Neuropathy of the facial nerve: treatment

Neuropathy of the facial nerve is one of the most common diseases of the peripheral nervous system. Its signs become noticeable almost from the first hours of the disease, because with facial neuropathy the face is distorted. Asymmetry can not be overlooked, although this is by no means the only symptom of this disease. Neuropathy of the facial nerve can not be categorically left without medical assistance. It is a disease that must be treated immediately after diagnosis. Otherwise, the asymmetry of the face and some other problems can remain with the person for the rest of his life. The article will be devoted to the treatment of facial nerve neuropathy.

A little about the disease itself

Facial nerve (nervus facialis) - VII pair of cranial nerves

The facial nerve is the VII pair of cranial nerves. Before you get to the face, the nerve passes through a narrow canal of the temporal bone, where it is compressed in case of illness. The facial nerve innervates mostly facial muscles of the face. It is thanks to him that a person can smile, open and close his eyes, wrinkle his brow, whistle and so on. When there is lesion of the facial nerve, called neuropathy of the facial nerve, then all of the above is impossible. The eye on the affected side does not close completely, tears flow from it (or there is a pronounced dryness of the mucous membrane of the eye), water and liquid food pour out of the mouth, taste sensitivity is broken, and sometimes even the speech becomes a little indistinct. With complete paralysis, one half of the face is completely immobilized.

Disease can appear both on the background of complete well-being, and can be caused by many reasons. Most often, hypothermia plays a role. And sometimes other diseases can cause damage to the facial nerve (for example, diabetes, inflammatory diseases of the ear, hypertension and so on). With neuropathy, the facial nerve swells and swells, its walls are compressed by the walls of the bone channel of the temporal bone.

Symptoms of the disease appear one after another for several hours - a maximum of days. It is very important, when the first signs appear, to contact the neurologist immediately, because the treatment started in the first three days from the onset of the disease has a more favorable outcome. If therapy is started later, then the probability of complete recovery of the function of the facial nerve is less. And this is fraught not only with the asymmetry of the face, but also with ophthalmologic problems (conjunctivitis and keratitis due to non-closing eye fissure and even loss of vision), the appearance of uncontrolled muscle twitching in the affected area. Independently the disease does not pass. In order to get rid of the numerous signs of facial nerve neuropathy, complex treatment with conservative methods (medicines, physiotherapy techniques, massage, physiotherapy exercises). And sometimes you can not do without surgical intervention. Let's talk more about each type of treatment.

Drug therapy

It is shown from the first days of the disease. But the drugs that are used in the first 10 days (in the acute period) are different from the drugs used later (that is, already in the recovery period). So, in an acute period the patient is shown:

• non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac, Xefokam, Meloxicam and others). They have analgesic, anti-edematous, anti-inflammatory effect on the affected nerve. Usually they are used for mild and moderate forms of the disease;
• corticosteroids (Prednisolone, Metipred and others). They are used for severe forms of the disease (when the paresis of facial muscles is sharply expressed). They have a pronounced anti-inflammatory and anti-edematous effect. The patterns of hormonal drugs are different. Possible pulse therapy, when large doses of hormones are administered intravenously drip for 3 days, and then the drug is taken inside (the calculation of the dose goes by the weight of the patient) for another 5 days, and then the dose gradually decreases until the drug is completely discontinued. Another scheme provides initially taking the drug inside (in the first half of the day) at a dose of 1 mg per kg of body weight for 7-10 days, followed by a gradual cancellation. Sometimes hormones are used topically, injecting them with a syringe together with an anesthetic into the mastoid process (at the point of nerve exit to the face). In any case, the doctor selects the treatment scheme individually;
• diuretics (Lasix, Furosemide, L-lysine escinate). Appointed for just a few days to quickly get rid of the nerve edema;
• vasoactive drugs (Pentoxifylline, Nicotinic acid, Dipyridamole, Cavinton). They are needed to normalize blood flow and nutrition in the nerve zone;
• metabolic drugs (Thioctic acid, Actovegin). Thioctic acid has a beneficial effect on the recovery of nerve fibers. Actovegin is also a vasoactive drug. Applying it, you can immediately kill two birds with one stone: affect metabolism and blood flow with a single drug;
• in cases when the disease is caused by the herpes virus, the first 5 days of antiherpetic drugs (Acyclovir, Valaciclovir);
• antibacterial preparations. They are prescribed in cases when the bacterial inflammatory process in the ENT organs (otitis, mastoiditis) became the cause of the disease.

After the first 10 days, the disease passes into the early recovery period. Here the tactic changes a little. Some drugs are canceled (diuretic, antiherpetic, antibacterial). Nonsteroidal anti-inflammatory drugs sometimes continue to use up to 14 days. Hormonal drugs are gradually being canceled. Treatment with vasoactive and metabolic drugs continues. In the recovery period, new ones are added to them:

• anticholinesterase (Neuromidine, Amiridin, Aksamon). These drugs help to improve the transmission of the nerve impulse from the facial nerve to the facial muscles, due to which the muscular contractions become more productive. Earlier, Prozerin was used for this purpose, but later it was proved that it promotes the formation of muscle contractures, so they refused it;
• vitamins of group B (Milgamma, Kombilipen, Neurorubin, Neuromultivitis and others). These neurotropic vitamins are able to stimulate the healing of a damaged nerve, improve the impulse along it, and even have an analgesic effect.

With stimulating muscle contraction drugs need to be careful. The fact is that sometimes the neuropathy of the facial nerve ends with the formation of muscle contractures on the affected half of the face. In these cases, muscle tone increases, there may be twitching in them, as well as pathological muscle effects (for example, chewing closes the eye gap or flowing tears on the affected side of the face, when the conversation "jerks" the eye and the like). If against the background of the appearance of the first signs of muscular contracture continue to use anticholinesterase drugs, this will only exacerbate the situation. If the treatment process is controlled by electroneuromyography (a special study evaluating the conduct of a nerve impulse and the excitability of the muscles), then the tendency to develop contractures will be revealed even before the appearance of any clinical signs.

In those cases when the first signs of the formation of muscle contracture appear, anticholinesterase drugs are canceled. Instead, they are prescribed muscle relaxants (Sirdalud, Midokalm, Baclofen) and Carbamazepine (Finlepsin).

If the contracture still finally formed (usually about this can be said after 6 months from the onset of the disease), then it is combated with botulinum toxin, which is injected into the muscles. Of course, this gives a temporary effect, but still fairly stable. Within 3-4 months, botulinum toxin provides a reduction in twitching and a decrease in muscle tone. Women like injections are called a "prick of happiness", because after them the appearance becomes more aesthetic.

Physiotherapeutic treatment

In an acute period, the electric field of UHF, an alternating magnetic field, phonophoresis with hydrocortisone is allowed. Well-proven acupuncture. After 10-14 days from the onset of the disease, the arsenal of physiotherapeutic methods expands: electrotherapy (diadynamic, sinusoidal modulated currents, electrostimulation of muscles, electrophoresis with various substances by the Halfmask method Bergogne), magnetotherapy, darsonvalization, laser therapy. Acupuncture is also effective in this period. In a later period, mud applications, chloride-sodium, iodide-bromine, radon baths are useful.

When forming contractures, electrophoresis is prescribed with muscle relaxants, vasodilator substances, paraffin and ozocerite applications on the collar zone, ultrasound treatment. Mud and hydrotherapy are also indicated in this case.

Massage and physiotherapy exercises

Massage is also used to treat this pathology, but not earlier than a week after its debut

Physical methods of treatment are used already in the acute period. In the first 10 days, the treatment is carried out by the position:

• sleep on one side on the affected side;
• 3-4 times a day for 10-15 minutes a day to sit, tilting his head in the direction of defeat and propping it with the back of the brush. The hand must rest on its elbow;
• tie the face with a handkerchief so that the muscles of the healthy side are pulled to the affected. This is done in order to prevent overstretching of the muscles of the affected side.

In the acute period, also shown is the adhesive tape tension from the healthy side to the patient. A patch is glued on one side to the healthy half of the face, stretching the muscles to the patient (so that the healthy muscles do not overtake the affected ones). The second half of the patch can be attached to a special mask-helmet or to a tape of the plaster, pasted in the safe zone of the affected half of the face. Adhesive plaster is applied for 30-60 minutes in the first days (mainly during active actions - eating, talking), and then the time is gradually increased to 2-3 hours per day.

Therapeutic physical culture in the acute period is carried out mainly for the muscles of the healthy side. 2 times a day for a duration of 10 minutes performed exercises that provide dosed relaxation and muscle tension, which participate in facial expressions (for example, expression of sadness or joy), provide reproduction of sounds (b, p, c, f, m, y, o).

At the end of the acute period, the exercises already take on the sick half of the face, as if training the muscles, because they need to be taught to work anew. Exercises are very simple and performed in front of the mirror for visual quality control:

• frown, blink;
• raise your eyebrows up ("marvel");
• expand the nostrils;
• whistle;
• inflate cheeks and "roll" air from side to side;
• blow on the supposed candle;
• smile with open mouth;
• take turns to "put on" your lips against each other;
• stick out your lips forward for a kiss;
• tongue out with a tube and so on.

This is only a small part of the exercises as an example. In fact, in this period the patient needs to make faces in front of the mirror in every possible way, so that as many of the muscle fibers as possible participate in the process. But it's important not to overdo it with classes.

Massage is recommended to begin no earlier than on the 7th day after the onset of the disease. The duration of the procedure is 10 minutes. The methods of massage should be gentle, first touching the healthy side and the collar zone. Then lightly strokes and kneading of the affected side are slowly added, vibration along the points. After 15-18 sessions, take a break. Then the course can be repeated.

Surgery

Operative methods of treatment with facial nerve neuropathy can be divided into two groups:

• methods that restore the conduction of the nerve;
• plastic surgery, the main purpose of which is to restore the cosmetic defect and replace the function of paralyzed muscles.

The question of surgical treatment of the facial nerve neuropathy usually arises when there is not the slightest effect within 2-3 months from the onset of conservative treatment. Some doctors believe that one should refrain from surgical methods of treatment for at least 10-12 months, although there is an opinion that in this case the ability of the nerve to restore is already extremely low. The exact indications for surgical intervention are not currently defined. This is partly due to the complexity of predicting the outcome of the disease. After all, at the beginning of the disease it is difficult to say how the nerve will be restored, how much it is squeezed in the temporal bone channel, what its recovery potential is. In general, we can say that the question of surgical intervention is solved individually.

At present, the following methods are used to restore the electrical impulse along the nerve:

• decompression of the nerve in the temporal bone channel (i.e., surgical removal of nerve compression);
• reinnervation of the facial nerve. The essence of such an operation is the stitching of the appendage of the facial nerve with the site of another, unaffected nerve. Thus, the muscle tone is maintained on the affected half of the face, muscle atrophy does not develop. As a nerve donor, the sublingual nerve is most often used, but neurosurgeons can also take the diaphragmatic and accessory nerves. Another method has been developed, according to which healthy branches of the facial nerve act as a donor (if any).

Plastic operations are quite diverse. They do not lead to the recovery of the nerve or the restoration of its function. Such interventions reduce all the negative consequences of face asymmetry. It turns out that this type of treatment is used in the period of residual phenomena, when there is no hope for the restoration of the nerve.

Plastic operations can be of two types: static and dynamic. To static carry:

• tarsorphia (partial suturing of the eyelids). This reduces the width of the eye gap, thereby eliminating asymmetry and reducing the frequency of conjunctivitis;
• pulling up the facial skin (hanging the cheek, lifting the eyebrows and so on).

Dynamic operations are needed to replace the function of paralyzed muscles. In such operations, a muscle-tendon flap with a vascular-neural bundle is cut from the temporal or subcutaneous muscles of the neck and transplanted to the affected area of ​​the face. In this way, the ability to muscle contraction remains. The transplanted muscle takes on the function of the affected. Unfortunately, it is not always possible to achieve the desired result. Sometimes the muscles undergo a degeneration into the scars, and all the measures taken are in vain. With the introduction of microsurgical techniques, the long-term results of such operations have become much better.

In the postoperative period, an obligatory condition is the performance of exercise physical therapy exercises.

Thus, the treatment of facial nerve neuropathy is very variable. There are general principles of treatment that form the basis of a personified approach to the patient. It takes into account both the cause of the disease, and its course, and the effect of the use of medications, and electroneuromyography. It should be remembered that most cases of facial nerve neuropathy with timely access to medical help can be defeated without any damage to health.