Causes, symptoms and treatment of facial nerve inflammation. Recovery
Neuropathy of the facial nerve is the disease characterized by the acute inflammation of the facial nerve resulting in weakness of the muscles it innervates. The disease deprives a person of the possibility to control his/her face and show emotions: frowning, smiling, raising eyebrows in surprise, and even chewing food normally. At this, the face looks asymmetrical and skewed.
Neuropathy of the facial nerve is the second in frequency among diseases of the peripheral nervous system.
- idiopathic neuropathy of the facial nerve (Bell’s palsy) – in 75 % of cases, the cause remains unknown, but presumably the disease is associated with an infectious factor (influenza, mumps, etc.);
- space-occupying formations of the brain;
- traumatic brain injuries;
- damage by the herpes virus (Ramsey Hunt syndrome), which lives in the body of most people and does not reveal its presence in any way, but when the immunity decreases, the virus actively multiplies, resulting in inflammation and swelling of the nerve (6.5 %);
- otogenic neuritises (up to 15 % of cases), after surgeries on the middle ear.
There is a high percentage of the patients with pancreatic diabetes, arterial hypertension among those with Bell’s palsy.
Symptoms
- develops acutely, most often within a few hours (less often 1–3 days). Slowly increasing weakness of the facial muscles (within weeks or months) is not typical, most cases are caused by a tumor;
- unilateral paresis (weakness) of all the muscles innervated by the facial nerve;
- blear-eyedness or dry eye syndrome;
- aching and burning pains;
- in half of the cases, it begins with pain behind the ear, which can sometimes irradiate to the back of the head or face;
- distorted, unpleasantly enhanced perception of sounds from the diseased side;
- taste abnormalities on the anterior 2/3 of the tongue on one side.
Diagnostics
In case of an isolated nerve damage and a typical course of the disease, the diagnosis is determined based on the clinical picture of the disease and a neurological examination. In case of suspected secondary genesis of the disease, it is advisable to undergo an additional examination:
As for children, idiopathic neuropathy is rare, therefore, the occurrence of paralysis of the facial muscles should stimulate the search for the primary disease (for example, middle ear diseases).
Treatment
- Glucocorticosteroids. Hormones should be prescribed only in the first days of the disease (but not later than the first week), while the earlier treatment is started, the better its results are. Hormones are not used only for the patients with mild prosoparesis, since in this category of patients a complete spontaneous recovery can be expected. Contraindications to this therapy may be as follows: circulatory failure, renal disease, recent exacerbation of peptic ulcer disease, bacterial infection, impaired coagulation.
- Antiherpetic agents are indicated in case of Ramsey Hunt syndrome. Their early prescription is important, within the first 24 hours from the moment the rash appears.
- Micro-circulation and venous drainage improving agents.
- Alpha lipoic acid medications.
- B-group vitamins.
- Neuromidin.
From the end of the first week of the disease, gymnastics for the mimic muscles is recommended, as well as adhesive plaster traction, which prevents overstretching of the paretic muscles, from the second week – acupressure, acupuncture, physiotherapy, electrical stimulation of facial muscles.
The terms of recovery depend on how quickly the treatment has been started and, with favorable development, occurs within 4–6 weeks. In other cases, improvement occurs after 3–6 months, and it is only partial.
- elderly age;
- distorted, unpleasantly enhanced perception of sounds from the diseased side;
- taste perversion;
- severe weakness of the facial muscles from the very beginning.
Author of the article: Viktoriya Penner, M.D.
Date of publication: 06.12.2020
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