What causes neuritis of the facial nerve. Symptoms of inflammation of the facial nerve

The human face is capable of expressing the most subtle and deep shades of emotional experiences. This opportunity is the basis of communication, which is vital for every individual to adapt in modern society. Neuritis of the facial nerve - the so-called Bell's palsy, depriving part of the muscles of the face of mobility and ugly distorting facial expressions, becomes not only a medical, but also a social problem for the patient.

What causes Bell's palsy?

Inflammation of the facial nerve may be due to:

• infectious, viral or bacterial invasion;
• metabolic disorders, such as persistent hyperglycemia in diabetes;
• congenital narrowness of the bone canal that releases the facial nerve from the skull;
• traumatic narrowing of the canal in fractures of the body of the temporal bone;
• inflammatory processes in the ear;
• diffuse collagenosis;
• tumor processes;
• inflammation of the meninges;
• multiple sclerosis;
• edematous syndrome during pregnancy;
• acute NMC.

The start of the inflammatory process in the nerve trunk is given by general and local hypothermia. Very often, Bell's palsy is provoked by drafts.
In pediatric practice, neuritis of the facial nerves are as common as in adults. But the list of causes that cause them is much shorter. The starting factor for neuritis in a child is mainly otitis media, provoked by hypothermia or drafts.

How does Bell's palsy occur?

In the pathomechanism of the lesion, the most significant stages are conditionally distinguished:

• spasm of blood supplying arterioles;
• lack of blood supply to the nerve;
• hypoxia of nerve cells;
• swelling of the nerve trunk;
• the formation of microhemorrhages in it.

The resulting inflammatory process blocks or limits the transmission of nerve impulses from the brain to the receptors of the facial muscles. Imperative signals from the nuclei of the brain remain without a mimic response, which in a patient with neuritis is manifested by the inability to control the muscles of the affected half of the face. Wherein:

• the clinical picture of the initial attack and the acute process appear at lightning speed - within a day or faster;
• it may be accompanied by pain.

But this is not necessary, often the patient, quite unexpectedly for himself, suddenly sees a reflection of an asymmetric face in the mirror. He realizes that he cannot smile, frown or raise his eyebrows, finds difficulty in chewing food.

The main symptoms of neuritis

The visual picture of the immobilized half of the face, innervated by the inflamed nerve, resembles a mask. At the same time, it is striking that, compared with the healthy side:

• palpebral fissure is slightly wider;
• noticeably below the level of the corner of the mouth;
• there is a smoothness of the nasolabial fold;
• the severity of transverse frontal wrinkles is determined.

When trying to express emotions, the degree of asymmetry increases:

• An attempt to smile turns the mouth into a shape resembling a tennis racket.
• An attempt to close one's eyes demonstrates what a "hare's eye" symptom is, when the eyelid does not close completely, and the sclera turns white in the remaining gap.

While eating, you can observe that:

• attempting to take liquid food ends up running down the chin on the affected side;
• an attempt to chew a hard piece of food is accompanied by biting the cheek.

Neurologists are engaged in the final diagnosis of neuritis, when making a diagnosis, the following are taken into account:

• complaints and deviations of the neurological status;
• results of clinical studies of blood and urine;
• X-ray data;
• electromyography indicators;
• conclusions of computer (CT) and magnetic resonance (MRI) tomography.

Features of the course of the disease

The restoration of the nervous tissue is extremely slow, respectively, the clinical course of neuritis is characterized by:

• duration and sustainability;
• resistance to ongoing therapy;
• prone to relapse.

The question of how much neuritis is treated is asked by the attending physician almost every patient. Recovery of nerve tissue may require months of treatment. The disease, receding for a short time under the influence of drug therapy, tends to return again and again, persistently showing a tendency to recur. It is considered a great success if it is possible to cure the patient in a month, more often a complete recovery does not occur even after six months of treatment. In pediatric practice, the prognosis is much more favorable, only 2-3 weeks separate from the complete recovery of an acutely ill child.

Tactics of therapeutic measures

Only the right approach to treatment and adherence to the right tactics can:

• provide the patient with a stable recovery;
• eliminate undesirable consequences;
• ensure a favorable prognosis.

The primary conditions for guaranteeing therapeutic success are:

• the start of drug therapy should be given immediately;
• treatment should be carried out in a hospital or in day hospitals of polyclinics;
• therapeutic measures should be comprehensive.

It is impossible to achieve stable positive dynamics with neuritis at home. There is a risk that violations of the innervation of the facial muscles will become permanent, their contractures will occur. Therapeutic efforts for neuritis should be comprehensive, include several mandatory areas:

• medicinal effect;
• electro-physiotherapy procedures;
• massage courses;
• training of facial muscles;
• acupuncture sessions.

Medical treatment

The understanding of the pathomechanism of neuritis development has given clinicians the opportunity to determine how and with what to treat Bell's palsy in order to achieve the optimal result. The drug therapy regimen should include components that affect each of the stages of the inflammatory process:

• antispasmodics;
• decongestants;
• anti-inflammatory;
• neurotropic.

Depending on the suspected cause of the disease, antiviral or antibiotic therapy is prescribed. If necessary, painkillers and vitamin complexes are prescribed. Improving the conduction of nerve signals through the muscles is achieved by anticholinesterase agents, using modern effective drugs such as Neuromidin, Ipigrix or Amiridin. The appointment of a drug complex is the absolute prerogative of the doctor. The patient should not decide for himself how to treat such a therapy-resistant disease or replace the medicines recommended by the attending doctor with folk remedies.

Physiotherapeutic effect

The purpose of prescribing physiotherapy is to increase the effectiveness of treatment. Under their influence:

• stimulates local blood circulation;
• conduction along the nerve trunks of impulses increases;
• the effect on the nervous tissue of drugs is enhanced.

Types of physiotherapy, the sequence and duration of their courses are selected individually for each patient. Successful application in the treatment of neuritis found methods:

• magnetotherapy;
• diadynamic therapy;
• phono- and electrophoresis;
• carboxypunctures;
• laser therapy;
• darsonvalization;
• UHF and UFO.

Assigned on time (namely, from the 7th to 10th day of the treatment process), physiotherapy increases the effectiveness of drugs and reduces the possibility of developing unwanted complications.

Restrictions in the appointment of physiotherapy

The success and safety of the use of physiotherapy courses is ensured by the observance of reasonable caution. For example, during pregnancy, due to the possibility of a negative effect on the fetus, the use of:

• magnetotherapy;
• microwave therapy.

The appointment of physiotherapy for children with malnutrition, with reduced adaptive and reactive capabilities of the body, with the risk of dissemination of a concomitant disease, against the background of hyperthermia and a tendency to hemorrhages, is limited. There are also age restrictions for the use of physiotherapy in children. Allowed appointment:

• UHF, UV and microwave therapy - from birth;
• electrophoresis - from the second month of life;
• ultrasound and electrical stimulation - from two years;
• dynamic currents - only from the age of seven.

Restoration of facial expressions with massage and exercise therapy

Massage courses are prescribed no earlier than 3-4 weeks from the start of drug therapy, their duration is selected individually for each patient. On average, a full course can include from 10 to 15 sessions. Massage for neuritis should be carried out only by an experienced massage therapist, because:

• the impact zone is an extremely sensitive area - the face;
• the procedure will require special training and specific professional skills from the health worker.

During a visit to a session with a specialist, the patient is recommended to remember the sequence and intensity of the manipulations, so that later, already at home, to be able to continue the course on their own to consolidate the effect. Perfectly combined, complementing each other, massage and gymnastics for the face. Interacting, they give an enhanced effect, allowing you to quickly restore facial expressions. It is recommended that patients continue to perform exercises that train the facial muscles even after discharge at home.

Application of surgical methods

In cases where complex therapy measures fail to achieve clinical improvement even in 8-10 months, the patient is transferred to surgeons. Most often, surgical intervention is resorted to:

• with compression of the facial nerve in the fallopian canal;
• in violation of its integrity of traumatic origin.

The facial nerve trunk and its branches after the operation are able to fully restore their functionality. The help of plastic surgeons is resorted to when muscle contractures appear on the face after neuritis. In this case, the surgical method is subject only to the elimination of a cosmetic defect. Contracted muscles that have lost their elasticity due to prolonged inactivity are unable to regain their functionality.

Neuritis of the facial nerve is defined as a unilateral lesion that occurs in the seventh pair of cranial nerves. These nerves are particularly responsible for the movements produced by the mimic muscles of one face. The clinical manifestation characteristic of such a diagnosis as neuritis of the facial nerve, the symptoms of which are expressed in the patient's impotence in controlling the facial muscles in the affected area, is the occurrence of facial asymmetry, which appears due to muscle paralysis or paresis in the area of ​​the corresponding half of the face.

Causes of neuritis of the facial nerve

In the vast majority of situations under consideration, it is not possible to establish the specific cause of the onset and subsequent development of neuritis. Among the provoking factors, local hypothermia is often singled out as the main factor (for example, a draft from a car window that contributes to blowing one half of the face, etc.), in some cases it can be combined with an infection (). The development of neuritis is also facilitated by inflammatory processes in the middle ear (mesotympanitis,) and processes in the posterior cranial fossa (meningoencephalitis, arachnoencephalitis).

Often, the defeat of the facial nerve is facilitated by a traumatic fracture or a crack that has arisen at the base of the skull, tumors in the region of the cerebellopontine angle, and operations performed to eliminate the purulent process that has arisen in connection with otitis media, mastoiditis and other diseases. Diseases of a systemic nature, as well as diseases associated with metabolism, traumatic brain injury in general, heredity - these factors should also not be excluded as the causes of the development of the disease in question.

We also note that the disease in some cases is observed in its recurrent, as well as in a bilateral form.

Neuritis of the facial nerve: symptoms

External manifestations of neuritis are expressed, as we have already noted, in facial asymmetry, in which smoothing of the folds of the forehead skin or their absence is observed on the side of the nerve lesion. In addition, the palpebral fissure undergoes changes, which expands to a large extent.

Smoothing and omission occurs with the nasolabial fold, the lower lip hangs down. Baring the teeth of the sick, as well as laughter, are accompanied by pulling the mouth to the healthy side. The opening of the mouth is characterized by a greater sharpness of its angle from the side of the lesion than when compared with a healthy area. Raising the eyebrows does not contribute to the formation of horizontal wrinkles on the skin of the forehead, because the eyebrow does not rise from the paralyzed side. Closing the eyes is characterized by incomplete closure of the eyelids, in which the palpebral fissure simply gapes from the side of the lesion, as if the patient is peeping, squinting his eyes. This symptom is defined as lagophthalmos, the more common name of which sounds like "hare's eye".

When considering such a condition as neuritis of the facial nerve, the symptoms of which are pronounced, it can also be noted that the patient loses the ability to stretch his lips with a “tube”, cannot whistle and kiss. In the process of eating, it is noted that it gets stuck between the teeth and the affected cheek. Reduced or absent corneal, superciliary and conjunctival reflexes. The degree of damage also determines the addition of signs of taste disturbances to this picture of the disease, which affects the region of the two anterior thirds of the tongue.

Actual phenomena are hyperakasis, as well as a hypertic rash formed in the area of ​​​​the external auditory canal. In some cases, such a symptom as “crocodile tears” becomes relevant, in which tears begin to flow during eating, while the rest of the affected eye is in a dry state. There may also be an increased sensitivity characteristic of hearing, in which the sounds from the neuritis are felt as louder.

The danger of neuritis of the facial nerve lies in the possibility of complications in the form of contractures of facial muscles. It manifests itself by the characteristic reduction of half of the face that has succumbed to defeat, and in such a way that it seems that it is not the healthy side that is paralyzed, but the sick side. It is formed in the fourth or sixth week from the onset of the disease, which is facilitated by the incomplete recovery of all motor functions.

Diagnosis of neuritis of the facial nerve

To confirm the diagnosis of neuritis of the facial nerve, the symptoms of which bother the patient, as well as to establish the degree of general damage to the facial muscles, electromyography (or EMG) is performed, and appropriate studies are carried out aimed at determining the conductivity characteristic of the facial nerve at this particular stage. To exclude another type of disease, magnetic resonance or computed tomography may also be prescribed for brain examination.

Treatment of neuritis of the facial nerve

Treatment should be started as early as possible, because this is the possibility of preventing complications and the occurrence of residual phenomena. In particular, it is recommended to take corticosteroids - prednisolone. It should be taken internally in the morning for five days, starting with 60 mg with a gradual decrease in dose and subsequent cancellation from 10-14 days. This dose is safe and, at the same time, effective in considering the possibility of effectively reducing nerve edema with its characteristic infringement of the intraosseous canal. In this case, there is a faster recovery, the pain formed in the behind-the-ear region also disappears.

Given the openness of the eyelids and a violation in tear secretion, preparations used to create artificial tears should be used for the eyes. In addition, a massage is also prescribed for the face, occipital zone and collar zone. At first, the massage is done gently, after which you can move on to medium gain. For the muscles of the face, a set of specific exercises is being developed.

Upon reaching the so-called remote period, characterized by subsiding of the acute process and coming from 10-15 days, physiotherapy procedures are prescribed. Complicated cases, in which treatment is difficult, sedatives are used (relium, sibazon, seduxen), which should be taken four times a day at a dosage of 5-10 mg. Phenobarbital is also used for treatment, which is taken three times a day at a dosage of 30-60 mg. Under the action of these drugs, by reducing anxiety, muscle spasms are reduced, as well as other manifestations of the disease are eliminated.

Secondary neuritis of the facial nerve determine the need for treatment, first of all, the disease that provokes them. As for recovery, it occurs in up to 2-3 weeks, but for the final restoration of all functions, it will take a little longer - up to a year.

Naturally, for taking any type of medication, you need to get appropriate recommendations from your doctor. In this case, to diagnose and determine the course of treatment, it is urgent to visit a neurologist.

Neuritis of the facial nerve is an inflammation of one of the 7 pairs of cranial nerves. As a result, a person cannot normally own his own face and express emotions. It looks skewed and asymmetrical.

It should be borne in mind that this disease is quite common, especially in the cold season. To restore the work of facial muscles, you need to see a doctor as soon as possible.

Anatomy

The facial nerve is responsible for the normal functioning of facial muscles. Also in its composition there are fibers of the intermediate nerve, which are involved in the synthesis of tears and saliva. They are also responsible for the sensitivity of the tongue and skin.

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The nerve trunk is a long process of neurons, which are covered with a sheath. If the inflammation affects only the membrane, then the disease has mild symptoms.

The facial nerve includes the following components:

• part of the cerebral cortex - responsible for facial expressions;
• motor fibers of nerve cells;
• nuclei of the facial nerve - responsible for taste buds, facial expressions and the release of tears and saliva;
• vessels - blood and lymph.

If this nerve becomes inflamed, the volume of its nerve fibers increases. In narrow places, this leads to compression and disruption of nerve cells. Neuritis of the facial nerve has its own ICD 10 code - G51.0 "Bell's palsy".

Classification

There are two main types of facial neuritis:

The reasons

Reliable reasons for the development of the disease have not been established to this day. However, the following factors can influence the development of the inflammatory process:

The mechanism of the development of the disease

Due to the influence of adverse factors on the body, a spasm of the arteries occurs. In this process, stagnation of blood in the capillaries is observed and their expansion occurs.

The liquid part of the blood accumulates in the spaces between the cells. As a result, tissues swell, which provokes compression of the veins and lymphatic vessels, and this is fraught with problems with the outflow of lymph.

As a result, the blood circulation in the nerve suffers, and it faces a lack of nutrients.

It is worth noting that nerve cells show increased sensitivity to oxygen deficiency. The nerve trunk increases in size, and hemorrhages form in it.

As a result, the transmission of impulses from the brain to muscle tissue is disrupted. This causes the symptoms of pathology.

Signs and symptoms of neuritis of the facial nerve

Neuritis of the facial nerve always develops rapidly. If the symptoms increase slowly, this indicates the presence of another pathology.

Symptoms of this disease include the following:

Symptoms of the disease will allow an experienced specialist to identify a specific area of ​​damage to the facial nerve:

Diagnostics

If symptoms of neuritis appear, you should immediately contact a qualified neurologist. An experienced specialist will be able to identify diseases without research.

However, sometimes there is a need to use instrumental methods. With their help, you can determine the causes of the development of inflammation. Neuropathy can be the result of tumor formations, inflammatory processes in the brain, stroke.

To make an accurate diagnosis, perform:

Treatment

For treatment to be as effective as possible, it should be started as early as possible and be comprehensive.

Medical

For the treatment of the disease, the following categories of drugs are used:

Treatment of this disease is carried out under the supervision of the attending physician. Self-administration of drugs can cause serious side effects.

Physical procedures

Means of physiotherapy can be used only from 7-10 days after the onset of the disease.

With such a diagnosis, the following methods are most effective:

• ultraviolet irradiation of half or the entire face;
• decimeter therapy on the affected side of the face;
• ultrahigh-frequency therapy of low thermal intensity;
• electrophoresis of medicinal preparations - prozerin, dibazol, potassium, nivalin, vitamin B1 are used;
• diadynamic therapy;
• paraffin or ozokerite applications.

During therapy, it is very important to avoid hypothermia, as it can provoke a worsening of the condition. After the procedure, it is advisable to stay indoors for 15-20 minutes. In cool weather, wear a hat and cover the affected area with a scarf.

Massage

This procedure can be started only 5-7 days after the onset of the disease.

A qualified specialist should perform massage for neuritis of the facial nerve, since it has certain features:

1. Before starting the process, attention should be paid to warming up the muscles of the neck. To do this, tilt and turn the head. All movements should be done 10 times. They need to be done slowly enough and make sure that your head is not spinning.
2. Massage should begin with the neck and occipital region. This helps to prepare the lymphatic vessels as they need to receive additional lymph volume.
3. Then you need to massage the affected and healthy part of the head. It is important to pay special attention to the face, cervical region and mastoid process. Also be sure to stretch the collar area.
4. Massage should be done superficially, especially at the very beginning. Otherwise, it can provoke painful contractions of muscle tissue.
5. The procedure should be performed with stroking movements. A little vibration will also help to achieve excellent results. Such movements must be made in the direction of the outflow of lymph.
6. Fingers should make movements from the middle part of the chin, forehead, nose in the direction of the parotid glands. At the same time, it is forbidden to touch the areas of localization of the lymph nodes, as this can provoke their inflammation.
7. You can do the following exercise on your own: place the thumb behind the cheek and gently stretch the muscles, while using the thumb and forefinger of the second hand to massage the cheek from the outside.
8. After performing a facial massage, you need to massage the neck and back of the head again. This will help normalize the outflow of lymph in the direction of the main ducts.
9. At the end of the procedure, you need to perform exercises for the neck muscles.

The session should last 10-15 minutes. Perform massage should be until the absolute disappearance of signs of the disease. As a rule, a massage therapist performs 10-20 procedures, after which a person can do self-massage.

Folk remedies

Such prescriptions can be an addition to the main therapy. With their help, you can significantly speed up the healing process.

The most effective folk remedies include the following:

Gymnastics

Before doing exercise therapy, you need to perform exercises to warm up the muscles of the cervical region and shoulders. Then you need to sit in front of the mirror and try to relax.

For rehabilitation to be successful, each exercise is performed 5-6 times. For this you need:

• raise your eyebrows in surprise
• frown;
• look down and close your eyes;
• squint;
• perform circular eye movements;
• smile without opening your teeth;
• raise the upper lip, opening the teeth;
• lower the lower lip, showing teeth;
• smile with your mouth wide open;
• lower your head and snort;
• inflate the nostrils;
• puff out cheeks;
• move air between the cheeks;
• blow out an imaginary candle;
• try to whistle;
• retract cheeks;
• stretch your lips into a tube;
• lower the corners of the mouth;
• put the upper lip on the lower;
• move the tongue in different directions, closing and opening the mouth.

If you are tired, you need to pause and stroke your face. Such gymnastics should last about 20-30 minutes. It must be performed 2-3 times a day - this will significantly speed up recovery and help cure even neglected neuritis.

After doing the exercises, you need to fix your face with a scarf folded diagonally. Then pull the muscles from the diseased side up, and from the healthy side - down.

Acupuncture

This method is one of the most effective in the development of neuritis of the facial nerve.

Acupuncture allows you to:

• eliminate the inflammatory process;
• relieve pain;
• accelerate the process of eliminating paralysis of mimic muscles;
• cope with twitching of the lips or eyes.

By influencing acupuncture points, you can restore the tone of muscle tissue on the affected side and relax on the healthy side. This allows you to make the face symmetrical.

For the treatment to be effective, you need to contact a qualified specialist who will select the optimal technique. Of no small importance is the internal mood of the patient.

When punctured, a person feels a slight pain, then around the needles, warmth or coolness, tingling, pressure will be felt. Such sensations indicate that the impacts are made in the right places.

At the first symptoms of the disease, the procedure is carried out exclusively on the healthy side. From 5-7 days you can have an impact on the affected area. With this procedure, it will be possible to speed up the healing process by about half.

Operation

If conservative methods of treatment do not give results for 8-10 months, there is a need for surgical intervention. It will give the desired results only during the first year of the disease, after which irreversible changes occur in the muscles.

In most cases, intervention is required for ischemic neuritis, when the nerve is compressed in a narrow canal. This may be due to prolonged inflammation of the ear or a fracture of the cranial bones. Also, an operation is needed for traumatic origin of neuritis, when a nerve rupture has occurred as a result of damage.

If neuritis is the result of nerve compression, a semicircular incision is made behind the auricle. The wall of the nerve canal is removed with a special tool.

This must be done very carefully so as not to disturb the nerve trunk. As a result, it is placed in an open groove, due to which the compression of the temporal bone stops. This intervention is performed under general anesthesia.

If there is a need for suturing the nerve, an incision is made in the region of the auricle. After that, the doctor finds the ends of the nerve and cleans the torn area - this will ensure a better fusion.

If the distance between the ends of the nerve is no more than 3 mm, they are sutured. If this distance exceeds 12 mm, it becomes necessary to free the nerve from nearby tissues and lay a new channel. This procedure allows you to connect the nerve with one suture, but at the same time its blood circulation suffers.

It is also possible to restore the integrity of the nerve by means of an autograft. In this case, a part of the nerve of the required length is taken from the thigh and placed at the site of the rupture.

This allows you to restore part of the nerve, which is several centimeters long. However, there is a need for suturing the nerve in 2 places, which leads to impaired signaling.

Effects

After neuritis, the process of cell renewal is extremely slow. During this period, they are highly sensitive to hypothermia, stressful situations and exposure to toxic substances.

If you do not follow all the doctor's prescriptions, neuritis can lead to dangerous consequences: