Facial nerve neuropathy (neuritis) ✔️: symptoms, signs and causes, diagnosis and treatment

Weakness of the facial muscles of one half of the face, which presumably developed after hypothermia, infection with the herpes virus or diseases of the ENT organs, is neuropathy of the facial nerve. It is extremely rare - no more than 6% of all patients - damage to the facial nerve is bilateral. In the vast majority of cases, the true cause cannot be identified. The historical name for this suffering is Bell's palsy, named after the physiologist from Scotland, a member of the Royal Society of London, Charles Bell, who first described it.

This nerve is the seventh pair of cranial nerves, responsible for the facial muscles, the lacrimal gland, the smallest muscle in the human body - the stapedius, the tensor tympani, and the sense of taste on the anterior two-thirds of the tongue.

The facial nerve consists of a motor and sensory portion. It forms the parotid plexus and gives off 14 branches along the way. The narrowest place that the nerve has to pass is the pyramid of the temporal bone. The bone canal in this place is filled with nerve substance by 70%. A small amount of swelling in this area is enough for the nerve to be compressed and damaged.

The incidence of facial nerve neuropathy (abbreviated as FN) is high - 25 cases per 100 thousand population. The average age of patients is 40 years.

At CELT you can get advice from a neurologist.

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Information about the disease

The facial nerve is responsible for ensuring the movements of facial muscles, the lacrimal gland, the tensor tympani muscle, and also innervates the anterior two-thirds of the tongue. It leaves the skull in a narrow canal located deep in the temporal bone. The slightest swelling in this area leads to compression of the fibers and the development of corresponding symptoms.

The pathology most often occurs in middle-aged people, who often neglect preventive measures due to the high pace of life. The peak incidence occurs in the cold season, since low temperatures are one of the provoking factors.

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Central palsy - facial nerve

Central paralysis of the facial muscles (facial muscles) is observed as a result of damage to the corticonuclear fibers going to the nucleus of the facial nerve. Central paralysis is characterized by dysfunction of the muscles of the lower half of the face, which have unilateral cortical innervation. The main symptom of central paralysis is the smoothness of the nasolabial fold on the side opposite to the lesion. In some patients with central paralysis of the facial muscles, mild deficiency of the orbicularis oculi muscle can be detected. Central paresis of the facial muscles is usually observed in combination with central hemiparesis, or hemiplegia. In contrast to peripheral paralysis, with central paralysis of the facial muscles, the conjunctival reflex, brow reflex, and corneal reflex are preserved, and there is no degeneration reaction.

Causes

Depending on the cause, the following forms of facial nerve neuropathy are distinguished:

idiopathic: the cause of paralysis remains unidentified (the most common variant of the disease);
infectious: pathology occurs against the background of infectious damage to nerve fibers due to herpes, tuberculosis, mumps, syphilis and some other diseases;
otogenic: is a complication of inflammation of the middle ear or mastoid process;
traumatic: neuropathy develops against the background of traumatic brain injury;
ischemic: the disease is associated with impaired blood flow and decreased oxygen supply to nerve fibers.

The risk of pathology increases significantly in the following situations:

for metabolic disorders, including diabetes mellitus;
with advanced forms of arterial hypertension;
during pregnancy, especially with severe toxicosis.

The triggering factor for the development of pathology is often hypothermia.

Types of trigeminal neuralgia

There is an additional classification that can also be used in making a diagnosis.

Acute

Acute trigeminal neuralgia, accompanied by frequent and severe attacks.

Chronic

Chronic trigeminal neuralgia is a consequence of an untreated disease. The patient has been observed for a long time: remissions alternate with exacerbations.

Atypical

Atypical trigeminal neuralgia occurs against a background of stress and nervous exhaustion (psychosomatics).

Postherpetic

Postherpetic trigeminal neuralgia occurs after a history of herpes and its symptoms differ from the classic type. The pain is usually burning and may not go away for two to three hours.

Symptoms

Symptoms of facial neuropathy make it possible to immediately suspect the disease. Signs arise from the affected nerve. Patients note:

acute pain: it usually begins in the ear area and gradually spreads throughout the face and begins to radiate to the occipital region;
intense lacrimation, less often dry mucous membranes of the eyes;
discomfort or ringing in the ear due to sharp sounds;
disturbance of the sense of taste in the anterior parts of the tongue.

As the disease progresses, signs of damage to the motor fibers of the nerve appear:

smoothness of skin folds, especially nasolabial folds;
swelling of the cheek when exhaling or trying to pronounce a consonant sound;
lack of complete closure of the eyelids, rotation of the eyeball upward and outward (lagophthalmos);
leakage of fluid from the corner of the mouth;
food getting stuck between the gum and cheek when eating;
limitation of facial expressions: the patient cannot frown or smile.

If the cause of neuropathy is an infectious process, the characteristic signs are accompanied by symptoms of general intoxication:

high body temperature;
headache;
nausea and vomiting;
weakness.

Facial nerve: symptoms, lesion syndromes

When the trunk of the facial nerve, the root of the facial nerve or the nucleus of the facial nerve is damaged, paresis of the facial muscles (muscle paresis) of the same half of the face develops - prosoplegia. Facial asymmetry occurs, which is pronounced even at rest. The entire affected side is motionless and mask-like. The forehead folds and nasolabial folds are smoothed. The palpebral fissure is widened. The corner of the mouth is downturned. Due to loss of function of the circular muscle of the eye (musculus orbicularis oculi), the eye does not close. This is lagophthalmos , or hare's eye. When you try to close your eyes, the eyeball on the affected side turns upward, the iris goes under the upper eyelid - Bell's symptom. With mild paresis of the orbicularis oculi muscle, the palpebral fissure closes, but less tightly than on the healthy side, the eyelashes remain visible (eyelash symptom). When the normal function of the lacrimal gland is preserved, lagophthalmos is usually accompanied by lacrimation, which is caused by difficulty in moving tears to the lacrimal canal due to insufficient adherence of the lower eyelid to the eyeball and impaired absorption due to displacement of the opening of the canal. Also, lacrimation is facilitated by the strengthening of the tear reflex due to the constantly open eye. Inflammatory phenomena, conjunctivitis, and keratitis often develop due to irritation of the eye membranes by air flow and dust.

The asymmetry of the face increases sharply when teeth are shown. The corner of the mouth is pulled back and it is skewed towards the healthy side - this is the phenomenon of the exclamation point, it is associated with paralysis of the musculus risorius. Due to the weakness of the orbicularis oris muscle, whistling and stretching of the lips into a tube are impossible. The patient often has difficulty speaking and eating. Liquid food on the affected side spills out of the mouth, thick food gets stuck between the cheek and teeth. When frowning and wrinkling the forehead, folds do not form on the side of paralysis, it is impossible to puff out the cheeks, and there is no tension on the musculus platysma of the neck. The brow reflex, nasopalpebral reflex, corneal reflex, and conjunctival reflex are lost or weakened. If damage to the facial nerve occurs in a child of the first year of life, then the sucking reflex, proboscis reflex, and search reflex are reduced. As with any peripheral paralysis, atrophy of the facial muscles is possible. When studying electrical excitability and myography, a degeneration reaction is noted.

Peripheral paralysis of the facial muscles is sometimes accompanied by pain in the face, ear, and mastoid process. The pain is associated with the phenomenon of repercussion. Repercussion is the irradiation of excitation from the motor branches of the facial nerve to the sensory branches of the trigeminal nerve.

Prolonged peripheral paralysis can lead to the development of contracture of the affected muscles, which is manifested by a narrowing of the palpebral fissure on the affected side and a pulling of the mouth when baring teeth towards the affected affected side. Symptoms of incipient contracture are often pathological synkenesis of the facial muscles - ocular synkenesis. They are characterized by the following symptoms. The closing of the eyes is accompanied by movement of the corner of the mouth or baring of the teeth. Baring your teeth causes the eye on the affected side to close.

In pathological processes that cause irritation of the nucleus or fibers of the facial nerve, facial hemispasm is observed - this is squinting the eye and pulling the mouth and tip of the nose to the affected side with simultaneous contraction of the chin muscles and tension of the subcutaneous muscle of the neck. Signs of irritation of the facial nerve are also tics of facial muscles and Chvostek's sign.

Diagnostics

Neurological disorders characteristic of facial neuropathy can also occur with other diseases, in particular with stroke. That is why, if any similar symptoms occur, you should urgently consult a neurologist.

Diagnosis of pathology includes:

collection of complaints;
taking an anamnesis, during which the doctor clarifies the time and circumstances of the onset of symptoms, records previous and chronic diseases, injuries and other important details;
neurological examination, during which a specialist checks skin sensitivity, motor function, muscle strength, quality of reflexes, functioning of the central nervous system, etc.;
tests: general blood and urine analysis, biochemical blood test with mandatory determination of glucose levels, determination of antigens and antibodies to infectious diseases if their presence is suspected;
X-ray of the chest organs: allows you to diagnose tuberculosis, tumors;
MRI or CT scan of the brain: helps visualize tumors, areas of acute ischemia, hemorrhages, consequences of injuries and strokes;
CT scan of the temporal bone;
electroneuromyography: assessment of the speed of impulse transmission along nerve fibers and muscles, allows you to determine the level of damage and severity of the disease;
consultations with specialists: therapist, otorhinolaryngologist, endocrinologist, infectious disease specialist, if necessary.

The list of studies can be adjusted depending on the specific clinical situation.

Primary neuritis of the facial nerve

Primary facial paralysis is caused by herpes viruses, mumps, enteroviruses, and adenoviruses. Bell's palsy can develop with general or local hypothermia of the face. Bell's palsy is characterized by acute development within 3 to 24 hours. The leading role in the development of Bell's palsy belongs to ischemia, which develops due to vasospasm, or vasodilation with the development of swelling of the facial nerve and compression of the nerve.

Often, neuritis of the facial nerve occurs for no apparent reason against the background of absolute complete health. Sarklinik observed many cases where the first symptoms of facial neuritis appeared after a person slept, at the moment of awakening. This may be due to the activation of chronic infection with weakened immunity, the development of various allergic reactions.

Treatment of facial nerve neuropathy

A combination of drug and non-drug methods is used for treatment. As a rule, doctors prescribe medications from these groups:

non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, meloxicam, nimesulide, diclofenac and other drugs; necessary to relieve pain and inflammation, eliminate swelling; used for mild to moderate neuropathy;
glucocorticosteroids: prednisolone, hydrocortisone, dexamethasone; have an anti-inflammatory effect, relieve swelling; used for severe forms of the disease, as well as when NSAIDs are ineffective;
diuretics: furosemide, lasix; necessary to eliminate tissue swelling;
vascular drugs: pentoxifylline, nicotinic acid, cavinton; stimulate active blood flow in the affected area, improve tissue nutrition;
metabolic agents: actovegin; necessary to stimulate metabolism and regenerate damaged structures;
antiviral and antibacterial agents for the infectious nature of the pathology;
anticholinesterase drugs: neuromidin, axamon; improve the transmission of excitation from nerve to muscle, help to quickly get rid of paralysis of facial muscles;
B vitamins: milgamma, combilipen; stimulate nerve regeneration and improve impulse conduction.

If neuropathy has become chronic and muscle paresis has given way to spasm, muscle relaxants are prescribed: mydocalm, carbamazepine, baclofen. They replace anticholinesterase drugs and promote muscle relaxation. If these remedies are ineffective, injections based on botulinum toxin are used.

Drug treatment is complemented by physiotherapy. In the acute period the following are used:

UHF;
exposure to alternating magnetic field;
phonophoresis with hormones.

After one and a half to two weeks from the onset of the disease, these methods are added:

electrotherapy (diadynamic currents, etc.);
electrical stimulation of muscles;
electrophoresis;
magnetic therapy;
laser therapy;
Darsonvalization.

An additional effect is provided by mud applications, therapeutic baths, and acupuncture.

During the acute period it is also recommended:

sleep only on your side (affected side);
tie a scarf around your face to prevent stretching of paralyzed muscles;
carry out muscle taping: tighten the muscles using an adhesive plaster (duration from 30-60 minutes to 2-3 hours);
tilt your head in the direction of the lesion several times a day and support the muscles with your palm; The duration of the procedure is 10-15 minutes.

After acute inflammation has subsided, it is recommended to perform therapeutic exercises to develop the affected muscles:

frown and raise your eyebrows;
open and close your eyes wide;
widen the nostrils;
puff out one's cheeks;
smile with your mouth open and closed;
stretch out your lips, blow out an imaginary candle, whistle;
stick out tongue, etc.

The more the patient grimaces, the faster the muscles will recover. During the same period, a light therapeutic massage to stimulate blood circulation is acceptable.

If treatment does not bring effect within 2-3 months, doctors recommend using surgical treatment methods. Two types of operations are used:

restoration of impulse transmission along the nerve: decompression of the nerve fiber when it is compressed in the canal of the temporal bone;
reinnervation: replacement of the affected area with a donor nerve (segment of the hypoglossal, phrenic or accessory nerve, as well as healthy branches of the facial nerve);

plastic surgery to eliminate a cosmetic defect:

partial suturing of the eyelids (tarsophasia);

tightening facial skin, etc.

The choice of a specific treatment method depends on the form of the disease, its cause, severity and level of damage.

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Diagnosis of the level of damage to the facial nerve

Isolated lesions of the nucleus of the facial nerve are observed quite rarely. It is manifested by total paresis of the facial muscles and occurs in the pontine form of polio.

More often, pathological foci localized in the pons are more common and lead to the involvement of the nucleus of the facial nerve, radicular fibers, and pyramidal tract in the process, which is manifested by alternating Millard-Hübler syndrome. Simultaneous damage to the nucleus of the abducens nerve is manifested by alternating Foville syndrome.

When the pathological process is localized in the cerebellopontine angle, the symptoms of damage to the facial nerve are combined with damage to its companions (the intermediate nerve and the greater petrosal nerve) and the vestibulocochlear nerve. Paralysis of facial muscles in these cases is accompanied by dry eyes - xerophthalmia, impaired taste in the anterior 2/3 of the tongue on the affected side. Xerostomia may be felt - dry mouth, but more often it does not occur due to the functioning of other salivary glands (parotid, sublingual, submandibular on the healthy side). Hyperacusis does not occur due to concomitant damage to the cochlear nerve. Hearing loss or deafness is more common. There may be signs of dysfunction of the trigeminal nerve and abducens nerve located in the immediate vicinity, as well as cerebellar disorders.

When the facial nerve is damaged in the facial canal above the origin of the greater petrosal nerve, dry eyes, taste disorders and hyperacusis develop simultaneously with paralysis of the facial muscles.

The lesion after the departure of the greater petrosal nerve is accompanied by increased lacrimation, taste disturbance, and hyperacusis.

When the facial nerve is damaged below the origin of the stapedius nerve, but above the origin of the chorda tympani, paralysis, lacrimation, and taste disturbance are observed.

Damage to the nerve in the bony canal below the origin of the chorda tympani or after exiting the stylomastoid foramen causes only paralysis with lacrimation.

When the process is localized in the area of the outer knee of the facial nerve with involvement of the knee node, Hunt's syndrome can be detected - this is paresis of the facial muscles (facial muscles), severe pain and herpetic rashes in the area of the auricle (ear).

Sometimes there are cases of bilateral damage to the facial nerve. Bilateral damage to the facial nerves is called diplegia facialis. The patient's face is mask-like, his eyes are half-open, it is impossible to form his lips into a tube or close his mouth.

Prevention

Compliance with the rules for the prevention of facial nerve neuropathy can reduce the likelihood of pathology occurring. This is especially true if there is an increased risk of developing the disease. Doctors recommend:

avoid hypothermia and facial injuries;
observe safety precautions at work to prevent eye damage;
consult a doctor in time for infections and otitis media;
control blood sugar levels;
promptly diagnose and treat chronic diseases.

Treatment at the Energy of Health clinic

Facial nerve neuropathy requires the fastest and most accurate diagnosis and comprehensive, comprehensive treatment. Only in this case can a rapid restoration of impaired functions be achieved. Neurologists at the Energy of Health clinic use the most effective techniques:

modern drug regimens that affect the cause of the disease and relieve symptoms;
physiotherapy courses for tissue restoration;
massotherapy;
training in facial gymnastics techniques;
taping the affected areas;
observation throughout therapy, adjustment of dosages and medications if necessary;
a full range of measures for quick and complete rehabilitation;
organization of sanatorium-resort treatment for the most complete recovery.

Treatment of trigeminal neuralgia

Treatment and drugs

For successful treatment, complex drug therapy is used. First of all, these are anticonvulsants (carbamazepine, finlepsin or clonazepam), which are included in the mandatory rehabilitation program and relieve the main manifestations of neuralgia. The dosage and duration of treatment are determined strictly by the attending physician.

For additional effect, antihistamines and local pain relievers may be prescribed. To compensate for the lack of gamma-aminobutyric acid (a kind of mediator between the brain and the nervous system), baclofen, phenibut or gabapentin are prescribed. In the stage of exacerbation of neuralgia, specialists often prescribe antidepressants to eliminate psychological discomfort (the most common remedy is finlepsin). If the cause of the disease is a virus or infection, antiviral and antibacterial agents, as well as NSAIDs, are prescribed. During the recovery period, it is recommended to take B vitamins.

Physiotherapy

To eliminate pain, novocaine blockades and sodium hydroxybutyrate injections are actively used. The most popular and effective physiotherapeutic techniques: acupuncture, ultraphonophoresis, magnetic therapy, and low-frequency laser therapy. Massage for trigeminal neuralgia is also a good addition to general treatment and allows for better blood circulation.

Advantages of the clinic

The Health Energy Clinic provides each visitor with medical care of the highest level, regardless of his age and reason for visiting. We offer:

screening diagnostic programs to assess health status;
accurate and quick diagnosis of obvious and hidden pathologies;
modern methods of drug therapy, physiotherapy, exercise therapy, massage;
minor surgical operations within the walls of the clinic;
course treatment of chronic diseases in comfortable day care wards;
organization of hospitalization in a specialized hospital if necessary;
preparation of documents for sanatorium-resort treatment, selection of sanatorium;
remote consultations with foreign doctors to obtain an alternative opinion;
modern rehabilitation programs.

Facial nerve neuropathy is a fairly common pathology. To prevent it from leading to irreversible facial asymmetry, contact a specialist as soon as possible. Neurologists at the Energy of Health clinic will always come to the rescue.