Facial nerve palsy, also known as peripheral facial palsy, is one of the more common diseases of the pediatric neurological system, with a statistical incidence of about 3/(100,000) children under 10 years of age, 10/(100,000) people between 10 and 20 years of age, and a higher incidence of 23/(100,000) adults. The author found that in recent years, the number of children with facial palsy in our pediatric neurology clinic has been increasing year by year. 8 cases were seen in 2012, 11 cases in 2013, and 6 cases in the first half of 2014. The age of onset ranged from 2.5 to 15 years old, male: female, 5:1. The reasons for the increase in patients with facial palsy are not yet very clear.
The clinical manifestations of facial nerve palsy are mainly paralysis of one side of the expression muscles, such as disappearance of the frontal lines, widening of the eye fissure, disappearance of the nasolabial fold, crooked corners of the mouth, and inability to do such actions as frowning, cheek puffing, whistling, etc., which seriously affects patients’ daily life and aesthetics. Some patients also have auditory allergy and sensation of louder sound. In severe cases, patients may feel pain behind the ipsilateral ear.
The etiology of peripheral facial palsy is complex. westin et al. have systematically summarized the literature on the etiology of facial palsy in MEDLINE between 1996 and 2003, and they concluded that, so far, there is no commonly accepted and more scientific classification system for the etiology of facial palsy. At present, the main etiologies are primary facial palsy (Bell’s facial palsy), traumatic facial palsy, otogenic facial palsy, and facial palsy caused by tumors, among which Bell’s facial palsy accounts for 60% and is the main cause of peripheral facial palsy.
1.Viral infection
May be related to infections such as herpes zoster virus, herpes simplex virus type I, cytomegalovirus, EBV, coxsackievirus, and human immunodeficiency virus.
2, blood transport disorders said
Facial palsy is caused by spasm of the small arteries supplying blood to the facial nerve due to external wind and cold, followed by ischemic edema of the nerve, and edema of the facial nerve, which in turn causes pressure on the blood vessels, leading to increased ischemia.
3.Immune abnormality says
Part of it is due to reduced immunity, and the other part may be due to autoimmune reaction, and hormone therapy effectively supports this theory.
4.Hereditary theory
Some patients have a family history or familial anatomical abnormalities, such as facial nerve canal stenosis.
5, physical and mental stress theory
The onset of the disease is related to fatigue and emotional stress.
6, other factors
including diabetic neuropathy, vascular compression, congenital stenosis of the facial nerve canal, bleeding in the facial nerve canal, etc.
7, Chinese medicine believes that
This disease may be due to the lack of solidity of the external guard, wind and phlegm in the ligaments, lack of qi and blood, combined with cold and wind invasion, resulting in local stagnation of meridians and tendons and veins.
Based on the different understanding of the etiology of peripheral facial palsy, different pharmacological treatments have been proposed. At present, a comprehensive treatment method based on medication is mostly used, and commonly used drugs include steroid hormones, B vitamins, vasodilators, antivirals and neurotrophic drugs. Hormones can be taken orally prednisone; B vitamins can be used B1B12, Micropo (vitamin B12 methylcobalamin preparation) has a repair effect on peripheral nerves, and is commonly used in the treatment of facial nerve palsy; neurotrophic drugs, mainly nerve growth factor, which is one of the most important bioactive substances of the nervous system, has biological properties such as nerve nutrition and regulation of nerve regeneration, and is important for the development, repair and normal function of the nervous system. It has an important role in the development, repair and maintenance of normal functions of the nervous system.
Therefore, it has been used in the treatment of peripheral facial palsy in recent years, and has achieved more satisfactory efficacy both from animal experiments and practical applications. A related study showed that nerve growth factor was better than the control group in the treatment of peripheral facial palsy, with statistical differences in efficiency and cure rates between the two. The results of 30 cases of facial neuritis treated with gangliosides combined with glucocorticoids showed that the treatment group improved better than 29 control cases at day 14 and day 28 (p < 0.05), and the total effective rate of the treatment group was better than that of the control group (p < 0.05). It is believed that gangliosides combined with glucocorticoids can effectively improve the prognosis of facial neuritis.
Some individual parents have concerns about the use of hormones in pediatric patients. I once met a parent who turned his head and ran away as soon as he heard that hormones would be used for his child. If used properly, the side effects of hormones can be avoided or minimized. On balance, hormones are still a drug of choice, and there is a strong case to be made for their use.
The American Academy of Medicine (AAN) published its latest guidelines for the treatment of Bell’s palsy online in the journal Neurology on November 7, 2012, and the level of evidence supporting the use of steroid hormone medications has been raised in the new version of the guidelines. In the previous version of the guidelines, steroids such as prednisone were considered probable effective for the treatment of Bell’s palsy, and in the new guidelines they are considered highly likely to be effective. (Previously a B-level recommendation, now an A-level recommendation). Evidence also suggests that the addition of antivirals may not be beneficial to treatment. This new guideline was revised by the American Medical Association (ANN) in response to new evidence for Bell’s palsy, based on guidelines published in 2001. The second major change in the new guidelines is that the first version of the guidelines suggested that antivirals might be effective, but the new guidelines do not recommend them. The new evidence suggests that antiviral therapy is not beneficial, although these studies did not have sufficient statistical power to rule out a possible slight benefit.
In addition to medications, attention should be paid to good rehabilitation exercises, functional exercises and massage of the paralyzed facial muscles while receiving medications. Acupuncture can be performed during the rehabilitation period, but not too early. For physical therapy, the physical therapist can choose electrotherapy, Muscle Electrical Stimulation, Laser therapy, Ultrasound Treatment, Cold Therapy (Cryotherapy), (Short Wave Diathermy) short wave diathermy, facial muscle exercise and other treatments. If the symptoms do not improve satisfactorily or the paralysis is severe, surgery may be required.