Facial palsy is the result of facial nerve paralysis, which is a common and frequent disease that is not limited by age. The general symptom is a tilted mouth and eyes, and patients are often unable to perform even the most basic movements such as raising the eyebrows, closing the eyes and puffing the mouth. Facial palsy can be divided into central facial palsy and peripheral facial palsy, and facial nerve decompression has a very important role in the treatment of peripheral facial palsy.
The 6 major causes of peripheral facial palsy
1.Bell’s facial palsy (bell, spalsy)
It is an acute facial palsy of unknown cause, probably related to viral infection. About 70% of acute facial palsy is caused by Bell facial palsy, with an incidence of about 15-20/100,000 and a high incidence at the age of 20-40. The indications for facial nerve decompression for this disease are still controversial, and it is generally believed that patients with complete facial palsy (enog showing nerve degeneration >90%) should undergo early facial nerve decompression.
2. Temporal bone fracture, facial nerve trauma
Surgery should be performed as soon as possible so that the facial nerve can be decompressed as soon as possible. The earlier the surgery, the better the recovery of facial palsy.
3.Surgical injury
Causes of injury:Cranial skull base surgery, including cpa area surgery, transvagal and inferior temporal fossa skull base surgery, etc.; Ear surgery, including otitis media surgery, otosclerosis, cochlear implantation, etc.; 3) Neck surgery, such as parotidectomy, etc.
4. Otitis media
Patients with otitis media who have been examined and confirmed to have inflammation or destruction of the mastoid bone should be operated as soon as possible so that the facial nerve can be decompressed early. The earlier the surgery is performed, the better the recovery of facial palsy. Those who do not improve significantly are related to severe inflammatory damage to the facial nerve and prolonged loss of nerve function.
5.hunt syndrome (ramsey-huntsyndrome)
It is a special type of herpes zoster with typical otalgia, external ear herpes and peripheral facial palsy.
6.Other diseases
It includes facial nerve tumor, temporal bone and lateral skull base tumor, etc.
Peripheral facial palsy affects facial appearance and can cause blindness in severe cases. Facial palsy not only affects facial appearance, but also causes conjunctivitis due to incomplete eyelid closure, and corneal outgrowth injury, inflammation and ulceration, which can cause blindness in severe cases, so it should be treated actively.
Internal treatment of peripheral facial palsy
1.Medication is applicable to peripheral facial palsy caused by facial neuritis, partial facial nerve injury and auxiliary treatment after facial nerve anastomosis. Commonly used drugs include: prednisone orally, which is suitable for the acute phase of facial neuritis.
2, physical therapy such as infrared, induction electricity, iodine penetration, short wave, etc. can also be used with the above drug treatment. Electrical stimulation can be used in the second week of the disease, but if facial muscle contracture has already appeared, electrical stimulation cannot be used.
Surgical treatment of peripheral facial palsy
1.Facial nerve decompression (facialnervedecompressionfnd)
For facial nerve contusion caused by facial neuritis and temporal bone fracture, facial nerve decompression can be performed in time to obtain good recovery effect of facial nerve. The timing of facial nerve decompression is important for the recovery of facial muscle function. The surgical approaches include: transmural surgery, transcranial middle fossa surgery, transcranial vagus surgery, etc.
2. Various facial nerve anastomoses and transplantation procedures
If the integrity of the facial nerve is destroyed, various facial nerve anastomoses are needed, including cpa surgery to damage the facial nerve in one phase of intracranial external nerve graft surgery. If there is no tension in the facial nerve dissection, end-to-end anastomosis is feasible, and if the absence after dissection is greater than 2~25mm, nerve grafting or facial nerve sublingual nerve anastomosis is performed.