Facial neuritis, commonly known as facial nerve palsy (i.e. facial nerve palsy), “crooked mouth” and “hanging wind”, is a disease characterized by motor dysfunction of the facial expression muscles. It is a common and frequent disease, and is not limited by age. The general symptom is crooked mouth and eyes, and patients are often unable to perform even the most basic movements such as raising eyebrows, closing eyes and puckering mouth.
Etiology
There are various causes of facial neuritis, which can be clinically classified into central facial neuritis and peripheral facial neuritis according to the location of the damage. Central facial neuritis lesions are located in the cortical medullary tract between the facial nucleus and the cerebral cortex and are usually caused by cerebrovascular disease, intracranial tumors, traumatic brain injury, and inflammation. Peripheral facial neuritis lesions occur in the facial nucleus and facial nerve.
The common causes of peripheral facial neuritis are.
(i) infectious lesions, mostly caused by activation of latent viruses in the sensory ganglia of the facial nerve;
(ii) Otogenic diseases, such as otitis media;
(iii) autoimmune reactions;
(iv) tumors;
⑤Neurogenic;
(6) Traumatic;
⑦ poisoning, such as alcoholism, long-term exposure to toxic substances;
⑧Metabolic disorders, such as diabetes mellitus, vitamin deficiency;
⑨Vascular insufficiency;
congenital facial nerve nucleus hypoplasia.
Clinical manifestations
The facial expression muscles are paralyzed, forehead wrinkles disappear, eye fissures are enlarged, nasolabial folds are flattened, and the corners of the mouth droop. When smiling or showing teeth, the corner of the mouth drops and the facial tilt is more obvious. The sick side cannot make movements such as frowning, frowning, closing the eyes, puffing and pouting. When puffing the cheeks and whistling, the affected side of the mouth leaks air because the lips cannot be closed. When eating, food residues are often left in the gap between the teeth and cheeks of the affected side, and saliva often flows down from that side. As the tear dots are ectropioned with the lower lid, the tears do not drain normally and spill out.
Facial palsy caused by facial neuritis is mostly one-sided, and the right side is more common. Most patients often suddenly find that one cheek does not move well and the mouth is crooked when washing the face or rinsing the mouth in the early morning. Some patients may have taste disorder in the front 2/3 of the tongue and auditory hypersensitivity.
Peripheral facial neuritis caused by trauma can be divided into two types: early onset (facial palsy immediately after injury) and late onset (facial palsy 5 to 7 days after injury). The degree of facial nerve injury can be evaluated based on the delay and degree of post-injury facial palsy, electrical excitation and electromyography to determine the prognosis.
Examination
1.Static examination
(1) Stem mastoid Check whether the stem mastoid is painful or whether one side of the temporal region or face is painful.
(2)Forehead Check whether the skin wrinkles on the forehead are the same, become shallow or disappear, and whether the outer part of the eyebrows are symmetrical and drooping.
(3) Eyes Check whether the size of the eye fissures are symmetrical, smaller or larger on both sides, whether the upper eyelid is drooping, whether the lower eyelid is ectropion, whether the eyelid is twitching and swollen, whether the conjunctiva is congested, and whether there are symptoms of lacrimation, dryness, acidity and swelling.
(4) Ear Check for tinnitus, stuffy ears, hearing loss or allergy.
(5) Cheeks Check whether the nasolabial folds become shallow, disappear or deepen. Whether the cheeks are symmetrical, flat, thickened or twitchy. Does the face feel tight, stiff, numb or atrophied.
(6) Mouth Check whether the corners of the mouth are symmetrical, drooping, uplifted or twitching; whether the lips of the mouth are swollen and whether the human middle is oblique.
(7) Tongue Check whether the sense of taste is involved.
2.Motor examination
(1) Eyebrow raising movement Check the motor function of frontal occipital muscle. In severe patients, the forehead is flat, wrinkles generally disappear or become significantly lighter, and the outer part of the eyebrows droop significantly.
(2) Frown Check whether the frown muscle can move and whether the amplitude of brow movement is the same on both sides.
(3) Eye closure When closing the eyes, attention should be paid to the affected side of the corners of the mouth with or without lifting the corners of the mouth movement, whether the affected side can be closed tightly, and the degree of closure.
(4) Shrugging the nose Observe whether there are wrinkles in the nasal pressure muscles and whether the amplitude of upper lip movement is the same on both sides.
(5) Showing teeth Pay attention to the amplitude of mouth angle movement on both sides, whether the mouth cleft is deformed, and the number and height of exposed upper and lower teeth.
(6) Nuzzles Pay attention to whether the distance from the corners of the mouth to the middle of the person is the same on both sides and whether the shape of the nuzzles is symmetrical.
(7) Cheek puffing Mainly check the motor function of the orbicularis oris muscle.
Treatment
1.Non-surgical treatment
Principle: Promote the local inflammation and edema to subside early, and promote the recovery of nerve function.
(1) For peripheral facial nerve palsy caused by facial neuritis, if it is a viral infection available antiviral, nerve-nourishing, glucocorticoid, B vitamins and other drugs.
(2) Protect the exposed cornea and prevent conjunctivitis with eye shields, eye drops, eye ointment, etc;
(3) Massage, the patient himself massages the facial palsy facial muscle by hand in front of the mirror several times a day for 5 to 10 minutes each time.
(4) Physiotherapy, commonly used are ultrashort wave, low and medium frequency electrotherapy, laser, drug introduction, etc.
(5) Acupuncture treatment.
2.Surgical treatment
After 3 months of conservative treatment, if the nerve paralysis is still not recovered, and the measurement of facial nerve conduction velocity and electromyography of facial muscle are not responsive, i.e., potential activity, surgical treatment can be used.
Care
1.Eye care
During the acute period, go outdoors less often to keep the eyes clean; use eye shields to cover the affected eyes or apply eye ointment to prevent conjunctival and corneal infections; minimize eye use.
2.Eating care
Patients with taste disorder should pay attention to the hot and cold degree of food; avoid hard food; try to put food on the back of the healthy side of the tongue and chew slowly; pay attention to rinse the mouth in time after meals to keep the mouth clean.
3.Recovery care
Hot compresses can be applied to the affected side to promote local blood circulation. When the facial muscles start to recover, it is necessary to do muscle training of facial muscles, mainly to train the expression muscles, do eye opening, forehead wrinkling, sucking, lip curling, opening smile, lifting the corners of the mouth, whistling, lip pouting, jaw pulling and other actions, about 20min each time, once a day until the final recovery.