Facial palsy is commonly known as “crooked mouth”, “crooked mouth”, “hanging line wind, “hanging slant wind”, “facial neuritis”, and “crooked mouth wind”, etc. It is a disease of unilateral or bilateral facial nerve paralysis and expression muscle paralysis caused by trauma, surgery, facial neuritis, occupational disease, etc. It mostly occurs unilaterally. Those who do not recover completely within 2 years of the disease are called early facial palsy, and those who have had the disease for more than 2 years are called advanced facial palsy. The general symptom is a tilted mouth and eyes, it is a common and frequent disease, and it is not limited by age. Western medicine is called facial nerve palsy, facial neuritis, Bell’s palsy, Hunter’s syndrome, etc.”
Clinical manifestations: the clinical manifestations of facial nerve palsy are mainly manifested in the following aspects.
1, sudden onset, mostly found in the morning after waking up, there may be a history of cold stimulation of the face.
2, the affected face facial expression muscle completely paralyzed, forehead wrinkles disappear, eye fissures are enlarged, nasolabial folds become shallow, the corners of the mouth droop, and the corners of the mouth are skewed to the healthy side when teeth are exposed. The expression is painful, the corners of the mouth are skewed, the healthy side is skewed upward, they dare not close their lips tightly, they cannot puff their cheeks or blow, they cannot speak well, and they leak water when drinking. When eating, food residue is often left in the gap between the teeth and cheeks on the sick side, and saliva often flows down from that side.
The eyelids are poorly closed, the lid fissures are enlarged, the upper and lower lids cannot be closed, the conjunctiva is exposed, and the eyeballs turn outward when they are closed with force, resulting in Bell’s sign.
4. Dysfunction of salivary gland secretion and lacrimal gland secretion. As the tear dots turn inward with the lower lid, the tears cannot spill out according to normal drainage.
5.The shallowing or disappearance of forehead wrinkles and the inability to frown are important clinical features of Bell’s facial palsy.
6. Auditory examination, mostly bass hypersensitivity or auditory enhancement is seen.
Facial nerve palsy is divided into two types: peripheral and central.
The most common type of facial nerve palsy is facial neuritis or Bell’s palsy, which is generally referred to as “facial palsy”, and in most cases refers to facial neuritis. Peripheral facial nerve palsy is a type of facial nerve palsy that can occur at any age, mostly in young adults, but also in children. The disease is not only painful for the patient, but also affects the aesthetics of the person.
Diagnosis: The diagnosis of peripheral facial palsy is usually based on the following aspects.
1. Sudden onset: There are often no conscious symptoms. It is often found in the morning when washing the face and brushing the teeth, and the corner of one side of the mouth is distorted. Some patients may have pain in the ear or mastoid region before the onset of the disease.
2. Typical symptoms: loss of frontal lines on the affected side, inability to frown; shallow nasolabial folds, inability to close the upper and lower eyelids completely; crooked corners of the mouth, showing that the corners of the mouth of the teeth deviate to the healthy side; inability to puff the cheeks, blowing dysfunction.
3.Functional examination.
(1) Taste: the first 2/3 of the tongue (sweet, salty, sour) on both sides of the contrast has not changed.
(2) Hearing: tuning fork (256Hz) contrast on both sides from far to near. The affected side may show bass hypersensitivity or auditory enhancement.
(3) Tear examination: two filter papers, bent at 2 mm from one end, placed in the conjunctival sac of the lower lids of both eyes. 5 minutes later, the length of the test paper stained with tears about 2 cm is normal.
4. Damage localization.
(1) Lesions outside the stapedial mammary foramen: facial palsy.
(2) Lesion between the tympanic cord and stapedius muscle: facial palsy + loss of taste + salivary gland secretion disorder.
(3) Lesions between the stapedius muscle and the geniculate ganglion: facial palsy + loss of taste + salivary gland secretion disorder + auditory changes.
(4) Lesion of the geniculate ganglion: facial palsy + loss of taste + salivary gland and lacrimal gland secretion disorder + auditory changes.
5. Ancillary tests.
(1) Laboratory examination: blood glucose, urea nitrogen, blood routine.
(2) Imaging examination: X-ray radiographs of the skull and mastoid region.
(3) Neurological examination: electroencephalogram.
(4) Tear test: two pieces of filter paper, bent at 2 mm from one end, placed in the conjunctival sacs of the lower lids of both eyes. 5 minutes later, the length of the test paper stained with tears of about 2 cm is normal.
Differential diagnosis.
Bell’s palsy, also known as facial neuritis, is a peripheral facial palsy caused by nonspecific inflammation of the facial nerve in the stem mammary foramen. Based on the form of onset and clinical features, the diagnosis of Bell palsy is mostly uneventful.
However, it needs to be differentiated from the following conditions.
1, Central facial palsy: manifesting facial palsy below the eye fissure on the opposite side of the lesion, often accompanied by central tongue palsy and hemiparesis on that side, seen in cerebrovascular disease, tumors, etc.
2.Differentiate from peripheral facial palsy caused by other causes.
(1) Structural lesions adjacent to the facial nerve canal: seen in otitis media, mastoiditis, middle ear mastoid surgery and skull base fracture, etc. There may be a history of primary disease and specific symptoms.
(2) Acute infectious polyneuritis: the lesions are often bilateral, and most of them are accompanied by symmetrical paralysis of other cranial nerves and limbs and cerebrospinal fluid protein cell separation phenomenon.
(3) Pontocerebral damage: damage to the facial nucleus of the pontocerebrum and its fibers may present as peripheral facial palsy, but is often accompanied by damage to adjacent structures within the pontocerebrum, such as the abducens nerve, trigeminal nerve, pyramidal tract, and spinal cord thalamus, with ipsilateral extraocular rectus palsy, facial sensory deficits, and contralateral limb palsy. This is seen in tumors, inflammation, and vascular lesions in this area.
(4) Cerebellar pontocerebellar horn damage: The trigeminal nerve, the local auditory nerve, the ipsilateral cerebellum and the medulla oblongata are mostly damaged at the same time, so there are often symptoms such as ipsilateral facial pain disorder, tinnitus, deafness, vertigo, nystagmus, limb ataxia and contralateral limb paralysis. It is often seen in tumors and inflammation of this part.
(5) Lesions other than stem mammary foramen: peripheral facial palsy due to parotitis, parotid tumor, surgery on the jaw and neck and parotid area, etc., with their primary history and clinical features.