The sequelae of facial palsy generally refers to the condition in which the duration of facial palsy is more than 3 months, and the condition is delayed due to improper treatment methods or is not cured after multiple methods of treatment. Specific manifestations include no eyebrow raising movement or low eyebrow raising, large or small eyes or loose upper eyelids, wrong corner of the mouth when raising the eyebrows, pulling the corner of the mouth when closing the eyes, small eyes when puffing the mouth, shallow nasolabial folds, facial stiffness, stagnant food and lacrimation, etc., which bring inconvenience to the patient’s life and psychological discomfort.
Causes
The common causes of facial palsy sequelae are.
1, some patients are not treated in time, or improperly treated (such as premature use of acupuncture treatment, unused or insufficient course of antiviral drugs, too small a dose of hormonal drugs, etc.), delaying the best time for treatment.
2, the patient’s own condition is serious, such as EMG examination suggesting severe facial nerve injury, such as Hunt syndrome, etc.
Clinical manifestations.
There are four common types of post-paralytic complications: facial muscle spasm, combined facial muscle movement, crocodile tear syndrome, and facial muscle fibrous spasm.
1.Facial muscle spasm
The main manifestation is paroxysmal involuntary spasm or convulsion of facial expression muscles on one side, occurring in the eye, corner of the mouth, broad neck muscles, etc., mostly one-sided, and the involvement of both sides is rare.
2.Facial muscle joint movement
The corners of the mouth move toward the affected side when the eyes are closed, or the eyes are closed on the affected side when the corners of the mouth move.
3.Crocodile tear syndrome
Tearing in patients with facial palsy is often accompanied by facial muscle spasm or diffuse facial muscle reaction performance, and the tears of patients with facial palsy become constantly dry, or even unable to flow tears.
4.Facial muscle fibrous spasm
Rapid, non-constantly positioned jerking contractions appear on one side of the facial palsy and are often accompanied by transient eye movements as well.
Diagnosis.
1. Medical history
Sudden paralysis of facial expression muscles on one side, loss of frontal lines on the diseased side, inability to close eye fissures, shallow nasolabial folds, drooping corners of the mouth, cheek puffing, air leakage when whistling, easy retention of food between the teeth and cheeks on the diseased side, may be accompanied by loss of taste in the first 2/3 of the tongue on the diseased side, auditory hypersensitivity, tearfulness, etc.
2.Imaging examination
Brain CT, MRI and other imaging examinations are normal, and intracranial lesions are excluded.
3.Clinical manifestations
Clinical manifestations of the above four types of clinical manifestations after the appearance of facial palsy, and there is a sequential relationship between the occurrence of symptoms and the occurrence of facial palsy in time
Treatment.
1.Drug treatment
Generally, drug therapy such as nerve nutrition (B vitamins) is used to improve local blood circulation, reduce facial nerve edema, and promote functional recovery. Carbamazepine is preferred for facial muscle spasm.
2.Chinese medicine treatment
Patients try not to use electric acupuncture, electric massage too heavy, too frequent stimulation treatment methods, in the use of acupuncture treatment at the same time can be combined with Chinese medicine fumigation and nerve nutrition drugs to help the recovery of the nerve.
3.Botulinum toxin type A injection
When the sequelae of facial palsy manifest as facial muscle spasm, type A botulinum toxin can be injected at the spastic area. The injection can be carried out under the guidance of electromyography as much as possible, and most patients can achieve satisfactory results, but some patients will relapse 3-6 months after type A botulinum toxin injection, and the injection will still be effective again.
4.Surgical treatment
Patients with facial paralysis sequelae for whom conservative treatment is ineffective can be treated by plastic surgery. The latest method applied at home and abroad is small muscle free transplantation, which has the advantages of no facial bloating deformity and secondary disorders in the donor area, little damage, little pain to the patient, short course of disease, static effect in the near future and dynamic effect in the long term.
Prevention.
1, Patients with facial palsy should be treated early and the condition should be controlled as soon as possible to avoid sequelae.
2, Patients with facial palsy should pay attention to rest, ensure sufficient sleep, avoid various mental stimulation and excessive fatigue, and also pay attention to keeping the head and face warm to facilitate the recovery of the disease.
3.Patients with facial palsy should have confidence and patience in treatment, overcome anxiety and pessimism under the guidance of doctors, adopt a positive and optimistic attitude towards the disease, enhance self-control, re-establish a reasonable and healthy way of life and work, and actively cooperate with treatment.