Neuritis of the facial nerve: symptoms and treatment, causes

Neuritis of the facial nerve( Bell's paralysis, facial nerve neuropathy) is an inflammatory disease that is characterized by a partial or complete loss of facial muscle functions.

The second pathology is due to the Scottish physiologist and anatomist Charles Bell, who first officially described the symptoms in 1821, although Avicenna mentioned another neurite in his works.

Causes and Classification of

Bell paralysis is a very frequent occurrence among many localizations of damage to the peripheral part of the facial nerve. The disease occurs as a result of edema and nerve contraction in the fallopian canal.

Vulnerability in this location is due to the fact that the thickness of the nerve column is up to 70% of the cross-sectional area of ​​the canal and does not decrease, even though the bone channel narrows in some places. Therefore, the disease is considered as a tunnel syndrome.

Among the reasons for the appearance of neuritis of the facial nerve, it should be noted:

• activation of the herpes simplex virus of the first type;
  
• supercooling( draft, cold airflow from the air conditioner);
  
• arterial circulation disorder;
  
• respiratory infections;
  
• demyelinating diseases( multiple sclerosis);
  
• injury;
  
• atherosclerosis of cerebral vessels;
  
• systemic diseases;
  
• decreased immunity;
  
• complicated otitis media;
  
• inflammation in the facial part of the skull;
  
• unsuccessful dental treatment;
  
• oncological diseases( brain tumor, lymphoma);
  
• developmental abnormalities;
  
• surgical intervention;
  
• metabolic disorder.

Often the disease appears against a background of nervous overstrain, emotional instability and stressful situations.

1. 1) Primary neuritis of the facial nerve. It is a complication of catarrhal disease, when there is severe hypothermia. It occurs as a result of spasm of vessels and edema of tissues, leading to a disruption of nerve supply and development of its paralysis.
   
2. 2) Secondary neuritis is a complex of symptoms that occurs against the background of organism intoxication, tumor processes, in traumas, otitis, inflammations.

Symptoms of the neuritis of the facial nerve

The first symptoms of neuritis manifest suddenly, it all begins with the complete or partial immobilization( paralysis) of facial muscles, which is manifested by slow motion or immobility of one part of the face.

The process is always one-sided, bilateral defeat can occur, but in very rare cases. The clinical picture is characterized by the following symptoms:

• nasolabial and frontal folding;
  
• facial asymmetry;
  
• impossibility to completely close the eye on the affected part of the face( hare eye);
  
• changes the shape of the glottis;
  
• numbness of the face;
  
• difficulty in eating - the liquid can not be held in the mouth, and solid food sticks between the gum and cheek;
  
• can not blink, smile or frown;
  
• taste disorders;
  
• face becomes masky, without expression;
  
• indistinct speech;
  
• painful sensitivity to sounds;
  
• when talking or exhaling there is bloating of the cheek( sailing symptom);
  
• hearing loss;
  
• pain in the ear from the sore side.

Pathological manifestations are caused by the point of nerve damage. It is known that three branches leave the trunk of the facial nerve in the bone canal. For example, if the disorder occurred before the large rocky nerve departs, in addition to the immobility of the muscles, there will be a decrease in lachrymation, salivation and taste disorders.

The same signs will be with lesion of the facial nerve before the withdrawal of the staple nerve, only in place of xerophthalmia there is lacrimation.

Diagnosis of neuritis

To confirm the diagnosis it is necessary to appear to a neurologist and an otolaryngologist. At the beginning of the disease it is very important to establish the character, determine the extent and localization of nerve damage.

The doctor states the presence of the neuritis of the facial nerve, guided by simple tests. The patient is asked to raise his eyebrows, frown, whistle, close his eyes, inflate his cheeks, bared his teeth. The presence and extent of damage to mimic muscles is determined by how the person being tested copes with the task.

With the course of the pathological process, diagnostic methods are sent to establish the cause of the disease. For this purpose, a computer or magnetic resonance imaging of the head is prescribed. If necessary, MR angiography with contrast enhancement is performed.

In case of neuropathy of the facial nerve, an electromyographic study( EMG) is also proposed, during which the electrical activity of the facial muscles is evaluated in response to stimulation, and the rate of passage of electrical impulses along the fibers. The first time it is desirable to spend 4 days from the onset of paralysis for differential diagnosis of lesions on the face and in the bone canal. Re-examination is prescribed after 10-15 days to compare the results after the treatment procedures. EMG is also carried out after 1.5-2 months and even later with a prolonged course of the inflammatory process.

Read also how to treat inflammation of the trigeminal nerve.

Treatment of neuritis of the facial nerve

The onset of neuritis treatment should be timely, because the more the disease is started, the less effective the therapeutic measures are:

• in the use of dehydrating drugs( furosemide);
  
• vasodilator drugs( nicotinic acid);
  
• of B vitamins;
  
• antioxidants( alpha-lipoic acid);
  
• analgesics( in case of severe pain syndrome);
  
• of corticosteroids;
  
• antiviral drugs.

Various physiotherapeutic procedures are shown and widely used: microwave therapy, Minina lamp, alternating magnetic field, sollyx, acupuncture.

The patient must perform simple tasks:

• rest at night on the side of the lesion;
  
• to maintain eye protection during sleep;
  
• conduct adhesive stretch stretch from the healthy side to the patient to remove the asymmetry of the face;
  
• tie a shawl to tighten the muscles.

All the above described treatment measures are recommended in the early period from 1 to 10 days of illness. Further, massage is shown by a gentle method and exercise therapy with increasing load.

For the facial muscles, you can use the exercises:

• whistle,
  
• exposure of upper and lower teeth,
  
• smile with closed mouth,
  
• extension of nostrils,
  
• eye-sighting behind the finger in motion,
  
• retracting the cheeks with the closed mouth,
  
• quenching the lit match.

At this time, the intake of antioxidants and vitamins continues. From the third week from the onset of the disease, anticholinesterase drugs( proserin) are advisable, as well as more intensive physiotherapy( ultrasound with hydrocortisone).If after 2-3 months recovery does not occur, biostimulants are prescribed, massage and exercise therapy are continued.

If there is no effect for a long time( 8-10 months), the question of surgical intervention may arise. Some specialists to remove pressure on the nerve suggest removing some of the bone, but the effectiveness of the procedure is not proven.

Prognosis and prevention of facial nerve neuritis

If treatment of facial nerve neuritis is initiated in the first hours after the onset of the disease, the majority of patients can achieve full recovery. But in 20-30% of cases at 4-6 weeks develops contracture.

Symptoms that are unfavorable in the prognostic plan:

• complete paralysis of facial muscles;
  
• recovery does not occur in three weeks;
  
• pain behind the ear;
  
• is elderly( over 60 years old).

With partial impairment of functions, when there is still a certain amount of movement in the muscles, the possibility of full recovery is quite high. In individual episodes after Bell's paralysis, there may be residual effects: slight relaxation of facial muscles, twitching of the eyelid or lip.

Prevention of facial nerve neuropathy consists of:

• in hardening;
  
• regular walks in the fresh air;
  
• in the prevention of hypothermia;
  
• timely treatment of diseases of the nasopharynx and ears;
  
• in wearing adequate clothing relative to weather conditions.

There are no established principles of prophylaxis for paralysis of facial muscles. To detect the disease before the appearance of visible symptoms in our time is also not possible.

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