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Abstract: The young patient in this article had a sudden onset of mouth distortion and incomplete eye closure, first with pain behind the ear, followed by a distorted mouth, and after a comprehensive examination, a diagnosis of facial neuritis was made. The patient was recommended to be hospitalized. The patient recovered well after standardized treatment with injectable drugs as well as oral drugs, and the symptoms of left-sided postauricular pain and mouth distortion were significantly relieved without leaving serious sequelae.
Basic information】Male, 24 years old
Disease Type】Facial neuritis
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Injectable medication (methylcobalamin injection + glycerol fructose injection + shuxinin injection + ganciclovir injection + injectable methylprednisolone sodium succinate) + oral medication (methylprednisolone tablets + vitamin B1 tablets)
Treatment period】7 days in hospital, review after 1 week
Treatment effect】Significant relief of pain behind the left ear and crooked mouth
I. Initial consultation
Three days before admission, the patient had pain behind the left side of the ear after sleeping with the window open and blowing. Two days before admission, the patient developed a crooked mouth, which showed that the mouth was crooked to the right side, the cheeks were puffed out, and water flowed out from the corner of the mouth when brushing teeth, accompanied by incomplete closure of the left eye. We asked the patient in detail that there was no previous disease, no clumsy speech, no weakness and numbness of the limbs, etc. We told the patient not to be too nervous, not like cerebrovascular disease, and tentatively diagnosed facial neuritis. The patient was advised to continue to improve relevant examinations after admission to the hospital to further clarify the diagnosis, and the patient agreed.
II. Treatment history
After admission, the patient was examined: clear, temperature symptoms, normal blood pressure, heart rate of 75 beats/min, respiration of 15 breaths/min, peripheral facial palsy on the left side, free eye movement, tongue extension in the center, the patient was given a cranial magnetic resonance examination, which showed no significant abnormalities and no diffusion restriction in DWI, and the diagnosis of facial neuritis was confirmed. After admission, laboratory tests such as routine blood and urine, liver function and kidney function were also completed, and no significant abnormalities were found. We communicated with the patient and his family that facial neuritis was not life-threatening and not a so-called stroke, but hormone therapy was needed and the effect might be better, and the patient and his family agreed to use hormones after discussion. Mecobalamin injection was given to nerve nutrition, ganciclovir injection was given to anti-virus, vitamin B1 tablet was given orally to nerve nutrition, glycerol fructose injection was given to relieve facial nerve edema, shuxin injection was given to improve microcirculation, and injectable methylprednisolone sodium succinate was given to reduce inflammatory reaction. The patient continued to take methylprednisolone tablets and vitamin B1 tablets according to the doctor’s prescription after discharge.
III. Treatment effect
After 7 days of treatment with intravenous drugs combined with oral drugs, the patient’s symptoms of pain behind the left ear and crooked mouth were significantly relieved, the left nasolabial folds became slightly shallow, the left eye did not show the white kernels after closing, the brushing of teeth did not leak, the mental and physical condition was very good, the healing was good, and no serious sequelae were left, the patient was very satisfied with the treatment effect. After evaluation, the patient had reached the discharge index and was discharged from the hospital. The patient was instructed to review in 1 week.
IV. Precautions
The patient was still young, recovered well and would not affect her life afterwards, which was gratifying as a doctor. The patient was instructed to pay attention to cold and warmth after discharge, to avoid catching cold and flu, to avoid sleeping with the head facing the open window at night, to eat less spicy and inflammable food, such as seafood, chili, mutton, etc., and to eat less raw and cold food. Pay attention to rest and maintain a cheerful mood. Since the patient’s eyelids are not fully closed for a long time, which can easily lead to keratitis and conjunctivitis, he can wear eye shields for protection. After discharge from the hospital, the patient still continues to take oral methylprednisolone tablets, which should be slowly reduced. It is necessary to pay attention to the side effects of hormones, such as gastrointestinal bleeding, hyperglycemia, hypertension, etc.
V. Personal insight
For facial neuritis, it is important to prevent this disease by reducing cold stimulation in daily life, and once diagnosed, to treat it symptomatically and follow medical advice for care. For medical workers, when they encounter patients with facial palsy at work, they need to distinguish between facial neuritis and central facial palsy, the latter may be caused by cerebral infarction, cerebral hemorrhage, or brain tumor, often combined with numbness and weakness of limbs and clumsy speech, and MRI and CT can be used for differential diagnosis.