Neuritis of the facial nerve: symptoms and treatment

Each of us at least once in my life met a man with a "skewed" face. This symptom is the first thing that catches the eye of a patient with neuritis of the facial nerve. Neuritis of the facial nerve is a multifactorial disease of the peripheral nervous system, characterized by the defeat of the 7th pair of cranial nerves. Often occurs under the name of Bell's paralysis. Of all 12 pairs of cranial nerves, the pathology of the facial nerve is perhaps the most common: the incidence rate is 25 cases per 10, 00 population per year. So, let's find out what kind of disease it is, what symptoms should not be missed for proper diagnosis and how the treatment for this disease usually goes.

Causes

The facial nerve (their two: left and right) after exiting the brain passes through the canal of the temporal bone in the cranial cavity. On the person gets through a special hole in the temporal bone and here innervates (connects with the central nervous system) facial muscles that provide facial expressions. In addition, there are fibers in the nerve that provide lacrimation, salivation, a sense of taste on the front two-thirds of the tongue, and hearing. All these functions may suffer together or partially, depending on the level of nerve damage along the route. Like most neurological diseases, neuritis of the facial nerve does not have one cause. The culprits for its development can be:

• viral infections: herpes simplex virus, influenza, mumps, Epstein-Barra, adenovirus;
• bacterial infections: syphilis, brucellosis, leptospirosis, borreliosis, diphtheria, etc .;
• inflammatory diseases of the ear (in the outer, middle and inner ear - otitis, mesotympanitis);
• congenital anatomical narrowness of the canal of the facial nerve;
• fractures of the base of the skull with defeat of the temporal bone, surgical interventions in this area;
• tumors;
• meningitis, encephalitis, arachnoiditis;
• diffuse connective tissue diseases (systemic lupus erythematosus, scleroderma, nodular periarteritis, dermato- and polymyositis - so-called collagenoses);
• metabolic disorders (diabetes mellitus, for example);
• polyradiculoneuropathy Hyena-Barre;
• acute circulatory disorders of the brain;
• multiple sclerosis.

To the factors provoking the disease include hypothermia of the face (especially in the form of a draft - a trip to the machine with an open window, air conditioning), pregnancy (due to the development of the edema channel for the facial nerve becomes narrow).

Symptoms

When the motor portion of the nerve is affected, the so-called peripheral prozoparesis develops, i.e., weakness of facial muscles. Very often the symptoms appear suddenly for several hours, sometimes per day. A person may not feel pain at all, but, looking at himself in the mirror, discovers the asymmetry of the face:

• the eye gap on one side is bigger than the other, it does not turn out to squint, the eyelids on the affected side do not close - this is called lagophthalmus (hare eye);
• when you try to close your eyes, the sick eye as it "rolls up becomes visible white strip of sclera - the phenomenon of Bell;
• on the side of the eye paresis flashes less often;
• the eyebrow is higher than in the healthy half, the patient can not raise an eyebrow;
• It is impossible to wrinkle the forehead: creases on the forehead are not formed;
• cheek on the affected side of the "sailor it retracts on inhalation and inflates with exhalation, the patient can not cheat the cheeks;
• the nasolabial fold is smoothed, the corner of the mouth is lowered;
• it is not possible to whistle, spit, smile, speech can become vague.

All this looks like a "skewed" face. When washing, soap gets into the eyes. When eating, food spills out of the mouth, there is a so-called "crocodile tears" symptom - during the meal the patients involuntarily cry. Pain if it is, it is often insignificant, in the ear. Often, patients complain of just unpleasant feelings on the sick half of the face.

Depending on the level of nerve damage along the course of the insufficiency of facial muscles can join the symptoms of satellites. They occur when nerve fibers are damaged, responsible for lacrimation, salivation, taste and hearing:

• impairment of lacrimation: dry eyes appear;
• violation of salivation: dry mouth, the symptom may not be noticed by patients due to unbroken saliva production on the other hand;
• a taste disorder on the front two-thirds of the tongue;
• Hypersensitivity to sounds (hyperacusis) appears if the nerve fibers that enter the muscles of the tympanic membrane are affected.

Symptoms-satellites arise if the nerve is also affected in the cavity of the skull or in the canal of the temporal bone. If the nerve is already affected by the exit from the canal to the face, then only the weakness of facial muscles develops with lacrimation (due to irritation of the mucous membrane of the non-closing eye). This point is important for determining the level of nerve damage.

The neuropathologist reveals the decrease or disappearance of corneal and superciliary reflexes. Asymmetry of the face is strengthened when trying to perform active movements: the patient is asked to smile, draw his lips with a tube, whistle, etc.

Special variants of neuritis of the facial nerve have separate names in medicine. If the cause was the herpes virus, then this is called Hunt's syndrome. If the cause is in the narrowness of the nerve canal, then this is the true Bell paralysis. There is also a special form of the disease, manifested by repeated cases of neuritis of the facial nerve, often bilateral, with a hereditary predisposition, is a disease Rossolimo-Melkerson-Rosenthal.

A special danger of the neuritis of the facial nerve is the formation of the contracture of the facial muscles. This complication occurs when the nerve function is not fully restored, when the healthy side seems to be paralyzed. The cause may be an incorrect and inappropriate treatment. Sometimes this complication develops for no apparent reason. Signs indicative of the formation of contracture are:

• narrowing of the eye gap on the diseased side;
• nasolabial fold on the affected side is more pronounced than on the healthy one;
• the thickness of the cheek on the affected side is greater than that of the healthy one;
• spontaneous twitching of the facial muscles;
• when the eyes are closed, the angle of the mouth rises on the same side;
• when the eyes are closed, the forehead wrinkles;
• narrowing of the eye gap when eating.

Deformation of the face in this case can be eliminated only with the use of plastic surgery. Therefore, a patient with signs of neuritis of the facial nerve should immediately consult a doctor to prevent this complication.

Diagnostics

The diagnosis is made by a neuropathologist on the basis of typical patient complaints, given neurological examination. Additionally, a clinical study of blood tests, urine, radiography, electromyography, computed tomography (CT), magnetic resonance imaging (MRI) is conducted. They are necessary to establish the cause of the disease and the severity of the process. Electromyography allows you to trace the process of recovery of the nerve during treatment, to reveal the initial signs of contracture.

Treatment

For the treatment of neuritis of the facial nerve, medicamentous and physiotherapeutic methods are used. The course of the disease can be long, it may take months to recover. At best, it is possible to cope with the disease for a month, but sometimes a half-year treatment does not bring 100% results. Among the groups of medicines, it is expedient to use the following:

• Anti-inflammatory: among them in the first place on the effectiveness are glucocorticosteroids. In the first few days, intravenous administration (depending on the severity of the pathological process) or oral administration is possible. Prednisolone, methylprednisolone (methypred), dexamethasone may be used. The dose is selected individually. Duration of application is 2-3 weeks, during this time the dose of the drug is gradually reduced until cancellation;
• diuretic: this group is used to reduce nerve edema. These include lasix, furosemide, triampur. The first few days are applied against the background of a diet rich in potassium;
• vascular: this group of drugs can improve the "nutrition" of the nerve. Trental, agapurin, dipyridamole (quarantil), cavinton, nicotinic acid are used;
• vitamins of group B: kombilipen, milgamma, neurorubin, neurobex, etc .;
• antispasmodics: eufillin, no-spa;
• analgesics: with severe pain syndrome (nimesulide, ibuprofen, etc.);
• anticholinesterase: used from 5-10 days of illness, not earlier. They contribute to improving the conductivity of nerve impulses, restoring contractions of the facial muscles. Most often, neuromidine is used for this purpose;
• Locally on face area: applications with dimexidand nicotinic acid;
• if the neuritis of the facial nerve is caused by the herpes virus - treated with acyclovir, zovirax, herpevir;
• if the cause was a bacterial infection, appropriate antibiotic therapy is used;
• when the eye is dry, it is necessary to use drugs like artificial tears to prevent infection of the eye.

Physiotherapy procedures play a big role in the treatment. They begin to be used from 7-10 days of the disease in order to strengthen drug effects, improve blood circulation, conductivity along the nerve, prevent the development of muscle contractures. The arsenal of procedures is very extensive: UHF, magnetotherapy, laser therapy, infrared radiation, diadynamic currents, electrophoresis with medicinal substances (nicotinic acid, proserin, euphyllin, calcium chloride, magnesium sulfate), electrostimulation of the nerve branches, darsonvalization.

The patient is shown a massage from the 2-6th week after the onset of the disease (individually). Usually the course is 15 procedures with a duration of 10 min. If necessary, after a 10-day break, the course can be repeated. Also it is necessary to spend daily medical gymnastics (from 5-10 days of disease). It is necessary to work in front of a mirror, helping yourself at first to carry out movements on the sick half of the face. The goal of gymnastics is to "teach" the mimic muscles to work again.

An important place in the treatment of neuritis of the facial nerve is acupuncture, and it can be used even in the acute period of the disease.

Surgical methods of treatment are shown primarily to patients whose neuritis was caused by nerve compression. The absence of the effect of conservative therapy for 3 months can also serve as an indication for surgical treatment. However, no single method of treatment can give a 100% guarantee for recovery.

Plastic surgery goes to the first place for patients who developed contracture of the facial muscles and, as a result, its disfigurement. Of course, such patients constitute a small percentage of all cases (about 3%). The surgeon, of course, will eliminate the cosmetic defect, but the muscle function will not be restored. Usually a complex of medical measures, appointed by a competent neurologist, leads to a complete restoration of the functions of the affected nerve.

Prevention

The main ways to prevent disease include tempering (to improve immunity), maintaining a healthy lifestyle (with the goal of normalizing the exchange substances and prevention of diseases such as diabetes mellitus), timely treatment of inflammatory diseases of ENT organs, prevention of hypothermia and injuries.

Acute neuritis of the facial nerve. Treatment of neuritis. Advice of a neurologist M.М. Sperlinga ( Novosibirsk).

Acute neuritis of the facial nerve. Treatment of neuritis (doctor's advice on YouTube).

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