Facial neuritis - causes, symptoms and treatment

The facial nerve is responsible for contractions of facial muscles and consists primarily of motor fibers. It is one of twelve paired cranial nerves. It begins in the brain and, branching, innervates the face. Its inflammation can occur both at the base (in the core area) and throughout, involving one or more branches. Depending on this, the symptoms of the disease vary.

In most cases, treatment of neuritis of the facial nerve is carried out using conservative methods, and only in the most severe cases (for example, with injuries with a complete rupture of the nerve canal), if therapy is ineffective, surgical treatment is used.

At the Tibet Clinic, treatment of neuritis of the facial nerve is carried out without surgery, using reflexology and physiotherapy. Positive results are achieved in 97 - 98% of cases.

As a result of treatment, contractions of the facial muscles and facial symmetry are restored, spasticity and other symptoms disappear, and the inflammatory process is stopped. These results are long-term and persistent.

Symptoms

A common characteristic sign of the disease is immobilization and distortion of part of the face, in which it turns into a sedentary or completely motionless mask. Additional symptoms depend on where the inflammation occurs.

The facial nerve is a paired nerve; when it leaves the brain, it divides into two symmetrical branches. One of them is responsible for the innervation of the right side, and the other is responsible for the innervation of the left side of the face.

As a rule, inflammation affects only one of the two symmetrical parts, so the symptoms of neuritis are almost always unilateral. Contractions of the facial muscles become difficult or impossible, this manifests itself when trying to frown, smile, close an eye or raise an eyebrow. The face becomes distorted and asymmetrical.

The corner of the mouth and the edge of the eye are lowered, the nasolabial fold is smoothed out. When you try to close your eyelids, the eyeball turns upward (Bell's palsy). When you try to close your eyelids, a gap remains between them, this is called lagophthalmos or “hare's eye.”

Since the facial nerve consists primarily of motor fibers, inflammation of the facial nerve results in muscle symptoms. Sensitive, painful symptoms (in the form of neuralgia) are not typical for such neuritis.

However, the common nerve cord includes the intermedius nerve, which consists of sensory fibers and provides the sensation of taste to the outer two-thirds of the tongue, as well as the functioning of the salivary glands. Therefore, with neuritis of the facial nerve, symptoms such as disturbance, partial loss of taste, and increased salivation (drooling) are possible.

Another possible symptom is tear gland dysfunction, dry eye, or watery eyes. A combination of these two symptoms is possible - the so-called “crocodile tears”, when the eye becomes abundantly moisturized when eating, but remains dry the rest of the time (Bogorad syndrome).

Paresis or paralysis of the face usually develops within 24 hours after the appearance of pain behind the ear - the first sign of neuritis. As the disease progresses, symptoms such as hearing loss or intolerance to loud sounds (hyperacusis) are possible.

Ear pain with neuritis can radiate to the back of the head, temple, and be accompanied by loss of coordination, dizziness, and hearing loss. The complex of these symptoms is called Hunt syndrome.

Disruption of the innervation of the external eye muscle with neuritis of the facial nerve is manifested by convergent strabismus. Along with the characteristic signs of inflammatory damage to the facial nerve, symptoms of concomitant diseases may be observed, for example, shooting pain in the ear with otitis media. Or symptoms of cerebrovascular accident due to atherosclerosis.

From the point of view of Tibetan medicine, inflammation of the facial nerve, like other neuritis and neuropathies, refers to disorders of the governing basis Wind (Rlung - Tib.).
This is a light and cold base that has a great influence on other control systems of the body. Its disorder usually manifests itself not only with local symptoms (neuralgia, numbness, paresis, paralysis), but also with metabolic, immune, cardiovascular, respiratory, digestive, excretory, reproductive systems, as well as hormonal regulation.

Sanzhizhapova Avgustina Dondopovna Reflexologist, neurologist Experience 39 years

Symptoms of trigeminal neuralgia

Pain is noted in the area of innervation of one or more sensory branches of the trigeminal nerve, most often the maxillary. The pain is paroxysmal, lasting from a few seconds to 2 minutes, but attacks can quickly recur. The pain is shooting, excruciating, often disabling, and is often triggered by touching trigger points on the face or movements (for example, chewing, brushing teeth, or smiling). Often the patient cannot sleep on the affected side of the face; on average, the attack lasts up to 3 minutes; in about 7% of patients it lasts up to 3 days. Their number can reach 200 per day.

Over time, the pain progresses and may be constant, without intervals. The effectiveness of medications that relieve pain decreases and the patient can no longer control the pain. It becomes exhausting for him. Patients may withdraw from social contacts and daily activities for fear of pain returning.

Pain from trigeminal neuralgia can be observed in different parts of the face. It all depends on which branch of the nerve was affected, if the maxillary - in the area of the facial muscles, upper jaw and nose, the mandibular - the pain will resemble a toothache, the ocular - in the area of the temples, forehead and above the eyebrows. Other characteristic symptoms of inflammation of the trigeminal nerve: spasms of the facial muscles; increased salivation; increased or decreased sensitivity of facial skin; moderate increase in temperature; weakness and muscle pain.

Causes

Inflammation of the facial nerve can occur due to its compression by a tumor, aneurysm of a vessel, or swelling of soft tissues with the development of “tunnel syndrome.” In this case, damage to both the root and the trunk of the nerve canal is possible.

The inflammatory process may spread to nerve tissue from the adjacent area. In particular, neuritis can occur against the background of inflammatory disease of the middle ear (otitis).

Often the cause of nerve damage is a viral or other infection, such as herpes or paramyxovirus (mumps).

An ischemic cause of inflammation is also possible, that is, a violation of the blood supply to the nerve due to vascular atherosclerosis or stroke. The provoking factor for the development of the disease is usually severe cooling of the face in a cold wind, rain or draft. This especially often occurs against the background of emotional experiences, stress, psycho-emotional overload or overwork.

Another possible cause of inflammation is trauma received, for example, during deep dental treatment or surgery.

Neuritis of the facial nerve occurs when there is an imbalance of the Rlung base, the main causes of which are poor nutrition, hypothermia (especially exposure to cold wind), stress, overwork, lack of sleep, psycho-emotional overload, negative emotions and mental trauma.
Wind imbalance can occur against the background of fasting, low-calorie diet, strict diet, abuse of dry, rough foods high in plant fiber.
For example, a strict diet based on raw vegetables, greens, lettuce, citrus fruits can provoke an imbalance of Wind, which, on the one hand, manifests itself as restlessness, anxiety, irritability, insomnia, and on the other hand, increases the risk of neuritis and neuropathies, in particular the facial nerve.

Kulbuzhev Murat Sultanovich Reflexologist, neurologist Experience 30 years

Treatment

Drug treatment:

Analgesics such as acetaminophen (Tylenol, Panadol, Tempra), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and Celebrex.
Opioids – Your doctor may prescribe opioid analgesics for severe pain that is not controlled by regular analgesics, but these medications should be used with caution due to the risk of serious side effects. For example: This group includes tramadol or oxycodone. Some studies suggest that oxycodone may also help reduce allodynia.
Antidepressants – These medications are effective in treating depression. In addition, they improve sleep (for example, amitriptyline, Cymbalta, etc.).
Anticonvulsants – Drugs in this group are intended mainly for the prevention of convulsive conditions. But sometimes they are quite effective for postherpetic neuralgia (Neurontin, Lyrica, Topamax, carbamazepine).
Blocks - Injections of corticosteroid into paravertebral points sometimes lead to a significant reduction in pain.
Local painkillers - ointments, gels containing analgesics or anesthetics (lidocaine). Helps temporarily reduce symptoms.

Classification

Neuritis of the facial nerve can be primary or secondary.

The primary form of inflammation occurs as an independent disease in a healthy person due to hypothermia. This type of neuritis is called catarrhal neuritis.

The secondary form of inflammation develops against the background of infection, otitis media or another disease.

In the vast majority of cases, the disease is acquired, much less often it is congenital.

The congenital nature of the disease may be indicated by Melkersson-Rosenthal syndrome - swelling of the face combined with folding of the tongue.

Causes of neuritis

Local neuritis is caused by:

local infection;
local hypothermia;
injury. Often neuritis develops after a nerve injury;
compression of the nerve. Thus, neuritis of the axillary nerve can develop due to prolonged use of a crutch, neuritis of the peroneal nerve - due to working in an uncomfortable position, etc.;
arthritis (in this case the nerve of the joint may become inflamed);
tumor (if the tumor compresses the nerve).

Multiple neuritis (polyneuritis) can be caused by such reasons as:

infectious diseases, including measles, herpes, influenza, malaria, diphtheria and some others;
intoxication. Poisoning with arsenic, lead, mercury, carbon monoxide, phosphorus, bismuth and other highly toxic substances can lead to the development of various types of neuritis. The most common cause of multiple neuritis is alcohol poisoning;
systemic diseases (diabetes mellitus, rheumatism, gout);
avitaminosis;
vascular disorders;
as well as some other reasons.

Diagnostics

Thanks to the characteristic symptoms, establishing a diagnosis for neuritis of the facial nerve does not cause difficulties. Diagnostics is aimed mainly at determining the causes, nature of the inflammatory process, as well as concomitant diseases.

At the initial appointment, the doctor examines and palpates the face, assesses the degree of muscle spasticity and movement disorders. At the same time, he pays attention to the smoothing of natural folds (nasolabial, frontal, etc.), as well as to the non-closure of the eyelids (the inability to close the eye).

For this purpose, several standard tests are performed in which the patient is asked to close his eyes, try to smile, close his eyes, frown, wrinkle his forehead, puff out his cheeks, blow, wrinkle his nose, raise his eyebrows, and bare his teeth. In addition, the taste sensitivity of the tongue is determined.

If additional data is needed, the patient is sent for an MRI or CT scan to identify possible lesions of the brain, blood vessels (in particular, the presence of a tumor, hematoma, aneurysm, etc.), and the presence of inflammatory foci.

To assess the affected area and disturbances in the innervation of facial muscles, electromyography (EMG) is used - a method for studying bioelectrical activity. Using electroneurography, the speed of signal transmission through nerve channels (fibers) is assessed.

In addition, a general urine and blood test and a biochemical blood test are performed.

Important! Eastern medicine views the human body as a single system. Inflammation of the peripheral nerves in this context represents a particular, local manifestation of a general imbalance, almost never the only one.

Therefore, when diagnosing neuritis, a doctor of oriental medicine assesses the degree of imbalance as a whole, identifies concomitant diseases, disorders, functional disorders of the nervous, hormonal, reproductive, immune and other systems.

A treatment plan is designed to address the common causes of all these disorders.

Neuritis of the facial nerve diagnosis

Diagnosis of facial nerve neuritis is based on an analysis of the symptoms preceding and accompanying diseases of the nerve damage. Neurologists, neuropathologists, and reflexologists distinguish such forms of damage as neuritis of the facial nerve and neuropathy of the facial nerve. According to pathogenesis, neuritis is divided into primary and secondary.

Neuritis of the facial nerve must be differentiated from isolated damage to the motor nucleus of the nerve, a variety of common pathological processes in the area of the cerebellopontine angle. Damage to the nucleus of the facial nerve is accompanied by isolated paresis of the facial muscles of the same half of the face without autonomic and sensory disorders, which occurs mainly in the pontine form of poliomyelitis or poliomyelitis-like diseases, tick-borne encephalitis.

When the lower parts of the bridge are damaged, which occurs with tumors, encephalitis, vascular diseases, along with the nucleus of the facial nerve, the pyramidal tract is involved in the pathological process. In such cases, peripheral paresis of the facial muscles is combined with central hemiparesis of the opposite side (Millard-Hübler syndrome). If the nucleus of the abducens nerve is affected, then paresis of the external rectus muscle of the eye (Fauville syndrome) is added to the above symptoms.

Isolated neuritis of the facial nerve is differentiated from processes in the area of the cerebellopontine angle, which develop, for example, with arachnoiditis, tumors of the vestibulocochlear nerve, which is manifested by decreased hearing, deafness, paresis of the facial muscles, sometimes dysfunction of the trigeminal nerve, contralateral spastic hemiparesis.

Polyneuritis and polyradiculoneuritis often involve lesions of the facial nerve. Usually the lesion in these cases is bilateral, often asymmetrical, accompanied by limited or diffuse damage to other parts of the human peripheral nervous system.

Surgery

Surgical treatment of facial nerve neuritis is usually carried out to restore its integrity, damaged by injury (rupture of nerve fibers). For this purpose, the nerve is sutured.

In addition, surgery may be performed if the cause of nerve inflammation is compression by a tumor, aneurysm, scar tissue, or other neoplasm. The cause of the compression is removed (an example of such an operation is neurolysis - removal of connective tissue proliferation).

Another type of surgical treatment is replacing the damaged portion of the facial nerve with a graft. Such operations are usually performed for injuries. The section of nerve to be transplanted is taken from the leg. The volume of plastic surgery is determined by the surgical plan. In particular, the transplant can be sutured to the facial nerve on the healthy half of the face. In this case, the signal from the brain will arrive to the facial muscles simultaneously on the right and left sides.

Surgical treatment is indicated in cases where conservative therapy does not bring results. It can be carried out within 12 months from the onset of symptoms of neuritis. Carrying out the operation later does not make sense, since by this time the facial muscles have time to atrophy.