Facial nerve paresis: types and methods of treating the disease. Facial nerve paresis: symptoms and treatment Central facial nerve paresis symptoms

Facial nerve paresis- this is a malfunction nervous system, in which performance in the facial muscles is impaired. In most cases, the symptoms of the disease appear on one side.

The cause of the pathology is injury to the trigeminal nerve, which leads to disruption of transmission nerve impulses. The patient can independently determine paresis of the facial nerve due to pronounced symptoms.

Paresis of the facial nerve can be an independent disease or a symptom of other pathological processes that occur in the patient’s body. The disease develops with idiopathic or secondary lesions.

The occurrence of facial nerve paresis is diagnosed when the head is hypothermic. The disease develops against the background of:

• Syphilis;
• Poliomyelitis;
• Tuberculosis;
• Mumps.

With the pathogenic activity of the herpes virus, patients develop pathological process. It develops against the background of otitis media, which affects the nerve fiber. Common cause diseases are respiratory diseases. The disease is observed with head injuries that have varying degrees gravity. If in the facial area it is carried out incorrectly surgical intervention, then this leads to the development of pathology.

Facial nerve paresis is diagnosed when blood circulation in the facial part is impaired. This pathological process develops in diabetes mellitus. Patients with are at risk. The disease appears in people after hypertensive crisis. It is diagnosed against the background of ischemic stroke. The appearance of pathology is observed after dental operations.

There are various causes of facial nerve paresis, which are recommended to be identified in order to prescribe effective treatment for the pathology.

Types of pathology

Facial nerve paresis is divided into several types in accordance with the characteristics of the pathological process. He can be:

• Innate. This form of facial nerve paresis occurs in extremely rare cases. If the pathology is mild or moderate, then treatment is carried out using massage and gymnastics. With the help of these manipulations, blood circulation is stimulated and the functioning of the nerve is restored. In severe cases of pathology, surgery is recommended.

• Peripheral. This facial nerve palsy is diagnosed in most patients, regardless of their age characteristics. Patients complain of severe pain behind the ears, which most often manifests itself on one side. The appearance of facial paresis is diagnosed against the background of an inflammatory process, which leads to swelling of the nerve fibers.
• Central. This form of facial paresis is characterized by severe course and difficulties in treatment. With the disease, the muscle structures of the face atrophy, which leads to sagging skin. In this case, there is no damage to the forehead and visual apparatus. The disease occurs when neurons located in the brain are damaged.

Trigeminal nerve palsy is characterized by the presence of several varieties, which are recommended to be identified in order to prescribe effective therapy.

Degrees and symptoms of the disease

With paresis of the facial nerve, patients experience pronounced symptoms. It manifests itself in accordance with the severity of the pathological process, which can be:

• Easy. Facial paresis is characterized by mild symptoms. In some cases, a slight distortion of the mouth on the affected side is diagnosed. The patient closes his eyes and frowns with effort.
• Average. With paresis of the facial nerve of this degree, lagophalmos occurs. A person experiences a significant decrease in the mobility of the facial muscles. The patient cannot move his lips or puff out his cheeks.
• Heavy. With facial paresis, pronounced facial asymmetry is observed. Patients' mouths are severely distorted. On the affected side, the organ of vision is not completely closed.

With trigeminal nerve palsy, common symptoms appear. In patients, the nasolabial fold is smoothed and the corner of the mouth is lowered. On the affected side, the eye opens strongly and unnaturally. During the period of eating, food is observed to fall out from the affected side of the mouth.

A sick person cannot wrinkle his forehead much. Patients complain that with paresis of the facial nerve they experience a decrease or complete absence of taste sensations. The disease is accompanied by an exacerbation of auditory function.

In pathology, lacrimation is observed, which intensifies during meals. If you ask a person to form a tube with his lips, he will not be able to do it. Pain syndrome appears behind the ear.

With facial paresis, severe symptoms are observed, which allows the patient to independently determine the disease. When the first signs of illness appear, he should consult a doctor. Only an experienced specialist, after diagnosis, can prescribe effective treatment.

Treatment of the disease

With facial nerve paresis, the diagnosis is made in accordance with its symptoms. The patient is recommended to consult with an otolaryngologist, which will provide the opportunity to exclude pathological processes in the ear. To determine the cause of facial paresis, laboratory blood tests, electromyography, and head scanning are recommended.

The effectiveness of treatment for facial nerve paresis directly depends on the patient’s timely treatment for medical care. If the disease becomes chronic form, then he will not be able to get rid of facial asymmetry.

Drug therapy

If the patient has an acute form of the pathological process, then it is recommended to treat it with the use of medications. The causes of the disease are preliminarily determined, and therapy is aimed at eliminating them. With its help, swelling and inflammation are relieved, and the process of regeneration of nerve cells is activated. Treatment of facial nerve paresis is carried out:

• Analgesics. Drugs are used for severe pain syndrome. Treatment of the disease is carried out with Ketorol, Baralgin, Spazgan.
• Corticosteroids. Medicines in this group are used if the patient has severe or moderate paresis of the facial nerve. Therapy is carried out with Prednisolone, which helps relieve inflammation and swelling in the shortest possible time.
• Decongestant medications. To combat swelling, the use of Triampur or Furosemide is recommended.
• Vasodilator medications. The drugs help restore blood circulation in the area of ​​damage and speed up the treatment process. Patients are recommended to take nicotinic acid or Complamina.
• Sedative medications. Taking the drug is recommended if the patient has high anxiety. It can be eliminated with Relanium or Sibazon. They have a calming effect, which ensures patient relaxation.
• Vitamin and mineral complexes. During the course of the pathological process, patients are prescribed B vitamins.
• Artificial tears. The use of medications is recommended for damage to the visual organs. They are used to exclude the possibility of developing a secondary infection and help moisturize the mucous membrane.

In case of paresis of the facial nerve, the selection of medications is carried out by the doctor in accordance with the causes and severity of the pathological process.

Surgical intervention

To achieve high therapeutic effect Surgery is recommended within 12 months after the onset of the disease. If you delay the operation, this will lead to atrophy of the muscles that the nerve cannot control.

If there is a rupture, the nerve is sutured during surgery. In the case of a congenital form of the pathology, autotransplantation is recommended. During surgery, a graft is taken from the patient's leg and sewn into the face. At the next stage, the branches of the nerve are sutured to the healthy area. Thanks to the operation, one nerve will control facial expressions. After surgery, there is only a small scar behind the ear.

Physiotherapy

For early diagnosis of a pathological process, Sollux, which is a special lamp, is used to treat it. Light therapy is performed using the device. After completing the course, patients are given an appointment UHF, phonophoresis and paraffin therapy.

Acupuncture is characterized by a high effect in the fight against disease. This technique is based on the introduction of special needles into the area of ​​the affected nerve and other acupuncture points on the body. With the help of manipulation, blood circulation in the affected area is improved.

The use of homeopathy is recommended as an aid to pathology. The most commonly used drug is Heclesemium. Its use is permitted only after prior consultation with a doctor. otherwise, facial distortion may occur.

With paresis, wide psychotherapy is used. This is explained by the fact that the symptoms of the pathological process negatively affect the psycho-emotional state of a person. This leads to decreased self-esteem and the development of depression. If it cannot be eliminated with the help of sedative medications, the patient is recommended to seek help from a psychotherapist.

To improve muscle function in case of illness, massage is recommended. The use of the technique is allowed only after a week has passed after the onset of the disease. To ensure maximum effectiveness of therapy, it is recommended to consult a specialist. Also for paresis it is allowed self-massage.

Initially, massage the neck and back of the head, and then gradually move on to the face. It is recommended to perform simultaneous massage on the healthy and sore side. Massage is not performed in the area of ​​the lymph nodes. If the patient experiences muscle soreness, a light and superficial massage is recommended. It is recommended to pay special attention to the mastoid process during the manipulation.

It is a serious pathological process that negatively affects a person’s appearance, leading to psycho-emotional disorders. That is why, when the first symptoms of the disease occur, the patient is recommended to seek help from a specialist. Only a doctor, after conducting appropriate examinations, will make the correct diagnosis and determine the type of disease. This will allow us to develop an effective treatment regimen taking into account the individual characteristics of the patient and the severity of the disease.

Facial nerve paresis is a neurological disease characterized by impaired functioning of the motor nature of facial muscles localized on one side of the face. The pathogenesis of the development of the disease is based on a change in the transmission of nerve impulses due to damage to the trigeminal nerve.

The main distinguishing feature of the disease is asymmetry and lack of motor activity of part of the face. Such disorders prevent a person from expressing his emotions through facial expressions and speaking fully.

Reasons for development

Trigeminal nerve paresis can act as an independent nosological entity, as well as as a symptom of concomitant pathology. In most cases, the main one is the inflammatory nature of the disease. The causes are different, so it is customary to classify the disease:

• primary lesion (idiopathic);
• secondary, as a consequence of an inflammatory process or injury;

The facial trigeminal nerve may lose its ability to conduct impulses, characterized by inflammation and swelling of the nerve. Its main symptom is trigeminal neuralgia. In addition, neuritis can be a complication of otitis media and have an infectious (types of herpes infection) or non-infectious origin (trauma).

The causes of paresis also include disruption of the local blood supply to the nerve and parts of the central nervous system, for example, due to coronary disease, as well as as a result of the appearance of a tumor-like neoplasm or trauma.

Factors that contribute to facial nerve paresis are strong and prolonged exposure low temperatures on the body, background diseases - diabetes mellitus, complications of an existing pathology - stroke due to hypertension, the influence of certain medicines in the treatment of atherosclerotic vascular lesions, as well as surgical intervention.

Despite the nature of the disease, treatment should be aimed at restoring the lost functions of the facial nerve and correcting concomitant pathology.

Clinical manifestations of paralysis

The functions of the trigeminal nerve are considered to provide motor activity and sensitive perception of the face. Based on this, we can assume the consequences of paresis of this nerve. Among all the symptoms, the main ones are:

• loss of movement on one side of the face due to lack of nerve impulses from the brain’s regulatory center;
• weakness of the muscles responsible for facial expressions;
• lack of ability to close an eye, raise or frown eyebrows, puff out cheeks;
• it becomes difficult to reproduce speech correctly and take liquid food;
• dry eyes along with involuntary lacrimation;
• an aversion to loud music develops, a change in taste preferences and increased salivation.

Treatment of paresis

Therapeutic tactics for facial nerve paresis should consist of several points:

1. Removal of the causative factor of the disease.
2. Drug therapy.
3. Physiotherapeutic procedures.
4. Massage.

Thus, an integrated approach makes it possible to cure facial nerve paresis without residual effects. However, it should be remembered that restoration of previous functions takes a long time and takes up to six months.

If nerve paresis has developed as a result of otitis, then it is necessary to include in the treatment anti-inflammatory drugs that reduce swelling of the trigeminal nerve trunk. Also, the main focus is to ensure a constant outflow of purulent contents from the tympanic cavity. For this purpose, paracentesis is performed. In severe and advanced cases, opening the mastoid process is used.

If not produced timely treatment otitis, and the inflammatory process persisted for more than 3 weeks, then there is a high probability of facial paralysis due to mastoiditis or toxic damage to the trigeminal nerve. If there is a persistent impairment of muscle motor ability, surgical intervention is performed to eliminate the damaging factor of the nerve in the bone cavity.

Motor disorders, in particular paresis, respond well to integral therapy. The effectiveness directly depends on the start time and duration of use of the course, as well as on the degree of damage to the trigeminal nerve. If started early, the recovery rate reaches 80%.

The therapeutic course consists of physiotherapy and reflexology methods. In particular, electro- and acupuncture, acupressure, electromassage and the use of laser are widely used. In some cases, courses of electrophoresis, magnetic therapy and mud procedures are used.

The main effects of these procedures are aimed at:

• elimination of the inflammatory reaction and swelling of the nerve and surrounding tissues;
• activation of blood circulation and delivery of nutrients to nerve cells;
• stimulation of restoration processes in the trigeminal nerve;
• increasing the level of local immune defense;
• elimination of concomitant pathology.

Physiotherapy and reflexology used to treat the disease can be used by everyone. Their properties ensure safety in combination with high efficiency for the body. In addition, their regular use in parallel with medications has a positive effect not only on the affected area, but also on the body as a whole. Physiotherapy can also reduce adverse reactions after taking medications.

The consequence of the full course of treatment is an improvement in the motor activity of facial muscles, a reduction or absence of facial asymmetry and other manifestations of the disease, restoration of the functions of the trigeminal nerve and the elimination of concomitant pathology, which became the causative factor in the occurrence of paresis.

Facial nerve paresis in children

Paresis of the facial nerve in children can be congenital or acquired in origin. As in adults, the main cause of paralysis is considered to be trigeminal neuritis. At the same time, it should be noted that restoration of lost nerve functions in childhood occurs much faster and more often than in adults. In newborns, the incidence of the disease is at the level of 0.1-0.2%, almost all of which occur due to birth trauma.

The provoking factor for the occurrence of paresis is considered to be the use of forceps during childbirth and the inappropriate size of the woman’s pelvis to the fetal head. In addition, this group includes excess fetal weight (from 3.5 kg), hemorrhage in brain tissue, intrauterine injuries, a long anhydrous period of labor and the damaging effects of drugs or radiation on the body of a pregnant woman. A pathognomonic sign of the traumatic nature of the development of paresis in newborns is hematotympanum and hemorrhage behind the ear.

The tactics for treating facial nerve paresis in children depend on the cause of the pathology. In the case of a congenital anomaly, the chances of recovery are not high enough and treatment does not imply emergency surgery. Diagnosis of paresis must include certain methods that can confirm or exclude the disease. It is necessary to start with assessing the general condition of the baby, identifying all neurological symptoms, as well as identifying concomitant diseases. Next, additional instrumental diagnostic methods should be used, such as electroneurography, EMG and tomographic methods for visualizing lesions.

Electroneurography should be performed in the first two days after birth. If there is a reaction of the distal part of the nerve in response to stimulation, then the cause of the development of paresis was injury. The probability of complete restoration of the lost functions of the trigeminal nerve reaches 100%. If the cause of paralysis is serious congenital anomalies that cannot be corrected, then the facial nerve is not able to perform its functions.

To make a diagnosis, they also use questioning of parents for the presence of craniofacial pathology or anomalies of the development of the nervous system in relatives. In some cases, a muscle biopsy may be used.

Treatment of facial paralysis represents a difficult problem for both the doctor and the patient. This potentially disabling disease can have many causes, so a detailed understanding of the differential diagnosis and available treatments is necessary to select the correct management.

For optimal cosmetic and functional results all patients with facial paralysis treatment should be provided taking into account the individual characteristics of the disease with the participation of a team of various specialists.

Frequency of occurrence facial paralysis depends on its etiology. More detailed information is provided in the following articles on the site - we recommend using the search form on the main page of the site.

A) Classification of facial paralysis. A reliable method for assessing facial nerve function is the House-Brackmann scale. It is not applicable to patients with facial synkinesis. Other scales have also been proposed that assess the degree to which paralysis affects the physical and mental state of the patient.

b) Anatomy of the facial nerve. The facial nerve enters the temporal bone through the internal auditory canal and then follows the bony fallopian canal. Most often, compression and paralysis of the nerve due to various inflammatory processes occur in this segment of the nerve. After emerging from the stylomastoid foramen, the facial nerve passes through the parenchyma of the parotid salivary gland, so in the preauricular region the nerve is protected by gland tissue.

Then, within its thickness, the facial nerve divides into five main branches, which leave the gland deeper from the superficial muscular aponeurotic system (SMAS). Anterior to the parotid salivary gland, the distal branches of the nerve communicate with each other, so here the fibers of the facial muscles can be innervated by several nerves at once.

Educational video of the anatomy of the facial nerve and the projection of its branches

V) Congenital causes facial paralysis:

1. Birth injury. During childbirth, several factors can contribute to injury to the facial nerve with subsequent paralysis. These include the use of obstetric forceps, birth weight more than 3.5 kg, first pregnancy. The provoking factor is compression of the fetus as it passes through the birth canal. Under these conditions, the facial nerve is extremely susceptible to injury from stretching, and it takes time to restore normal function.

In general, the prognosis is extremely favorable; 90% of children experience complete restoration of facial nerve function without any surgical or pharmacological interventions. In rare cases where there is a high risk of nerve rupture, surgical exploration may be required.

2. Mobius syndrome. Moebius syndrome, first described in the 19th century, is characterized by combined paralysis of the facial and abducens nerves, which may be caused by underdevelopment of the peripheral part of the nerves or insufficient functioning of the nuclei of the brain stem. Sometimes there is damage to other cranial nerves. Clinically, there is a violation of the mobility of facial muscles; it is difficult for patients to display any emotions on their faces.

Other symptoms and signs include incomplete lip closure, drooling, decreased self-esteem, and social isolation. All these factors aggravate the general condition. In patients with this syndrome, free muscle tissue transplantation is successfully used to restore the function of facial muscles. It is highly desirable to carry out surgical treatment before starting school in order to prevent the psychological trauma that a child may receive due to insults from peers at a very early stage in his or her life.

3. Melkersson-Rosenthal syndrome. Melkersson-Rosenthal syndrome is characterized by a triad of recurrent facial nerve paresis, facial swelling, and folded tongue. In the treatment of exacerbations, glucocorticosteroids and anti-inflammatory drugs are used. There is no consensus on how to treat and prevent facial paresis. Some case reports provide information about decompression of the facial nerve (opening bone walls its channel to prevent compression of the nerve as edema increases), according to which the long-term prognosis for restoration of nerve function turns out to be more favorable when using such rather aggressive treatment tactics.

4. Hemifacial microsomia. The group of hemifacial microsomia includes a number of congenital anomalies developments, which are based on underdevelopment of one half of the face. The syndrome is characterized by a deficiency of soft tissue on one side of the face, underdevelopment of the lower and upper jaws, and the external ear. In the presence of combined facial nerve paresis, surgery for it can be performed simultaneously with craniofacial reconstruction of the jaws and ear. Particularly useful in restoring facial symmetry and the patient's ability to smile is the use of free muscle grafts, one of the additional effects of which is to add volume to the facial area.

G) Infectious causes of facial paralysis:

1. Bell's palsy. Bell's palsy is also known as idiopathic facial palsy. However, the data recent years indicate that most cases of Bell's palsy are caused by a virus herpes simplex. The incidence is about 30 cases per 100,000 people. Paralysis usually develops within 24-72 hours. It may be accompanied by pain around the ear, decreased taste, and decreased hearing on the affected side. And although in the vast majority of patients, nerve function gradually returns to normal, some of them continue to have limited mobility of the facial muscles, which is often combined with periodic aberrant twitching (syncinesia).

In the acute phase of the disease, glucocorticosteroids and antiviral drugs can be successfully used to improve the recovery of nerve function. In some cases where the electrical activity of the nerve is significantly reduced during the first two weeks (see examination section below), surgical decompression of the facial nerve canal should be considered. If restoration of nerve function has not occurred and synkinesis persists, a rehabilitation option that has a chance of success is chemical denervation of the nerve (paralysis) using botulinum toxin A followed by an intensive course of physical therapy.

2. Hunt syndrome. Hunt's syndrome (herpes zoster oticum) occurs when the Varicella zoster virus (human herpes virus 3) is reactivated in the area of ​​the facial nerve. Other symptoms include ear pain and the formation of vesicles (zoster oticus). Other symptoms may also occur: hearing loss, tinnitus, dizziness, nausea and vomiting, which are believed to arise from irritation of the vestibulocochlear nerve, located near the facial nerve in the thickness of the temporal bone. Although there are no randomized controlled trials evaluating the effectiveness various methods Treatment for this rare pathology, a combination of corticosteroids, antiviral drugs and analgesics can be successfully used to suppress inflammation of the facial nerve.

This treatment regimen is based on experience with the treatment of facial paralysis (corticosteroids), as well as Herpes zoster lesions of other parts of the body (which are treated antiviral drugs). In Hunt syndrome, the prognosis for restoration of facial nerve function is poor. After resolution of the infectious process, patients often continue to experience chronic neuralgia (pain).

3. Otitis media and mastoiditis. Otitis media and mastoiditis are acute inflammation of the mastoid process, which in rare cases (less than 1%) can lead to facial paralysis. It is believed that nerve damage is caused by swelling of the surrounding tissue and exposure to bacterial toxins. Successful treatment consists of timely recognition and eradication of the infection, which includes the use of broad-spectrum antibiotics and myringotomy with the installation of a ventilation tube to obtain material for culture. In some cases of mastoiditis, mastoidectomy (removal of the affected mastoid tissue) is indicated. If all of the above measures are performed, the prognosis for restoration of nerve function is favorable.

4. Cholesteatoma. Cholesteatoma is a slowly growing cystic formation epithelial origin, which over time causes destruction of surrounding tissues with their compression and the appearance of foci of chronic inflammation. The incidence of facial paralysis with cholesteatoma reaches 3%. Timely diagnosis And surgical removal cholesteatomas are necessary for the successful elimination of compression of the facial nerve that develops against the background of chronic inflammation and infection. Unfavorable prognostic signs include the spread of cholesteatoma to the apex of the pyramid (deep part of the temporal bone) and untimely surgery. Patients who receive early surgical treatment are most likely to regain facial nerve function.

5. Lyme disease. Lyme disease is caused by the pathogen Borrelia burgdorferi, which enters the human body through the bite of a tick infected with the microorganism. Typical symptoms and signs of the acute stage of the disease include headache, weakness, fever and erythema chronicum migrans (a characteristic skin rash that appears at the site of a tick bite). And although concomitant damage to the facial nerve can occur in 11% of cases, its function is completely restored in 99.2% of patients. Lyme disease should always be kept in mind when treating patients living in endemic areas who develop symptoms after tick bites in the summer. On the website of the US Centers for Disease Control and Prevention you can find a map that shows the frequency of occurrence of the disease in different US states. To confirm the diagnosis and start antibacterial therapy antibody level determination is required. Treatment is carried out in accordance with the recommendations of the Infectious Diseases Society of the United States.

6. Other. A number of others infectious diseases may manifest as dysfunction of the facial nerve. These include HIV infection, tuberculosis, Infectious mononucleosis and others. In most cases, these diseases are accompanied by a number of other symptoms; for a correct diagnosis, the doctor must be extremely alert. When carrying out differential diagnosis, it is necessary to take into account the patient’s medical history and the presence of relevant risk factors. The basis of treatment is correctly selected pharmacotherapy, except in cases where mastoiditis is detected as a result of additional examination. In this case, a mastoidectomy is performed to eradicate the infection and reduce swelling around the nerve.

d) Systemic and neurological causes of facial paralysis. These include autoimmune diseases, diabetes, sarcoidosis, Guillain-Barre syndrome, multiple sclerosis and others. In rare cases, these diseases manifest as isolated facial paralysis. In most cases, with timely diagnosis and prompt initiation of adequate treatment, it is possible to restore nerve function.

e) Traumatic causes facial paralysis. Head and skull injuries are one of the most common causes of acquired facial paralysis. If the injury was blunt and there are no fractures or soft tissue injuries, the integrity of the facial nerve is preserved and its function is likely to be restored. If nerve damage is suspected (penetrating injury to the skin and soft tissues of the face), immediate surgical revision of the wound is required to restore the integrity of the nerve. Under ideal conditions, surgery should be performed within three hours of injury while the distal fragment can be stimulated to allow identification of the nerve during surgery.

At combination of facial skeleton trauma With a fracture of the temporal bone, damage to the facial nerve occurs in 10-25% of cases. Depending on the relationship of the fracture line to the longitudinal axis of the temporal bone, the following types of fracture are distinguished: longitudinal (80%), transverse (10%) and mixed (10%). Facial nerve paralysis is more often observed with transverse (50%) fractures rather than longitudinal (20%). Complete restoration of nerve function is most often observed with delayed development. On the contrary, in 50% of cases of acute paralysis, recovery is extremely poor. Often, due to existing extensive injuries to the facial area and other emergency conditions, diagnosis and assessment of facial nerve function is not carried out in a timely manner. However, delayed surgery, which can be performed even several months after the injury, still has a reasonable chance of restoring or improving the function of the facial muscles.

Iatrogenic facial nerve damage may occur during operations on facial tissues, the skull, or during intracranial interventions. The choice of treatment method depends on the extent of nerve damage. In severe cases, restoring the integrity of the nerve is impossible, which is why it is necessary to resort to other methods.

e) Tumors as a cause of facial paralysis. Removal of tumors that penetrate the facial nerve or are located in close proximity to it often requires significant exposure to the nerve, which may result in its partial or complete transection. The most common tumors affecting the facial nerve include acoustic neuroma (vestibular schwannoma), glomus tumors, facial neuroma, and parotid cancer. If during the operation the integrity of the facial nerve was preserved, postoperative period careful monitoring of his condition is required. To clarify the prognosis, electrical stimulation of the nerve can be performed at the end of the operation. Corticosteroids are not usually used in this situation because several studies have clearly shown their lack of effectiveness in this setting. After surgery, electromyography (EMG) can be used to assess the process of reinnervation of the facial muscles.

Depending from the recovery stage(as well as individual patient preferences and difficulties), several simple techniques can be used to ensure eyelid closure, facial asymmetry, and complete lip closure.

and) Possible complications. If the integrity of the facial nerve has been successfully restored (or was not damaged initially), resolution of the paralysis depends on the regeneration of axons and their growth into the facial muscles. With pathological regeneration, there may be a change in the direction of the axons, or their branching to many fibers at once. As a result of this process, synkinesis arises, which are involuntary twitching facial muscles during their contraction.
To others possible complications Facial nerve paralysis includes severe dryness eyeball with subsequent keratopathy, incomplete closure of the lips with the flow of saliva, constant biting of the cheek.

Facial expressions, facial sensitivity (superficial), perception of tastes and sounds. It consists of two branches, but the lesion most often affects only one of them. Therefore, signs of paresis are usually observed only on one side of the face.

Facial nerve paresis: causes

Most often, paresis develops as a result of hypothermia or previous colds. Sometimes paresis can be otogenic, occurring due to nerve damage due to inflammation of the ear (mastoiditis, otitis media) or during surgery. In rare cases, paresis of the facial nerve becomes a consequence of tuberculosis, mumps, syphilis or polio. Damage can also occur as a result of trauma to the skull.

Facial nerve paresis: symptoms at different degrees of severity

The pathological process can have different degrees of severity. In mild cases, the patient can perform actions on the affected side of the face such as wrinkling the forehead, closing the eyes, and raising the eyebrows. Of course, these manipulations are difficult, but they are still possible. The mouth barely tilts to the healthy side. If the severity of paresis is moderate, the patient cannot close his eyes completely. When you try to wrinkle your forehead or move your eyebrow, you can see some movements, but they are very minor. When paresis of the facial nerve is severe, the patient cannot perform any movements on the affected side of the face. The pathological process can be acute (lasting no more than two weeks), subacute (lasting up to four weeks), chronic (lasting more than four weeks).

Facial nerve paresis: characteristic signs

With unilateral paresis of the facial muscles, the affected side becomes like a mask: wrinkles on the forehead (if any) and nasolabial folds are smoothed out, the corner of the mouth droops. When a person tries to close his eyes, complete closure does not occur, that is, a gap remains. But such signs do not appear immediately. At first, the patient will only feel numbness in the ear area, and only then, after a day or two, paresis develops. Also, the pathological process is accompanied by loss of taste on the tongue on the affected side, dry mouth or, conversely, drooling, decreased hearing or, conversely, its aggravation, dry eyes or lacrimation.

Facial nerve paresis: diagnosis

To make a correct diagnosis, you will need to be examined by a therapist, neurologist and otolaryngologist. The main doctor in this case is a neurologist, who will prescribe necessary treatment it will be he. An examination by an otolaryngologist is necessary to exclude the possibility that the existing condition is a complication of pathology of the throat, nose or ear. The therapist gives an opinion on general condition health of the patient. To determine the degree of paresis, electroneuromyography is performed. In addition, the nature of the pathological process is revealed.

Facial nerve paresis: treatment

It should be said that therapy must be started as quickly as possible, otherwise there is a risk of permanent paralysis. Also, treatment may be ineffective if the nature of the paresis is traumatic or otogenic. For treatment, vasodilators, anti-inflammatory and decongestant drugs, and antispasmodics are used. If there pain syndrome, additionally prescribe analgesics. Subsequent therapy is aimed at regenerating the affected nerve fibers and preventing muscle atrophy. For this purpose, physiotherapy and drugs that improve metabolism are prescribed. If conservative therapy is powerless, they resort to surgical intervention, during which the nerve is sutured, its plastic surgery is carried out, and in case of contraction, the facial muscles are corrected.