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Abstract: A 32-year-old female suddenly found weakness in cheek puffing and leaking from brushing her teeth one morning, and looked in the mirror and found that her mouth was crooked. She came to the neurology department of the hospital as soon as possible. Combining with the patient’s relatively young age and no previous history of disease, the possibility of facial nerve injury was considered, and the condition was recovered through acupuncture and physiotherapy and medication. The facial nerve injury is a small disease, but it needs to be treated properly, because without treatment it may affect the aesthetics and leave the sequelae of a crooked mouth at a later stage.
Basic information】Female, 32 years old
Disease Type】Facial Nerve Injury
Hospital】Shandong Provincial Third Hospital
Date of consultation】March 2021
Treatment plan】Medication (methylcobalamin, dexamethasone, calcium carbonate) + acupuncture and physiotherapy
Treatment Period】Outpatient treatment, 1 month outpatient follow up
Treatment effect】Facial palsy recovered, basically no neurological dysfunction remained, and the disease was controlled.
I. Initial consultation
When a 32-year-old woman got up in the morning and prepared to brush her teeth, she suddenly found that her mouth was crooked, her teeth leaked when she brushed them, and her muscles felt as if they were paralyzed. The patient was panicked and self suspected cerebral infarction and cerebral hemorrhage and rushed to the neurology department of the hospital for consultation. After viewing the patient’s current performance was crooked mouth and weakness of closed eyes, typical symptoms of facial nerve injury. I immediately calmed the patient and told her that facial nerve injury is a common disease that can occur in both children and the elderly, and that it is common in patients with low immunity and viral infections, and that it can be recovered after treatment, and that a few may leave the sequelae of crookedness of the mouth. Combined with the patient’s clinical symptoms, the preliminary diagnosis of facial nerve injury was made.
II. Treatment history
After comprehensive evaluation, the patient is now considered to have acute facial nerve injury with symptoms of facial palsy. No significant abnormalities were found in the cranial CT examination to exclude intracerebral lesions, and no significant abnormalities were found in the blood routine and C-reactive protein to exclude infectious lesions. The patient’s current facial palsy is severe. It is recommended to start with medication, including methylcobalamin, dexamethasone, and calcium carbonate. Early medication to improve circulation and nourish peripheral nerves and reduce edema of nerve roots will help reduce the edema state of nerves and avoid nerve damage. At the later stage, acupuncture and physiotherapy were given to promote the recovery of the disease, and the patient was given psychological guidance and encouraged to actively perform facial massage and masticatory muscle function training at home. After a series of treatment procedures, the patient finally became less nervous.
III. Treatment effect
Within 3 days of the onset of facial nerve injury is the best treatment period, the facial nerve is at the peak of edema at this time, early drug treatment can effectively reduce the edema of the nerve and avoid nerve damage. If there is no significant improvement within six months, it will be more difficult to recover later. This patient had a good result after timely consultation and standardized medication. The facial palsy was significantly relieved in about 1 week, and basically returned to normal in about 1 month, with no significant neurological dysfunction remaining.
Precautions
This patient’s symptoms improved through treatment, and we are happy for her. The patient was advised to wear an eye patch at night to avoid conjunctivitis due to incomplete eyelid closure during the onset of the disease. While taking hormonal medications, follow medical advice to take calcium supplements and do not stop the medication on your own to avoid complications. Since 40% of facial nerve injuries are related to herpes zoster infection, patients should pay attention to strengthening their own health after treatment, especially in the cold season, pay attention to keeping the head and face warm, avoid getting cold, don’t stay up late, and develop good living and eating habits.
V. Personal insight
Although facial nerve injury is a relatively common disease that is not dangerous to life, nerve injury needs to be taken seriously, and if the acute phase is missed, there is a risk of sequelae that can affect aesthetics, especially in children and young people, and if facial nerve dysfunction is left behind, it may affect future marriage and work. After communicating with the patient, the patient was advised to actively pay attention to not being picky in daily life and to exercise to improve physical fitness and immunity, which can effectively reduce the occurrence of facial nerve injury, and the patient expressed his gratitude.