Facial palsy is the common name for facial neuritis, which is a common clinical disease. Modern medicine mainly refers to facial nerve palsy caused by viral infection, also known as Bell’s palsy. It is different from the peripheral facial nerve palsy caused by trauma, tumor, external ear disorders and other physical factors, and the central facial nerve palsy caused by central nervous system lesions. The etiology of the disease is still unknown. According to clinical observation, there are factors such as external sensation, cold, mood swings, fatigue, and uncontrolled diet (alcohol consumption, spicy food). For the pathogenesis of facial palsy, it is currently accepted that viral infection causes spasm of the blood vessels that nourish the facial nerve, resulting in nerve ischemia and edema of the nerve sheaths in the facial nerve canal, which further aggravates the ischemia and further compresses the nerve.
Clinical manifestations
Unilateral peripheral neurological facial palsy is characterized by loss of frontal lines on the affected side, enlarged eye fissures, inability to close the eyelids, overflow of tears, shallowing or disappearance of the nasolabial fold, and crooked corners of the mouth toward the healthy side.
Diagnosis and localization
The facial nerve emanates from the pontine brain and then passes through the internal auditory canal and the narrow bony canal in the rock bone, which is the facial nerve canal, and finally exits the cranial cavity through the stem mammary foramen to distribute to the facial expression muscles. According to the location of facial nerve injury, it can be localized as nuclear palsy, pontocerebellar angle palsy, intra-facial nerve canal, and extra-facial nerve canal. The first two are mostly seen in tumors and vascular lesions, while the latter two are clinically common.
Intra-facial nerve canal: The nerves in the facial nerve canal are ischemic, edematous, and obviously compressed, which easily lead to myelin or axonal degeneration, thus the condition is mostly heavy, with slow recovery, poor prognosis, and many sequelae. In addition to the clinical manifestations of facial palsy mentioned above, there may be hypogastric sensation in the anterior two-thirds of the tongue, i.e., damage to the bulbar nerve, and the patient may have numbness of the tongue and abnormal taste; and hearing hypersensitivity, i.e., damage to the stapedial nerve; and pain in the mastoid region (symptoms are aggravated at night), hypoesthesia in the external auditory canal and auricular region, i.e., damage to the geniculate ganglion; and reduced lacrimal secretion and absence of sweating, i.e., damage to the superficial greater nerve.
Extra facial nerve canal: i.e., edema and degenerative necrosis of the facial nerve outside the stem mammary foramen are mostly not obvious, and the condition is mild with good prognosis. In addition to the above clinical manifestations of facial palsy, there is only slight pain in the mastoid area.
Determination of disease condition
Electromyography is a definite guide to the localization of facial nerve injury, but there is a significant lag in the neurodegenerative response of electromyography, which often becomes apparent only 7-10 days after the onset of the disease. Generally speaking, the severity of the disease depends on the location of the facial nerve injury (intradural or extradural) and the degree of injury, and the higher the location and the more severe the injury, the worse the prognosis. According to the clinical manifestations of patients can be divided into three types: mild, medium and severe. Mild: the movement of closing the eyes, raising the eyebrows, shrugging the nose, puffing, and showing teeth can be completed, but the force is weaker than the healthy side; moderate: some facial muscles are completely paralyzed, but some facial muscles can be seen to produce movement; severe: the facial muscles are completely paralyzed or can see slight contraction of the facial muscles, but no movement.
Clinical treatment
Patients with facial palsy may experience pain in the mastoid area on one side in the early stage, the painful pressure point is mostly behind the earlobe (cataract point), the pain sometimes radiates along the back of the ear to the head or along the front of the ear to the jaw, the painful symptoms are worse at night, the eyes on the affected side of the face may not close tightly, and the water flows out from one corner of the mouth when gargling.
Western medical treatment
In the acute and resting phases, Western medicine mostly uses oral hormone prednisone and the drug dibazol to improve microcirculation, and intramuscular injection of vitamin B1 and B12.
Hormone therapy can change the phospholipid composition of the cell membrane and maintain the stability of the cell membrane, while achieving anti-inflammatory and edema elimination effects. Patients with hypertension and diabetes mellitus should not take oral hormones. Dibazol improves local microcirculation and eliminates local edema as soon as possible. Intramuscular injection of vitamin B1 and B12 provides the material basis for nerve repair. Oral vitamin B1, B12 and dibazol can be taken during the recovery period.
Traditional Chinese medicine
Chinese medicine is based on the treatment of dispersing the wind and clearing the ligament with activating blood circulation and resolving blood stasis. Clinical prescriptions are often used to activate the blood circulation and clear the ligament capsule with whole tianma capsule then with clearing heat and detoxifying oral liquid.
Acupuncture treatment
Early and quiescent stage: few needles and shallow needling are the main methods, and electroacupuncture and strong stimulation are prohibited. Most acupoints of Shaoyang meridian are taken and combined with acupuncture and bloodletting cupping.
Recovery period: acupuncture plus acupuncture point injection (adenosine cobalamin for injection) 0.5J per day can be used for two acupuncture points respectively. (Acupoint injection should not be used too early) or acupuncture plus electroacupuncture can be used
Treatment of the posterior period: fire needling plus acupuncture plus acupoint injection is appropriate. (Pay attention to the direction and depth of needling)
Physical therapy
Ultrashort wave local irradiation is used in the acute (1-7 days) and resting (7-15 days) phases
Hyperbaric oxygen therapy
Most peripheral nerve fibers have myelin sheaths, and the nerve cell bodies and their nuclei play a key role in the growth, regeneration, function and maintenance of cell protrusions. The regeneration and repair of injured nerves depends mainly on the integrity of the neurogenic cell body. Hyperbaric oxygen promotes the dispersion of oxygen to cells and tissues, thus hyperbaric oxygen can directly improve the hypoxic state of nerve tissue caused by the compression, spasm or disconnection of neurotrophic vessels, and delay, stop or reverse the secondary pathological changes and collapse of nerve fibers and cell bodies.
Points to note in the treatment of facial palsy
Facial palsy usually requires one month of treatment. At the early stage of the disease, most patients are very impatient and eager to cure the disease, hoping to be cured as soon as possible. However, the occurrence and development of the disease have their own developmental rules, and some methods that are too hasty will not be able to achieve a multiplier effect, but may aggravate the disease in the early stage. Such as early in the face using heavy stimulation needling techniques and electro-acupuncture therapy and patients prematurely massage and facial muscle training on their own. The above incorrect methods can lead to swelling or pain in the affected face, thus prolonging the recovery period of the disease.
1, patients during treatment more rest, should not watch TV, computer so as not to cause eye muscle fatigue, affecting the recovery of the eye nerve, but also should not talk too much, eat hard, cold food and affect the repair of the nerve around the mouth.
2, diet should be warm, soft, light and easy to digest, avoid spicy, fish, shrimp and beef and mutton and other irritating food to avoid aggravating the disease.
3, avoid intercourse to protect the body’s positive energy.
4.You can apply heat to the face (15 minutes daily), but the temperature should not be too high, and facial massage is not recommended.
The four major complications of facial palsy sequelae
Linkage: when the affected eye does the movement of closing the eyes, the affected side of the mouth angle does the synchronous upward movement; crocodile tears: when the patient chews food, the affected side of the eye has tears overflowing; inversion: at the onset of the affected side of the mouth angle to the healthy side, and inversion is the affected side of the mouth cross to the affected side; facial muscle spasm: the affected side of the face muscle appears involuntary twitching; the above sequelae mostly appear after 3 months of onset, if improper treatment of the above four can appear superimposed.