryness of the conjunctiva and the development of trophic disorders, it is necessary to instill albucid and vitamin drops into the eye 2-3 times a day. From 5-7 days vitamin therapy is added, on days 7-10 drugs are added that improve nerve conduction and neuromuscular transmission(prozerin). The course of treatment necessarily includes physical therapy: infrared rays, UHF electric field, laser therapy, sinusoidal modulated currents, ultrasound, massage of the collar area. From the first days of the disease, therapeutic exercises are prescribed. Acupuncture is used for all forms of the disease.