When it comes to facial palsy, there is a folk rumor called “ghost blowing wind”, which says that after blowing a gust of wind at night, one suddenly finds a crooked face in the morning and leaks saliva when brushing one’s teeth. Professor Chen Bing of the Department of Otolaryngology at the Eye, Ear, Nose and Throat Hospital of Fudan University told reporters that facial palsy is a relatively common disease in otorhinolaryngology, and its causes are diverse and not as simple as “ghost blowing wind”.
Clinical manifestations of facial palsy
Prof. Chen Bing pointed out that facial palsy is commonly known as “crooked mouth and slanted eyes”, which can be seen when the frontal lines on the affected side disappear and the nasolabial folds become shallow at rest. The symptoms of facial palsy tend to peak 3-5 days after the onset of the disease, when the clinical manifestations are most obvious.
Causes and treatment of facial palsy
Prof. Chen said that the facial nerve is the longest pair of cranial nerves walking in the bony canal, and most of the total trunk of the facial nerve is encircled by the bony canal, and problems with either segment may lead to facial palsy. After nerve damage from various causes, the facial nerve is encased in the bony canal and the increased internal pressure due to space limitations can cause nerve conduction dysfunction, which can lead to the appearance of facial palsy symptoms. The causes of facial palsy are mostly related to the following conditions.
1. Bell’s facial palsy
It is often caused by cold weather and nerve ischemia behind the stimulation of blood vessel spasm by cold wind, which is commonly known as “ghost blowing wind”; in addition, the low immunity of the body and excessive fatigue can also cause this disease; some people think that it is caused by herpes simplex virus infection. Recovery is usually possible within 1-4 weeks after the onset of the disease, and about 80%-85% of patients can heal spontaneously, while 10%-15% of patients have a poor healing process and even require surgical intervention. For the diagnosis and treatment of Bell’s facial palsy, the doctor will do some electrophysiological examination of the facial nerve to initially determine the degree of nerve damage, and for those with mild facial nerve damage, conservative treatment, such as hormones and neurotrophic drugs, is feasible, and most patients will recover after a few weeks.
2. Viral infection
The most common form of facial palsy caused by viral infection, “Hunter’s syndrome”, is often caused by the herpes zoster virus, and is characterized by peripheral facial palsy with auricular herpes on one side of the patient, and the patient feels severe ear pain. Without active treatment, only about 10% of patients with complete facial palsy can obtain perfect recovery, and most of them have poor recovery; about 2/3 of patients with incomplete facial palsy have satisfactory recovery.
3.Facial palsy caused by acute and chronic otitis media
If the cholesteatoma erodes and destroys the facial nerve canal and directly presses on the facial nerve, it may lead to facial palsy. If the facial palsy caused by this condition is seen in time, not only the surgical effect is good, but also the postoperative recovery is faster.
4.Trauma
(1) There are also some patients with facial palsy caused by skull base fracture after a car accident, where the skull base fracture or fracture of the temporal bone affects the facial nerve and causes facial palsy. It is important to note that after trauma, the focus is often on saving lives and ignoring the symptoms of facial palsy. If the facial palsy occurs at the time of trauma, the injury may be severe; conversely, delayed-onset (occurring a few days after the trauma) facial palsy is mostly mild or caused by edema compression and mostly has a good prognosis. Depending on the condition, conservative treatment or surgery may be an option. In cases of temporal bone trauma with hearing bone dislocation or fracture, hearing reconstruction can be performed at the same time.
(2) Medically induced facial nerve palsy refers to facial palsy caused by some surgeries in the middle or inner ear or in the skull, such as otitis media surgery, stapes surgery or temporal bone tumor removal, etc. There is a risk of facial palsy. Of course, for experienced microsurgeons in ear surgery, the risk of facial palsy is very small for microsurgeries such as tympanoplasty for otitis media or artificial stapes for otosclerosis, and should generally be less than one percent. Medically induced facial palsy is mostly caused by surgeon error or lack of surgical experience or facial nerve variation. In mild cases, the surface of the facial nerve is damaged, and most of them can be cured by conservative treatment or facial nerve decompression surgery; in severe cases, it can lead to facial nerve dissection injury, which requires nerve transplantation, and most patients can get a more satisfactory recovery about one year after surgery.
5.Tumor
Facial neuroma and benign or malignant tumors of the middle ear can also cause facial palsy. For example, middle ear cancer invades the facial nerve and causes facial palsy, and jugular vein bulbar tumor invades and compresses the facial nerve and causes facial palsy.
(1) Facial nerve tumor. If a tumor grows on the facial nerve itself – even though it is benign – the end result is often facial palsy. Early onset of the disease does not necessarily have facial palsy symptoms appear, and the patient’s facial expression may be completely normal, but CT, MRI, etc. can detect the tiny tumor, and facial palsy occurs later or even several years later, and this kind of facial palsy after conservative treatment Therefore, doctors often recommend imaging tests to exclude diseases such as facial neuroma after conventional treatments are ineffective for patients with facial palsy.
The treatment options for facial neuroma patients are “waiting” and surgery. “Waiting” is for patients who have not yet developed facial palsy, or whose symptoms are not very severe. Because facial neuroma patients need to sacrifice facial nerve function after surgery to remove the tumor, facial palsy will definitely occur after surgery, and it is usually necessary to perform nerve graft repair surgery at the same time, and it takes more than six months for facial nerve function to gradually recover. Therefore, for patients who have not yet developed facial palsy, they can choose whether to have surgery as soon as possible or to wait until they have complete facial palsy. In addition, patients who come to surgery after facial palsy, if the facial palsy has been long (more than six months or even more than one year), even through surgery, tumor removal plus facial nerve graft, the facial nerve function may not be recovered very well. This is because the facial nerve function has been completely lost due to the long duration of the disease, even if the nerve transplantation is performed at the same time, it will not be viable. Therefore, whether to operate in time needs to be decided by the patient himself, and whether to operate as soon as possible or to continue to wait needs to fully weigh the pros and cons.
(2) Jugular vein bulb tumor. The jugular vein bulb acts as a facial nerve neighbor, and if a benign tumor grows on it, it can also compress the facial nerve or invade the facial nerve causing facial palsy. This disease can be surgically removed and the facial nerve can be well protected in most patients, even if the facial palsy occurs after surgery, it is often temporary.
(3) There are also some tumors in the internal auditory tract, such as auditory neuroma, which may lead to facial palsy if the tumor compresses the facial nerve or if the tumor is surgically removed, and if the injury site is so high that it is difficult to perform nerve anastomosis, it may be necessary to perform facial nerve rerouting surgery, such as facial-sublingual nerve anastomosis.
In conclusion, Prof. Bing Chen reminds that facial palsy should not be ignored or treated in a hurry, and it is recommended to go to the ENT department of a regular hospital for early diagnosis and treatment.