Facial paralysis, the scientific name of facial nerve paralysis, also known as facial neuritis, Bell’s palsy, Hunter’s syndrome, commonly known as “crooked mouth”, “crooked mouth”, “hanging wind”, “hanging line wind”, “crooked mouth wind”, etc., is a common disease mainly characterized by facial expression muscle group dysfunction, the general symptom is a crooked mouth and eyes. It is a common and frequent disease that is not limited by age or gender. The patient’s face is often unable to accomplish even the most basic movements such as raising eyebrows, closing eyes, puffing out cheeks and nuzzling the mouth. Clinical manifestations: mouth crooked. Forehead wrinkles disappear, eye fissures widen, nasolabial folds are flat, the corners of the mouth droop, and the corners of the mouth are skewed to the healthy side when the teeth are exposed. Complications: no eyebrow lifting movement or low eyebrow lifting, large or small eyes or flaccid upper eyelids, wrong corner of the mouth when lifting the eyebrows, pulling the corner of the mouth when closing the eyes, small eyes when bulging the mouth, shallow nasolabial grooves, facial stiffness, stagnant food, tearing, etc. Preventive measures: pay attention to maintain a good mood, ensure sufficient sleep, and appropriate sports to enhance the body’s immunity. Facial paralysis means paralysis of facial muscles, which is a condition caused by damage to the facial nerve due to various reasons, and mostly occurs unilaterally. Those who have not fully recovered from the disease within 2 years are called early facial paralysis, and those who have been suffering from the disease for more than 2 years are called late facial paralysis. The main manifestations are facial motor dysfunction, such as salivation at the corners of the mouth, distortion of the eyes and mouth, and strange and rigid facial expressions. Etiology 1. Infectious lesions. It is mostly caused by the activation of herpes zoster which is dormant in the sensory ganglion of facial nerve. 2.Psychological factors are one of the important factors triggering facial nerve palsy. Before the occurrence of facial nerve palsy, a considerable part of patients have physical fatigue, lack of sleep, mental stress and physical discomfort. 3.It is induced by trauma, surgery, facial neuritis, occupational disease. 4.Auriculopathies. 5, Tumor. 6.Poisoning: such as alcohol poisoning, long-term exposure to toxic substances. 7, Metabolic disorders: such as diabetes, vitamin deficiency. 8, Vascular insufficiency. 9, Congenital facial nerve nuclear hypoplasia. 10.Bell’s palsy. According to the site of the lesion, it is generally divided into two types: Central facial paralysis Loading facial paralysis Facial muscle paralysis caused by lesions above the nucleus of the facial nerve to the center of the cerebral cortex is supranuclear facial paralysis, or central facial paralysis. It is characterized by: 1) paralysis of the facial muscles below the orbit on the side opposite the lesion; 2) hemiparesis of the limb on the same side as the facial paralysis; and 3) absence of taste and salivation. Peripheral facial paralysis caused by lesions of the facial nerve nucleus and facial nerve is called peripheral facial paralysis. It is characterized by: 1) paralysis of all facial muscles on the same side of the lesion; 2) paralysis of limbs on the opposite side of the facial paralysis, e.g., crossover paralysis caused by brainstem lesions; 3) hyposmia and salivary secretion disorders of the anterior two-thirds of the tongue on the diseased side. Clinical manifestations The clinical manifestations of facial paralysis are very special: most patients suddenly find that one side of the cheek does not move well and the mouth is tilted when they wash their face and rinse their mouth in the morning. In patients with complete paralysis of facial expression muscles on the side, the forehead wrinkles disappear, the eye fissure widens, the nasolabial folds, flattens, the corners of the mouth, droops, and the corners of the mouth deviate to the healthy side when the teeth are exposed. The sick side could not make movements such as wrinkling the forehead, frowning, closing the eyes, puffing and pouting. When puffing the cheeks and whistling, air leakage occurs because the lips on the affected side cannot be closed. When eating, food residues often remain in the cheek gap on the affected side, and saliva often drips down from that side. As the tear point turns inward with the lower lid, the tear fluid cannot be drained normally and spills out. Complications Facial symptoms occurring after or during the recovery process of facial paralysis, mainly include: 1. Fibrillar spasm of facial muscle: after the degenerated nerve regenerates and re-innervates the muscle, the expression muscle on the affected side often has contracture of different degrees, which is manifested as the narrowing of the eyelid fissure on the affected side, and the nasolabial sulcus is too deep. 2, facial muscle spasm: occurring on one side of the facial expression muscles of the old involuntary spasm or twitching, most of the eyelids, the upper lip square muscle and lift the corners of the mouth muscle twitching, mouth crooked slanting, the sick side of the eye fissure is small, and sometimes, there will be facial muscle atrophy. 3.Facial muscle association movement: it is the movement of the corner of the mouth to the affected side when the eyes are closed, or the movement of the corner of the mouth when the eyes are closed on the affected side. 4, crocodile tears syndrome: patients with this syndrome often accompanied by facial muscle spasm or diffuse facial muscle reaction when tearing. 5.Facial nerve palsy: the patient will have the feeling of facial paralysis, and accompanied by tongue paralysis. Diagnosis The diagnosis is not difficult based on the form of onset and clinical features. This disease should be differentiated from central facial paralysis, facial nerve palsy caused by acute infectious polyneuritis, and facial nerve palsy caused by inflammation and tumor in the posterior cranial fossa. Transient eye movement: Observe the patient’s transient eye movement carefully, it can be seen that the transient eye movement is asymmetric bilaterally, and this phenomenon is more meaningful. If the patient is asked to do transient eye movement, the side of mild paralysis, transient eye movement is slow and incomplete. Eyelash sign Ask the patient to forcefully close the eyes, when a normal person forcefully closes the eyes, the eyelashes are mostly buried in the upper and lower eyelids. When the facial nerve paralysis, the eyelashes are exposed, especially in the case of mild paralysis, forcefully close both eyes, at first the eyelash asymmetry phenomenon is not obvious, but after a short period of time, the eyelashes of the mildly paralyzed side will be slowly revealed, called the positive eyelash sign. Eyelid tremor When the eyes are closed forcibly and the examiner pushes the closed upper eyelid, a slight muscle contracture tremor is felt on one side of the upper eyelid, but not on the other side. This phenomenon exists, indicating a mild facial nerve palsy, peripheral facial nerve palsy is common. Oblique ovoid mouth sign Ask the patient to open the mouth wide, in mild facial nerve palsy, the corner of the mouth on the affected side is drooping in an oblique ovoid mouth. The difference with the oblique oval-shaped mouth in trigeminal motor branch palsy is that there is no mandibular deviation. In central facial nerve palsy, this sign is not obvious. Treatment Acupuncture and moxibustion therapy is based on manipulation, and no drugs or electroacupuncture are added during the treatment. Laws: Dispel wind and clear the channels. Prescription: Hegu, Taichong, Zha Zheng, Cheek Che through Dicang, Dicang through Cheek Che, Fengchi, Xiaguan, Ying Xiang, Chengjian or Cheek Chengjian. Choose three or four points at a time. Addition and Subtraction: For those who cannot close the eyelids down and have tears in the eyes, add Zanzhu, Yuzhu, Sizhukong, and Yangbai through Yuzhu. For pain behind the ears, add Cataract. For loss of sense of taste, add Lianquan. Maneuver: flat tonic and flat diarrhea, drawing needle method. Operation: Hegu, Taichong, Fengchi needles with laxative method, Xianguan, Xiazheng, Yingxiang, flat stabbing, using the flat tonic and flat laxative method, Yangbai downward flat stabbing through the fish waist, Dicang to the cheek car flat stabbing, cheek car to the diagonal stabbing of the Dicang and the use of pumping needles, so that the facial muscles to the back of the twitching, stay in the needle for 20 minutes. The remaining points were treated with flat tonic and flat diarrhea methods. Note: Ordinary facial paralysis does not require any treatment, it is a self-limiting disease and should not be medicated in the regular health care system, and there is no evidence that acupuncture can treat facial paralysis. Surgical Therapy Surgical treatment is mainly for advanced facial paralysis. Surgical treatments can be categorized into static and kinetic treatments. Static treatment involves transplanting the broad fascia into the face in strips. After treatment, the facial expression is symmetrical on both sides under static conditions, but the affected side cannot move with the healthy side under dynamic conditions. Dynamic treatment is generally divided into two phases. In the first phase, the nerve taken from the patient’s calf is anastomosed with the healthy facial nerve, and the end of the transplanted nerve is placed on the affected side, and after the nerve grows into the affected side from the healthy side in 6 months to 1 year, the second phase of the surgery is carried out, i.e., transplanting the muscle with the vascularized nerve, and the muscles of choice can be the rectus femoris, thin femoral muscle, and vastus latus muscle, etc. Symmetry of facial expressions can be achieved bilaterally in static and dynamic conditions in 3 months to 1 year after the treatment. Once the acute phase of facial neuritis is diagnosed, it should be treated with antiviral, hormonal and symptomatic therapy as early as possible. If the best time for treatment is delayed, the sequelae of facial paralysis may easily result. Psychological care As the patients are mostly suddenly ill, it is inevitable that they will have nervousness, anxiety and fear, and some of them are worried about the change of face and are ashamed to see others and the after-effects of the treatment. At this time, it is necessary to do a good job in explaining and comforting and guiding patiently according to the different psychological characteristics of the patients, so as to alleviate their nervousness, make the patients emotionally stable, and keep their body and mind in the best state to accept the treatment and care, so as to enhance the effect of the treatment. Eye protection Due to incomplete eyelid closure or inability to close, transient eye movement and corneal reflex disappears, the cornea is exposed for a long time, which is easy to lead to intraocular infection and damage to the cornea, therefore, the protection of eyes is very important, reduce the use of eyes, wear sunglasses to protect them when they go out and at the same time, drop some eye drops that have the function of lubrication, anti-inflammatory and nutrition, and wear an eye mask or cover the gauze to protect them when they are sleeping. Local care Hot compresses to dispel the wind: apply ginger to the side of facial paralysis, 1/2 hour per day; apply warm wet towel to the face, 2-3 times per day, and massage the affected side in the morning and evening, the strength of the massage should be appropriate, the site is accurate; as long as the affected side of the facial muscles can be moved to the mirror to do their own wrinkled forehead, close the eyes, whistling, showing the teeth and other actions, each action to do 2 eight beats or 4 eight beat, 2-3 times per day, in order to prevent the face from being affected by facial paralysis. It is very important to prevent the atrophy of paralyzed muscles and promote the recovery 2-3 times a day. In addition, patients with facial paralysis should pay attention to not washing their face with cold water, avoiding direct wind, paying attention to weather changes, adding clothes in time to prevent colds. Rehabilitation training After the facial expression muscles of the affected side show movement, effective expression muscle rehabilitation training can significantly improve the therapeutic effect. The main expression muscles involved in facial paralysis are occipital frontalis frontalis, orbicularis oculi, levator ani, zygomaticus, levator ani, orbicularis oculi, and lower lip square muscle. Functional training of these major muscles can promote the normalization of the motor function of the entire facial expression muscles. The following treatments should be selected according to the different symptoms of the patients during the training, 2-3 times a day, 10-20 times for each movement. Prevention Prevention of facial paralysis, facial muscle spasm, the key is still to pay attention to the cold, especially according to the climate to avoid the cold wind long face (do not want to be cool); usually more sports, exercise, improve the human body’s positive qi, “positive qi within the body, the evil can not be dry,” the body of the positive qi is strong, the wind and the evil is not easy to invade; but also to pay attention to keep the spirit of happy! Also pay attention to keep the spirit happy, leisure, enough sleep time; pay attention to the diet, both to enhance physical fitness, but also to enhance the ability to resist disease. If you have suffered from facial paralysis, you should seek medical treatment in a timely manner, and the use of traditional Chinese medicine should be the first choice, which can achieve both the symptoms and the root cause of the disease, so as to prevent the aftermath of the disease. Psychological Hazards Mental depression Mental depression, low mood, fatigue, lack of interest in anything, negativity, and loss of confidence in life can occur in patients with facial palsy, facial palsy sequelae, and facial muscle spasm. Inferiority complex When facial paralysis, facial palsy, facial muscle spasm, the character will become more and more inferior, more and more autistic, unwilling to socialize with anyone, I do what I want, make my own decisions, and thus often make mistakes and have regrets for the rest of their lives. Multiple complications Long-term facial paralysis, facial paralysis sequelae, facial muscle spasm, the body may appear related lesions, liver, kidney, internal organs function, micro-blood circulatory system will be affected by it, over time, will lead to brain, kidney, internal organs function failure, qi and blood weakness, yin and yang disorders, anemia, insomnia, depression, facial muscle contracture, joint band movement, facial muscle spasm, ptosis, psychosis and other diseases occur, endangering the health of the person. Precautions 1, during the treatment period, avoid cold, greasy, spicy stimulating food, not easy to digest, hot tonic, hot food, smoke, mutton, dog meat, scallop, white wine, garlic, scallions, seafood, spicy hot pot, strong tea and coffee. 2. Eat more fresh vegetables and coarse grains, such as soybean products, pumpkin, corn, onion, lean meat, hawthorn, kelp, jujube, bitter gourd, loofah, winter melon, cucumber, melon, banana, lean meat, jujube and so on. 3, every night before going to bed with hot water foot soak and add foot massage. 4, reduce light source stimulation, such as television, computer, ultraviolet rays. 5, functional exercises such as: raise eyebrows, eyes closed, drumming, open mouth, nu mouth, show teeth shrugged nose and so on. 6, hot compresses with a towel, 3-4 times a night, do not use cold water to wash your face, when the wind, rain, cold, pay attention to head warmth. 7, appropriate sports, strengthen the body exercise, often listen to light music, mood calm and happy, ensure adequate sleep. 8. Insist on acupressure every day. Dietary therapy Chinese medicine believes that facial paralysis is mostly due to the emptiness of the veins and channels, wind and cold invasion, or wind-heat, wind-phlegm, blood stasis blocking the meridians, qi and blood disharmony, resulting in relaxation of the muscles and muscles do not collect. If the early attention to traditional Chinese medicine and acupuncture healing effect is good. Western medicine advocates the early application of glucocorticosteroids and other drugs to improve blood circulation, nutritive nerves and anti-viral drugs. However, overuse of hormones will produce many side effects, including swelling, water and sodium retention, decreased immunity, and slow recovery. Under the treatment plan set by the doctor, we can cooperate with scientific dietary methods, which can effectively assist the treatment.