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Abstract: The patient blew on the air conditioner overnight 1 week ago due to the hot weather and greed for coolness. On the second morning, he developed a crooked mouth and incomplete eyelid closure, and leaked when brushing his teeth, which became worse after acupuncture was performed. The patient was given drugs to improve circulation, nourish the nerves and reduce edema of the nerve roots, together with later acupuncture and physiotherapy. After active treatment, the patient’s condition was stabilized and the symptoms of facial palsy improved.
Basic information】Male, 44 years old
Disease Type】Facial neuritis
Hospital】Shandong Provincial Third Hospital
Date of consultation】May 2021
Treatment plan】Medication (Ginkgo biloba extract tablets, dexamethasone acetate tablets, methylcobalamin tablets, vitamin B1 tablets, calcium carbonate D3 tablets) + acupuncture and physical therapy
[Treatment Period] Outpatient medication for 5 days and review after week
Treatment effect】Stable condition and significant improvement of facial palsy symptoms
I. Initial interview
The patient, Mr. Zheng, had severe facial swelling at the time of consultation. He reported that he developed facial palsy after blowing on the air conditioner 3 days ago, manifesting as crooked mouth, inability to close the eyes, leaking wind from the cheek puffs, and leaking water from brushing teeth. The outpatient clinic initially diagnosed facial neuritis, and suggested perfecting cranial magnetic resonance examination to exclude intracerebral lesions and perfecting facial electromyography to clarify the severity of the injury, and the patient and family expressed understanding and actively cooperated with the examination.
II. Treatment process
The patient’s outpatient blood tests for routine blood, C-reactive protein, and liver and kidney function showed no significant abnormalities, and the inflammatory index was not high. The cranial magnetic resonance examination suggested multiple ischemic degeneration foci in the frontoparietal lobe, mild cerebral atherosclerosis, and no new cerebral infarction, and the facial electromyography examination suggested facial nerve damage and conduction disorder. The patient was given Ginkgo biloba extract tablets to improve circulation, dexamethasone acetate tablets to reduce facial nerve edema, mecobalamin tablets and vitamin B1 tablets to nourish peripheral nerves, and calcium carbonate D3 tablets to prevent hormonal side effects. The patient’s face is currently swollen and acupuncture is not recommended. After 5 days of oral medication, the patient’s condition was stable and the facial palsy was not further aggravated. Acupuncture and physiotherapy were given 7 days after the onset to promote nerve recovery. The patient was advised to avoid wind and cold, and to avoid spicy and stimulating food.
III. Treatment effect
Facial neuritis is a facial nerve dysfunction due to nonspecific inflammation of the facial nerve, resulting in symptoms of crooked mouth and incomplete eyelid closure, which can occur at any age. The patient was given Ginkgo biloba extract tablets to improve circulation, dexamethasone acetate tablets to reduce facial nerve edema, mecobalamin tablets and vitamin B1 tablets to nourish peripheral nerves, and calcium carbonate D3 tablets to prevent hormonal side effects. After 1 month, the patient’s symptoms of facial palsy were significantly better than before, and the symptoms could not be seen when he was not talking, but could be seen when he was talking.
IV. Notes
We are glad that after treatment the patient’s condition is stable and the symptoms of facial palsy have improved. It takes a process to recover from facial neuritis, so take your medication on time, do not stop or reduce it at will, return to the hospital for follow-up if uncomfortable symptoms appear, do not crave for cold, stabilize the room temperature at about 26℃, avoid long time direct blowing when blowing fans, pay more attention to rest, and pay attention to the functional status of facial muscles. Pay attention to wearing glasses when you go out, and wear eye shields when you sleep to avoid conjunctivitis. Eat lightly, drink more water, avoid spicy, stimulating and greasy food, quit smoking and drinking, and do physical exercise properly.
V. Personal Insights
Facial neuritis is also a common disease belonging to neurology, mainly manifesting as facial muscle dysfunction, which needs to be actively treated in the early stage to avoid leaving facial palsy sequelae and affecting aesthetics. You should develop good habits, avoid staying up late and straining, quit smoking and drinking, and exercise to improve your body immunity, which can prevent facial neuritis from occurring. The facial neuritis is a neurological dysfunctional disease caused by damage to the peripheral facial nerve and needs to be differentiated from central facial palsy. Patients with suspected facial neuritis should have a cranial magnetic resonance examination to rule out any intracerebral lesions. If facial neuritis is diagnosed, acupuncture and physiotherapy are not recommended in the early stage to avoid aggravation of facial palsy symptoms, and acupuncture and physiotherapy are usually started 5-7 days after the onset of the disease. In this case, the patient’s symptoms worsened due to untimely treatment, but fortunately the condition was stabilized and the facial palsy symptoms improved after subsequent treatment.