The facial nerve is the nerve of the seventh of the twelve cranial, it is considered a pair and affected more than others. Treatment of neuritis of the facial nerve is aimed at eliminating the negative factors which affect its blood supply or exert pressure on it.
What it is?
Neuritis - an inflammation of the peripheral nerve fibers. Very severe, sometimes irreversible and traumatic disease is aesthetically - neuritis of the facial nerve. At which occur unilateral partial or complete loss of facial mimic activity.
Causes of
Strong evidence of a particular theory of the origin NLN not received today. It is known however, that the basis of the pathogenetic mechanisms of disease is edema barrel facial nerve due to immune, viral or bacterial injury.
Most often the trigger for the development NLN is an infection that "wander" through the body with SARS, the flu or common cold sores. Much less often, facial nerve injury are recorded at neuroinfections, tumors of blood, rare hereditary diseases. The peripheral nervous system, which belongs to the facial nerve, is extremely sensitive to any shocks. Mainly, it has to deal with all sorts of infections caused by swelling and inflammation. Therefore, any neuropathy may begin as background bronchitis, tonsillitis or otitis media, and after suffering cystitis, pyelonephritis, or rheumatism.
In addition to these points, as a catalyst inflammation in NLN often acts banal supercooling ( "open window syndrome"), as well as psychological stress. Other precipitating factors of development of facial neuropathy decided today to refer violations of blood circulation in hypertension and cerebral arteriosclerosis. Sometimes facial nerve paresis becomes a complication of anesthesia during dental procedures.
It is necessary to differentiate between the concept of "neuritis" and "neuralgia". Neuralgia referred pain in the nerve trunk projection that accompanies the majority of cases within NLN, but It may be a separate feature or reaction facial trigeminal nerve to cold and other reflex stimuli.
Classification
Neuritis of the facial nerve may be acute, subacute and chronic (downstream), it can also be a one-way (99% of all cases) and bilateral. Unilateral optic neuritis in a typical localization occurs in an average of 1 - 2 cases per 10,000 population per year.
Nerve damage from two sides and complete paralysis of the facial muscles makes the human face mask petrified. This case is very rare: a man is much higher chance of breaking just two hands, two places each, than to get a double-sided facial nerve paresis.
Much more often first appears neuritis on the one hand, and then, a few days later joined the defeat on the opposite side. This occurs in a significant drop in immunity (for example, during the transition of HIV - infection in AIDS) or incorrect treatment.
Signs and photos
When the motor nerve lesion portion develops so-called peripheral prosoparesis m. E. the weakness of the facial muscles. Very often, the symptoms of neuritis of the facial nerve (see. photo) appear suddenly in a few hours, sometimes for days.
A person can not feel pain, but looking at myself in the mirror, detects asymmetry of the face:
- on the side of the paresis of eye blinks less often;
- when you try to close your eyes patient eye as it "rolled" up, it becomes visible white stripe sclera - the phenomenon of Bell;
- eye slit on one side more than the other, it is impossible to close his eyes, eyelid on the affected side are not closed - it's called lagophthalmos (rabbit eye);
- it is impossible to wrinkle forehead wrinkles on the forehead are not formed;
- eyebrow is higher than in the healthy half, the patient can not raise an eyebrow;
- smoothed nasolabial fold, lowered corner of the mouth;
- cheek on the affected side of the "sail": is drawn on inhalation and exhalation when inflated, inflate the cheeks patient can not;
- it is impossible to whistle, spit, smile, can become slurred speech.
All this looks like a "skewed" face. When washing soap gets in his eyes. When eating food spills out of his mouth, there is the so-called symptom of "crocodile tears" - during a meal, patients involuntarily cry. Pain if there is, then it is most insignificant in the ear. Often patients complain of simply unpleasant sensations on the affected side of the face.
Effects
If you start the treatment of neuritis of the facial nerve, or to ignore the advice of a doctor, the consequences can be serious:
- spontaneous contraction of facial muscles;
- atrophy of muscles - can be caused by malnutrition and muscle of inactivity;
- synkinesis - friendly movement. Due to illness of the nerve fibers die. Therefore, one nerve can control many muscles. Thus, during blinking can be raised corner of the mouth;
- Conjunctivitis - develops due to the inability to fully close their eyes;
- contracture of muscles - the contraction of facial muscles on the affected side of the face.
Special danger of neuritis of the facial nerve is the formation of contraction of facial muscles. This is a complication that occurs when an incomplete restoration of nerve function, when the paralyzed side seems healthy. The reason could be the wrong time and the prescribed treatment. Sometimes a complication develops for no apparent reason. Signs that the formation of contractures, are:
- restriction canthus on the affected side;
- nasolabial fold on the affected side is expressed more clearly than in the healthy;
- the thickness of the cheek on the affected side more than on the healthy;
- observed spontaneous twitching of facial muscles;
- closing the eyes at the mouth corner lying on the same side;
- on closing the eyes namorschivaetsya forehead;
- narrowing of the palpebral fissure when eating.
The deformation of the face in this case can only be eliminated with the use of plastic surgery. Therefore, patients with signs of neuritis of the facial nerve should immediately consult your doctor in order to prevent this complication.
Diagnostics
Diagnosis of neuritis of the facial nerve is carried out on the basis of:
1) complaints and medical history, physical examination of the face and the assessment of its symmetry at rest and during articulation and trying to smile.
2) Check the taste and temperature sensitivity of the language (dysgeusia) - violation of differentiation of salty and sweet, remains unchanged only feeling bitter.
3) Specific diagnostic tests with neuritis of the facial nerve: simultaneous closing of the eyes and alternately, squinting eyes, eyebrows wiggling (symmetrically and asymmetrically), the attempt to frown nose and eyebrows, pursed his lips tube.
Detection of pathological symptoms of neuritis of the facial nerve:
- Esotropia in stroke.
- Horizontal nystagmus at Hunt syndrome.
- Symptom Reviyo - it dyskinesia century, manifested when you try to close your eyes. On the healthy side of the eye is slightly open, due to the lack of control over the circular muscle of the eye.
- Unpleasant and immediately noticeable feature is the symptom of Bell - turn the eyeball up when you try to close your eyes. As a result, the following becomes noticeable sign - lagophthalmos or "rabbit eye", is a dehiscence white portion of the eye sclera.
- Symptom "racket" - when trying teeth bared, their exposure occurs only on the healthy side, due to the mouth slit takes the form of a tennis racket lying.
- Symptom sails - when trying to dial the air in the mouth and to close tightly lips blow candle or whistle, whistling air departs from the paralyzed corner of the mouth, and the "sail" cheek while.
4) Instrumental methods used in the study neuritis of the facial nerve etiological order: computer or magnetic resonance tomography.
5) electroneuromyography used to determine the localization of the inflammatory site.
How to treat neuritis of the facial nerve?
For the treatment of neuritis of the facial nerve requires a comprehensive approach that includes a variety of directions. In some cases, the disease recedes in a month, but the likelihood of recurrence in the future, and sometimes even the six-month treatment does not lead to complete recovery.
So, neuritis of the facial nerve involves the following treatments:
- Drug treatment includes receiving diuretics (to reduce edema), anti-inflammatory (for removal of inflammation), spasmolytics (for eliminating muscle spasm), neurotrophic (for improvement of nerve cells) anticholinesterases (to increase of the nerves in muscle pulses) funds. Depending on the symptoms prescribe antivirals, antibiotics, analgesics, B vitamins and other means. All drugs should be prescribed by a doctor, as they have many side effects.
- Facial massage is appointed a few weeks after the onset of illness. It is better to go to an experienced masseur as massage with neuritis of the facial nerve has a ton of features. 10-15 procedures are a specialist, then you can resort to self-massage in the same manner. Yourself at home, you can also perform the exercises, the purpose of which, as the purpose of massage - cause facial muscles to work again.
- Physiotherapy begins no earlier than 7-10 days of illness. With it amplifies the action of drugs, improves blood circulation and nerve conductivity, prevents the appearance of various complications. Your doctor may prescribe any procedure: UHF, UFO, magnetic therapy, diadynamic therapy, laser therapy, darsonvalization, electrophoresis, etc. After physical therapy the patient is important to prevent hypothermia, because the state can seriously deteriorate.
- Acupuncture is a popular way to deal with neuritis of the facial nerve. Thanks to him, you can restore muscle tone quickly on the affected side and relax the muscles of the healthy half.
- Surgery is necessary if the improvement of the treatment by other means is not observed for 8-10 months. Typically, operation is necessary, if the facial nerve is compressed in the Fallopian channel or severed due to injury. If the facial nerve neuritis complicated contraction of facial muscles (contraction, loss of elasticity) resorted to plastic surgery to correct a cosmetic defect, but the muscles at the same time does not work start.
It is worth remembering that the treatment of neuritis at home impossible treated either in hospital or in a day hospital (with a doctor's permission). Otherwise, your facial muscles may until the end and did not recover. Folk remedies for this disease are not effective and may aggravate the patient's condition.
preparations
Drug treatment of neuritis of the facial nerve is performed according to a predetermined scheme. Depending on the cause of the disease and its effective period different means:
- antivirals;
- analgesics - indomethacin;
- glucocorticoids - Prednisolone - anti-inflammatory drugs;
- means extending vessels - nicotinic acid, komplamin - improves blood circulation;
- B vitamins - help improve the functioning of nerve fibers;
- anticholinesterase drugs - Neostigmine, galantamine - to increase the conductivity of the nerve fibers;
- Decongestants - furosemide, triampur - to reduce swelling and prevent the progression of pathological changes;
- medications that stimulate the metabolism - Nerobolum.
Gymnastics
Before gymnastics do some exercises to stretch the muscles of the neck and shoulder girdle. Then sit in front of a mirror and relax the muscles on both sides of the face. Perform each exercise 5-6 times.
- Surprised raise eyebrows.
- Nahmurte angry eyebrows.
- Look down and close your eyes. If not, then the lower eyelid with your finger.
- Soschurte eyes.
- Make a circular motion through the eyes.
- Smile without showing teeth.
- Raise the upper lip and show teeth.
- Lower the lower lip and teeth show.
- Smile with your mouth open.
- Lower your head down and fyrknite.
- Inflate the nostrils.
- Inflate cheeks.
- Move the air from one cheek for another.
- Blow out an imaginary candle.
- Try to whistle.
- Pull the cheeks.
- Puffed out his lips.
- Lower corners of the mouth downward, the lips closed.
- Lower the upper lip to the bottom.
- Drive tongue from side to side when opening and closing the mouth.
If you are tired - relax and stroke the facial muscles. The duration of the gym for 20-30 minutes. Repeat complex must be 2-3 times a day - it is a prerequisite of recovery. After the gym, take a handkerchief, fold it diagonally and fix the person tying the ends of the handkerchief on the crown. After that, tighten the muscles of the face with the patient side up, and with a healthy, lower down.
physiotherapy
Physiotherapy has a very favorable effect, as a supplementary treatment with neuritis (neuralgia) facial nerve. Apply wave of ultrahigh frequency (UHF), UV rays, electrophoresis with drugs treatment with diadynamic currents darsonvalization, application of therapeutic substances, ozokerite, mud. After stihanija active manifestations recommended spa resorts.
Specific therapeutic properties have massage. Special techniques, the most effective with neuritis. Successfully used acupuncture.
Acupuncture
When neuritis of the facial nerve rehabilitation can be long and often to achieve rapid effect is used such a method of treatment.
These methods do not possess all the doctors to carry out acupuncture can only specially trained physician. Thus in certain reflex points on the face sterile thin needles are inserted that allow to cause irritation of the nerve fibers. According to numerous studies in Asia and Europe, this method has proved itself very well in the treatment of this pathology.
Massage and self-massage
Massage with neuritis of facial nerve can conduct as a specialist and the patient himself. In the second case, you should know exactly how to do it Below is a technique of self-massage in this disease.
- Put your hands on the face, preauricular. Massage and pull the muscles on the healthy side of the face down, and the affected - up.
- Close eyes. Use your fingers to massage the orbicularis oculi muscle. Movement on the healthy side should come from the top downwards and outwards, and on the affected bottom up and from the inside outward.
- Put your index fingers on the sides of the nose on both sides. On the healthy side to make strokes from top to bottom, and the affected - on the contrary.
- THUMBS smooth muscles in the corners of the lips. On the healthy side of the nasolabial folds to the chin, and the affected - from the chin to the nasolabial fold.
- Above the eyebrows to massage the muscles in different directions. In the healthy side and down to the bridge, on the affected - to the nose and upwards.
Surgery
It is shown in the case of congenital neuritis of the facial nerve or complete rupture of the facial nerve due to trauma. In the absence of effect of conservative therapy in 8-10 months and identify electrophysiological data on nerve degeneration also need to decide whether to have surgery. Surgical treatment of neuritis of the facial nerve makes sense, because in the future only in the first year comes irreversible atrophy of facial muscles deprived of innervation, and will be impossible to restore.
Carrying out an operation autologous transplantation of the facial nerve. Typically, graft take with the patient's legs. Through him, the muscles on the affected side of the face sutured 2 branches of the facial nerve with a healthy side. Thus, the nerve impulse from healthy facial nerve is transmitted immediately on both sides of the face and cause the natural and symmetrical movement. After surgery, scar remains small ear.
prevention
It happens that neuritis of the facial nerve occurs again on the same side of the face, then talk about the recurrence of the disease. In this case it requires a prolonged treatment, and the chances of recovery below. But if you follow preventive measures, the recurrence can be avoided.
- Timely treat viral diseases. If you feel sick, then immediately take antiviral drugs: Groprinozin, Aflubin, Arbidol. Can be instilled into the nose drops immunoglobulin Viferon. This will help prevent re-replication of the virus in the nerve cells.
- Avoid hypothermia. Scientists have proved that it is a major risk factor. Dangerous even small drafts. So avoid to be under air conditioning, to sit in the truck at the open window, do not go outside with a wet head, and in the cold season wear a hat or wear a hood.
- Drive to the resort. To consolidate the results of treatment, it is desirable to go to the resort. Ideal dry hot climate resorts of Kislovodsk, Yessentuki, Pyatigorsk, Zheleznovodsk.
- Avoid stress. Severe stress weakens the immune defense and disrupt the nervous system. Therefore, it is desirable to learn how to remove the tension by meditating, meditation. You can take Glitsised, motherwort tincture or hawthorn.
- Take your vitamins. It is important to consume adequate amounts of vitamins, especially B group They take part in the transmission of impulses along nerve cells and are part of their membranes.
- Eat right. Your diet should be high-grade. The main purpose - to strengthen immunity. To do this, use a sufficient amount of protein (meat, fish, cheese, eggs), as well as fresh fruits and vegetables.
- Self-massage. Throughout the year, the face massage on the massage lines for 10 minutes 2 times a day. Put one hand on the healthy side and the other on the patient. The muscles of the healthy side lower the bottom, and pull the patient up. This will help get rid of the residual effects of suffering neuritis and avoid relapse.
- Tempers. The gradual hardening strengthens the immune system, and you become insensitive to hypothermia. Start with a sun-air baths or simply sunbathing. Take douche: the first week of the temperature difference between the cold and hot water should be as low as 3 degrees. Every week make the water a little colder.
In general, prevention of injuries and hypothermia, adequate treatment of inflammatory and infectious diseases of the ear, nose and throat make it possible to avoid the development of neuritis of the facial nerve.