I. Concept.
Facial neuritis, or Bell’s palsy, is a peripheral facial palsy due to nonspecific inflammation of the facial nerve within the stalk mammary foramen.
The etiology is not fully elucidated, but may be due to wind and cold (driving into the wind, sleeping with windows open, sleeping with air conditioning, drinking, staying up late or after exertion, etc.), viral infections (such as herpes zoster) and autonomic instability that cause local neurotrophy and vasospasm, resulting in ischemic edema of the nerve. Early pathological changes are edema and demyelination of the nerve, and axonal degeneration may be present in severe cases.
II. Clinical manifestations.
1. Can occur at any age, slightly more in males;
2. Acute onset, with symptoms peaking in a few hours and 1 to 3 days;
3, the disease may be accompanied by paralysis of the mastoid area, intra-ear or mandibular angle pain;
4.Expression muscle paralysis on the affected side:
(1) Loss of forehead lines, inability to frown, and enlargement of eye fissures;
(2) Inability to close, incomplete closure, ell sign (white sclera exposed when eyes are closed);
(3) shallowing of the nasolabial folds, drooping of the corners of the mouth indicating that the corners of the mouth deviate to the healthy side;
(4) Cheek puffing or whistling leakage (orbicularis oris muscle paralysis);
(5) Food retention between the cheeks on the diseased side (buccal muscle paresis).
Facial neuropathy above the tympanic cord/loss of taste sensation in the anterior 2/3 of the ipsilateral tongue;
Stapedius muscle branch anterior damage/loss of taste in the anterior 2/3 of the tongue or auditory hypersensitivity;
Geniculate ganglion lesion (Hunt syndrome): peripheral facial palsy/ prelingual 2/3 taste loss; auditory hypersensitivity, pain in the affected mastoid region; hyperalgesia of the auricle or external auditory canal; herpes of the external auditory canal or tympanic membrane.
III. Treatment.
Treatment principles: improve local blood circulation, reduce facial nerve edema; relieve nerve compression and promote nerve function recovery.
1. Drug treatment
(1) Corticosteroids (corticosteroids): use as early as possible.
Dexamethasone: 10-20mg/d for 7-10 days; Prednisone 30mg/d orally for 5d and gradually reduce the dosage in 7-10d;
(2) B vitamins.
Vitamin B1100mg, vitamin B12500μg, intramuscular injection; adenosine cobalamin injection 1.0-1.5mg or methylcobalamin injection 1.0mg, intramuscular injection; if economic conditions allow, rat nerve growth factor, ganglioside injection can be used;
(3) Acyclovir (acyclovir): for people with clear viral infection, acyclovir or ganciclovir is commonly used.
2.Physiotherapy
Ultra-short wave heat therapy, infrared radiation or local heat application;
3.Eye protection
Eye shields should be worn to protect the cornea, and levofloxacin eye drops and Bevosol eye preparations can be used;
4.Chinese medicine treatment
(1) Traditional Chinese medicine treatment: scorpion, white sperm, silkworm, centipede, dragon, Chuanxiong, angelica, etc;
(2) Acupuncture or electro-acupuncture treatment: cataract, xiaoguan, yangbai, zygomatic s, sibai, dicang, cheek cheeks, and pinching syrup, etc;
(3) Facial muscle exercise: make exercises for raising eyebrows, closing eyes, shrugging nose, puffing cheeks, whistling, showing teeth and other movements to the mirror, which can be done three times a day.
IV. Prognosis.
Acupuncture treatment for facial neuritis is effective and has been unanimously recognized by doctors and patients; about 80% of patients can recover within a few weeks or 1-2 months; recovery of taste sensation within 1 week suggests a good prognosis; incomplete facial palsy can recover or be cured within 1-2 months; complete facial palsy takes 2-8 months or even 1 year to recover, and often leaves sequelae. In addition, nerve conduction velocity and electromyography can be done to determine the degree of injury to judge the prognosis.