Facial palsy is a common disease that can be caused by many factors, the most common of which is idiopathic facial palsy. Patients often have a crooked mouth and eyes that cannot be closed, making their faces ugly.
What is idiopathic facial palsy?
Idiopathic facial palsy, also known as facial neuritis and Bell’s palsy, is a paralysis of the facial muscles caused by an inflammatory disease that infects the facial nerve without a clear source of infection.
What are the causes of idiopathic facial palsy?
The causes of idiopathic facial palsy are not exact and the possible causes are.
1. viral infection.
2, ischemia.
3, autoimmune diseases.
4, genetic factors.
It is currently believed that activation of the herpes simplex virus latent in the cerebral ganglia is the main cause. The virus is activated, multiplies, and then spreads along the facial nerve, resulting in inflammation of the facial nerve, myelin loss, and eventually facial nerve paralysis and facial muscle paralysis.
Who can suffer from this disease?
1. it is estimated that 13-34 out of every 100,000 people will get idiopathic facial paralysis each year, which means that one out of every 60-70 people will get idiopathic facial paralysis in their lifetime
2. men and women have an equal chance of developing the disease, with the greatest number developing between the ages of 65 and 74
3. pregnant women are more than three times as likely to develop idiopathic facial palsy, especially in the last trimester of pregnancy or in the first week after delivery
4. some people with idiopathic facial palsy run in families and show autosomal dominant inheritance
5. 3% to 15% of patients will have a recurrence of idiopathic facial palsy What are the manifestations of idiopathic facial palsy?
The typical presentation is a gradual paralysis of one side of the face over a period of 12 to 36 hours. Many patients experience pain around the ear, altered taste or facial numbness in the evening before the onset of the disease, and then wake up the next day with facial paralysis.
The main symptoms are paralysis of the facial muscles on one side of the face.
(1) Inability to frown.
(2) Enlargement of the eye fissure.
(3) Inability to close or incomplete closure of the eyelid when the eye is closed, with the eyeball turning outward and exposing the white sclera.
(4) Ectropion of the lower eyelid, with tears spilling out of the eye.
(5) shallow drooping of the corners of the mouth and deviation of the mouth to the opposite side.
(6) Inability to pout and whistle.
(7) Air leakage from the affected corner of the mouth when puffing the cheeks.
(8) Salivation, with water leaking from the corners of the mouth when eating and washing the mouth.
(9) Food is often retained between the teeth and cheeks.
Some patients may also experience taste disturbances, dry eyes or excessive tears, inability to tolerate normal noise (auditory hypersensitivity), and ear pain. Facial palsy can also lead to psychological problems such as low self-esteem and self-imposed isolation.
What tests are needed for idiopathic facial palsy?
Electromyography, evoked electromyography or neuroelectrography are routinely performed and these tests help to assess the prognosis.
A cranial CT and/or MRI should be performed in the presence of
1. not fully consistent with the presentation of idiopathic facial palsy described above.
2. continued slow progression of facial palsy symptoms after three weeks.
3. there is no improvement in facial palsy at six months.
How is idiopathic facial palsy treated?
Medication Most patients with idiopathic facial palsy can be cured without medication.
However, two types of medications – corticosteroids (hormones) and antivirals (such as acyclovir) – are often used to achieve better outcomes.
Studies confirm that early use of steroids (hormones) is beneficial, and the most common side effects of hormones are indigestion, uncontrolled blood sugar and mood disorders.
Antiviral drugs are indicated in severe cases (e.g., patients with almost complete facial paralysis or complete paralysis), and clinical trials have confirmed that acyclovir (combined with steroids) therapy is safe and effective.
Non-pharmacologic rehabilitation exercises should be started early with functional training and rehabilitation by frowning, raising the forehead, closing the eyes, showing the teeth, puffing the cheeks and whistling in front of a mirror several times a day. Each time 10-15 minutes, supplemented by facial muscle massage.
Adjunctive treatment can be done with warmth therapy, magnetic therapy, electromagnetic therapy, ultra-short wave or microwave therapy, etc.
Acupuncture can be used after the acute stage of TCM treatment.
Surgical treatment is feasible for severe facial nerve palsy with 1 year of onset without recovery, facial nerve-sublingual nerve anastomosis is only applicable to severe patients. In addition, cosmetic surgery is also available for severe patients.
How should I take care of the patient in daily life?
1.Psychological care should try to be considerate and caring, strengthen the help in life, and communicate in language. To remove worries and build confidence, cooperate with treatment, which is more favorable to recovery.
2, diet early to the patient’s taste, nutritious, delicious and light, easy to digest semi-liquid or soft diet; avoid spicy, acid, dry, hard, rough food.
3, oral care pay attention to oral hygiene, brush teeth gently and thoroughly; chew slowly and carefully, do not bite the lips or inner cheek mucosa 4, eye care wear glasses; use artificial tears daytime regular finger closure of eyelids nighttime use of eye lubricants and eye pads.
For severe cases, surgery or botulinum toxin injections into the upper eyelid may be needed to protect the cornea.
5. Local care wear a mask outside and keep your face warm; do not wash your face with cold water, avoid direct blowing, prevent colds and flu avoid external stimuli: TV, computer, UV light, etc.
How long does it take for a follow-up visit?
Patients should follow up after three weeks and six months. If the facial weakness condition is developing after three weeks, further examination should be given, and after six months, if the function is not restored, further examination and treatment should also be given.
What is the prognosis for idiopathic facial palsy?
The prognosis for idiopathic facial palsy is good, with more than two-thirds of patients recovering completely on their own. 85% of patients show signs of improvement within three weeks. 15% of patients show some improvement at three to six months.
Eventually.
1. 71% of patients regain normal facial function.
2. 13% of patients showed insignificant sequelae.
3. 16% of patients have permanent loss of facial function, with atrophy of the facial muscles and associated movements (e.g., involuntary blinking when smiling spontaneously, involuntary mouth movements when closing the eyes spontaneously).
(1) children (<14 years) have a good prognosis.
(2) Patients with normal taste, hearing, salivation, and lacrimation have a good prognosis.
(3) Patients presenting with retroauricular pain have a good prognosis.
(4) Incomplete facial palsy has a better prognosis than complete facial palsy.
(5) Patients with diabetes mellitus have a poor prognosis.
(6) Hypertension does not seem to have an effect on prognosis.