Which part of the face begins to recover from paralysis. Facial nerve paresis, symptoms and treatment

Date: 04.03.2020

Facial nerve paresis is neurological disease, characterized by a violation of the functioning of the motor character of facial muscles, localized on one of the sides of the face. The pathogenesis of the development of the disease is based on a change in the transmission of a nerve impulse due to damage to the trigeminal nerve.

The main distinguishing feature of the disease is asymmetry and lack of motor activity parts of the face. Such violations prevent a person from expressing their emotions with facial expressions and talking in full.

Reasons for development

Paresis of the trigeminal nerve can act as an independent nosological unit, as well as a symptom of concomitant pathology. In most cases, the main one is the inflammatory nature of the disease. The causes of occurrence are different, therefore, it is customary to classify the disease:

primary lesion (idiopathic);
secondary, as a result of inflammation or injury;

The facial trigeminal nerve may lose its ability to conduct an impulse characterized by inflammation and swelling of the nerve. Its main symptom is trigeminal neuralgia. In addition, neuritis can be a complication of otitis media and be infectious (types of herpes infection) or non-infectious origin (trauma).

The causes of paresis also include a violation of the local blood supply to the nerve and parts of the central nervous system, for example, due to ischemic disease, as well as as a result of the appearance of a tumor-like neoplasm or trauma.

Factors that contribute to paresis of the facial nerve are strong and long-term exposure low temperatures on the body, background diseases - diabetes mellitus, complications of an existing pathology - stroke due to hypertension, the influence of some drugs in the treatment of atherosclerotic vascular lesions, as well as surgical intervention.

Despite the nature of the onset of the disease, treatment should be aimed at restoring the lost functions of the facial nerve and correcting concomitant pathology.

Clinical manifestations of paralysis

The functions of the trigeminal nerve are considered to provide motor activity and sensitive perception of the face. Based on this, we can assume about the consequences of the paresis of this nerve. Among all the symptoms, the main ones are distinguished:

loss of movement of one of the sides of the face due to the absence of nerve impulses from the center of regulation of the brain;
weakness of the muscles responsible for facial expressions;
lack of ability to cover eyes, raise or frown eyebrows, puff out cheeks;
it becomes difficult to reproduce speech correctly and take liquid food;
dry eyes in parallel with involuntary lacrimation;
an aversion to loud music develops, a change in taste preferences and increased salivation.

Treatment of paresis

Therapeutic tactics for paresis of the facial nerve should consist of several points:

Removal of the causative factor of the disease.
Drug therapy.
Physiotherapy procedures.
Massage.

In this way, A complex approach makes it possible to cure paresis of the facial nerve without the presence of residual effects. However, it should be remembered that the restoration of previous functions takes a long time and takes up to six months.

If the paresis of the nerve has developed as a result of otitis media, then it is necessary to include anti-inflammatory and reducing the edema of the trigeminal nerve trunk in the treatment. Also, the main direction is to ensure a constant outflow of purulent contents from the tympanic cavity. For this purpose, paracentesis is performed. In severe and advanced cases, an opening of the mastoid process is used.

If not produced timely treatment otitis media, and inflammatory process persisted for more than 3 weeks, then there is a high likelihood of facial paralysis due to mastoiditis or toxic damage to the trigeminal nerve. In the presence of a persistent violation of the motor ability of the muscles, surgical intervention is performed - the elimination of the damaging factor of the nerve in the bone cavity.

Movement disorders, in particular paresis, respond well to integral therapy. The effectiveness directly depends on the start time and duration of the course, as well as on the degree of damage to the trigeminal nerve. In the case of a timely start, the percentage of recovery reaches 80%.

The therapeutic course consists of the methods of physiotherapy and reflexology. In particular, electro- and acupuncture, acupressure, electromassage and the use of a laser are widely used. V individual cases they use courses of electrophoresis, magnetotherapy and mud procedures.

The main effects of these procedures are aimed at:

elimination of the inflammatory reaction and swelling of the nerve and surrounding tissues;
activation of blood circulation and delivery of nutrients to nerve cells;
stimulation of recovery processes in the trigeminal nerve;
increasing the level of local immune protection;
elimination of concomitant pathology.

Physiotherapy and reflexology used to treat the disease can be applied to every person. Their properties ensure safety in combination with high efficiency for the body. In addition, their regular use in parallel with medications has positive influence not only to the affected area, but also to the body as a whole. Physiotherapy can also reduce adverse reactions after taking medications.

The consequence of the full course of treatment is an improvement in the motor activity of facial muscles, a decrease or absence of facial asymmetry and other manifestations of the disease, restoration of the functions of the trigeminal nerve and elimination of concomitant pathology, which became a causative factor in the onset of paresis.

Facial nerve paresis in children

Facial nerve paresis in children can be congenital or acquired in origin. Like adults, the main reason the development of paralysis is considered to be trigeminal neuritis. At the same time, it should be noted that the restoration of the lost functions of the nerve in childhood occurs much faster and more often than in adults. In newborns, the incidence of the disease is at the level of 0.1-0.2%, almost all of which are due to birth trauma.

The provoking factor for the occurrence of paresis is the use of forceps during childbirth and the inappropriate size of the woman's pelvis to the head of the fetus. In addition, this group includes an overweight of the fetus (from 3.5 kg), hemorrhage in the brain tissue, intrauterine trauma, a long anhydrous period of labor and the damaging effect of drugs or radiation on the body of a pregnant woman. A pathognomonic sign of the traumatic nature of the development of paresis in newborns is hematotympanum and hemorrhage behind the ear.

The tactics of influencing paresis of the facial nerve in children depends on the cause of the pathology. In the case of a congenital anomaly, the chances of recovery are not high enough and treatment does not imply emergency surgical intervention... Diagnosis of paresis should include certain methods that can confirm or exclude the disease. You need to start with an assessment general condition baby, identifying all neurological symptoms, as well as identifying concomitant diseases. Then you should use additional instrumental methods diagnostics, such as: electroneurography, EMG and tomographic methods of visualization of foci.

Electroneurography should be performed in the first two days after birth. If there is a reaction of the distal part of the nerve in response to stimulation, then the cause of the development of paresis was trauma. The probability of complete restoration of the lost functions of the trigeminal nerve reaches 100%. If the cause of the paralysis is serious congenital anomalies that cannot be corrected, then the facial nerve is unable to perform its functions.

To make a diagnosis, they also use the questioning of parents for the presence of craniofacial pathology or anomalies in the development of the nervous system in relatives. In some cases, a muscle biopsy may be used.

The facial nerve passes in a narrow canal, which causes it possible defeat with infections, injuries, hormonal disruptions. When this occurs, paresis of the facial nerve (paralysis) occurs, with possible painful sensations. This disease usually involves weakening facial muscles; its symptoms are noticeable: one half of the face "sags", folds are smoothed out on it, and the mouth is twisted to one side. With a pronounced degree, it becomes difficult to cover the eye with the eyelid.

The disease has an acute course, develops in a few hours and lasts two weeks (as can be judged by the patient's medical history), after which the symptoms, under therapeutic influence or on their own, weaken and go away. Treatment should be prescribed from the first days of the appearance of paresis - in order to avoid the development of complications.

If doctors talk about paresis, they mean weakening of function. Paralysis means its complete loss and the absence of voluntary movements.

When paresis develops

The main possible reasons, due to which the disease develops:

traumatic brain injury;
infectious diseases (borreliosis, herpes, chicken pox, flu, measles, etc.);
hypothermia (mainly, the development of infection occurs against its background);
circulatory disorders, stroke;
otitis;
neurosurgical treatment;
inflammation of the brain and its membranes;
tumors and cysts that can compress the nerve;
hormonal imbalance;
autoimmune diseases.

In the event that paresis of the facial nerve is diagnosed in a newborn child, birth trauma is the main cause. Much less often, nerve damage occurs in utero due to infection, developmental anomalies. In an older child, the disease can develop against the background of otitis media (since the canal of the facial nerve originates in the internal ear canal) or during chickenpox (the facial nerve is affected by the varicella-zoster virus).

If symptoms of paresis (paralysis) of the facial nerve are recorded, the doctor is faced with the task of finding the causes of this pathology, since it can be concomitant with a serious disease ( tick-borne borreliosis, stroke, tumor). But in most cases exact reasons remain unknown.

Disease types

Facial nerve paresis is divided into two types:

peripheral;
central.

The first is the most common; it was his symptoms that were described at the beginning of the article. Other signs that accompany the disease:

swelling of the cheek when pronouncing vowels (sail syndrome);
rolling the eye up when trying to close it (lagophthalmos);
pain symptoms in some areas of the face, behind the ear and in the ear, back of the head, eyeball;
impaired diction;
leakage of saliva from the corner of the lips;
drying out of the oral mucosa;
hypersensitivity to sounds, ringing in the ears;
hearing loss;
decreased taste sensitivity;
symptoms of eye damage on the sore side: lacrimation or, conversely, drying out of the mucous membrane.

V easy stage peripheral paresis of the facial nerve is sometimes difficult to establish. To do this, a series of tests is performed: they close their eyes and assess how difficult it was to do it (one eye can be covered with effort), stretch their lips with a tube, frown their foreheads, puff out their cheeks.

Central paresis affects the lower part of the face - one (it is opposite to the focus) or both.

Its main symptoms:

weakening of the muscles of the lower facial part;
hemiparesis (partial paralysis of half of the trunk);
the safety of the eye and muscles of the upper facial part;
unchanged gustatory sensitivity.

Central paresis is mainly due to or associated with a stroke.

Diagnostic procedures

Treatment of the disease should begin as soon as it is identified. Sometimes paresis of the facial nerve can go away on its own, but in what cases it will happen is difficult to predict.

The symptoms of the disease are quite bright, but before treating, it is necessary to try to determine the reasons that caused the paresis (paralysis). In some cases, the elimination of the underlying disease leads to the restoration of the function of the facial nerve (this can occur, for example, with a brain tumor). For this purpose, tomography (computer or magnetic resonance imaging) is performed.

In addition, an examination of reflexes on an electroneuromyograph should be prescribed. The procedure allows you to assess the speed of passage of impulses along the fibers, their number, as well as the localization of the lesion. One of the ways to determine the degree of paresis (paralysis) is to conduct electrogustometry.

This procedure is performed on an electrodontometer. An anode is applied to the front of the tongue, the electrodes are located 1.5 cm from the midline. The current strength is gradually increased until the patient registers a sour or metallic taste.

Paresis therapy

Treatment in the acute period is aimed at relieving edema and inflammation, improving microcirculation. For these purposes, apply:

corticosteroids;
diuretics;
antiviral drugs (if the disease has arisen against the background of herpes or chickenpox);
antibiotics (with the development of paresis during infection, otitis media).

Gymnastics and massage can be prescribed no earlier than the third day from the onset of the disease and only under the supervision of a doctor, since self-treatment and improper use of techniques threatens the appearance of contractures and synkinesis.

The phenomenon of contracture is an increased muscle tone with pain on the affected side and twitching of facial muscles. There is a feeling of tightening of the face.
Synkinesias are movements that appear simultaneously with the main ones. This may include wrinkling of the forehead or raising the corner of the mouth when closing the eyes. Either raising the auricles or inflating the wings of the nose when closing the eyes with effort, etc.

These complications appear, as can be found out from medical histories, in 30% of all cases of paresis of the facial nerve. If this happens, massage and physiotherapy are temporarily canceled and the muscles are rested.

The principles of gymnastics and massage

Remedial gymnastics consists of some techniques. This could be:

puffing up of the cheeks (alternate, simultaneous);
snort, pronunciation of the letter "p" with a delay initial stage movement;
manual assistance in performing movements (when closing the eyes, wrinkling the forehead, etc.), which is performed by a specialist.

One of the recovery methods is post-isometric muscle relaxation, which is an alternating short-term isometric work of muscles and their passive stretching after. This type of gymnastics is performed only under the supervision of a doctor, since it has many nuances in its conduct, failure to comply with which threatens the appearance of complications.

The main massage is performed from the inside of the mouth, which allows you to identify the muscles and increase blood circulation in them. In addition, acupressure since the classic can lead to muscle strain.

V recovery period also prescribe drugs of group B and alpha-lipoic acid, UHF, phonophoresis.

If the lesion is severe, treatment should be directed to keeping the eye on the diseased side of the face. Drops are used to eliminate and prevent dry mucous membranes, but if the eyelid does not drop at all, this threatens the development of keratopathy and blindness. Doctors can suture eyelids together, inject into upper eyelid implants for its forced lowering. At the present time, the introduction of botulinum toxin is popular, which lasts 2-3 weeks. Injections are also effective against contractures and can be used to aesthetic correction persons subsequently.

In the acute period of the disease, it is not recommended to act on the affected side of the face mechanically, using such treatment methods as massage and gymnastics. At home, you need to use a patch that fixes the weakened muscles on the sore side of the face. The doctor will show you how this is best done.

Features of the course of the disease and treatment in childhood

A disease in children that is secondary in nature (that is, another disease acts as the cause of its occurrence), as a rule, is accompanied by pain in the parotid region. In some cases, pain and discomfort on various parts of the face and the back of the head, depending on the localization of the nerve lesion.

In a child, paresis of the facial nerve usually goes away faster than in an adult.... In this case, complications may be completely absent or their degree may be minimal. Symptoms of the disease in childhood more often than in adults can regress on their own. However, it is necessary to treat paresis, since there are no guarantees that it will go away without therapy.

In a newborn who has received nerve damage during childbirth, in addition to visual signs, there are lesions of some reflexes: palatine, search, sucking, proboscis. The complication that occurs with this pathology in an infant is the difficulty or complete impossibility of sucking on the mother's breast. In this case, feeding is carried out from a bottle with a lightweight teat.

Therapy

They begin to treat paresis even in the maternity hospital. standard scheme... In some cases, doctors do not use corticosteroids because their use in infancy can lead to complications.

A child with facial nerve damage often suffers from hyperacusis - it is necessary to protect him from loud noises and do not use rattles.

After the maternity hospital, paresis continues to be treated on an outpatient basis: during the recovery period, massage and physiotherapy can be prescribed. At home, parents have access to remedial gymnastics, with the help of which reflexes are triggered in a child.

The palmar-oral reflex is triggered by pressing the parent's fingers in the middle of the child's palm: the baby's mouth opens slightly.
To call the proboscis reflex, you need to easily touch your baby's lips with your finger: at the same time, his lips should stretch out into a tube.
The search reflex is triggered by stroking the baby's cheek near the corner of the lips, after which the baby moves his mouth towards it.
The sucking reflex is formed by the pacifier.

Also, at home, parents continue treatment with medications prescribed by a doctor. Massage, warming up and any other influences should not be carried out on their own - only in the clinic with a specialist. This will avoid the appearance of contractures and synkinesis.

If the pathology at birth is diagnosed as congenital, then surgical treatment is indicated.

So, paresis of the facial nerve - pathological condition, which occurs acutely and is characterized by a weakening of the muscles of one side of the face (peripheral paresis) or the lower facial part (with the central type). The reasons for this phenomenon often remain unclear, but tumors, infections, neurosurgical interventions, and in newborns - birth trauma can act as them. They begin to treat the disease with medication from the first day in order to avoid complications. During the recovery period, massage and therapeutic exercises can be added.

Facial nerve paresis- This is a disorder in the work of the nervous system, in which the performance in the facial muscles is impaired. In most cases, the symptoms of the disease appear on one side.

The cause of the pathology is trauma to the trigeminal nerve, which leads to impaired transmission of nerve impulses. The patient can independently determine paresis of the facial nerve due to pronounced symptoms.

Facial nerve paresis can be independent disease or a symptom of other pathological processes that occur in the patient's body. The disease develops with idiopathic or secondary lesions.

The onset of paresis of the facial nerve is diagnosed with hypothermia of the head. The disease develops against the background:

Syphilis;
Poliomyelitis;
Tuberculosis;
Parotitis.

With the pathogenic activity of the herpes virus, a pathological process occurs in patients. It develops against the background of otitis media, which affects the nerve fiber. A common reason diseases are respiratory diseases. The disease is observed with head injuries, which have varying degrees of severity. If surgical intervention is performed incorrectly in the face area, then this leads to the development of pathology.

Paresis of the facial nerve is diagnosed when there is a violation of blood circulation in the face. Such a pathological process develops when diabetes mellitus... At risk are patients with. The disease appears in people after a hypertensive crisis. It is diagnosed against the background of ischemic stroke. The appearance of pathology is observed after dental operations.

There are various causes of paresis of the facial nerve, which are recommended to be determined in order to prescribe an effective treatment for pathology.

Types of pathology

Paresis of the facial nerve is divided into several types in accordance with the characteristics of the pathological process. He can be:

Congenital. This form of paresis of the facial nerve is extremely rare. If the pathology is mild or moderate, then the treatment is carried out using massage and gymnastics. With the help of these manipulations, blood circulation is stimulated and the functioning of the nerve is restored. In a severe form of pathology, an operation is recommended.

Peripheral. This paresis of the facial nerve is diagnosed in most patients, regardless of their age. Patients complain of severe pain behind the ears, which most often manifests itself on one side. The appearance of facial paresis is diagnosed against the background of an inflammatory process, which leads to swelling of the nerve fibers.
Central. This form of facial paresis is characterized by heavy course and difficulties in treatment. With the disease, the muscle structures of the face atrophy, which leads to sagging skin... In this case, there is no damage to the forehead and the visual apparatus. The disease appears when the neurons that are in the brain are damaged.

Paresis of the trigeminal nerve is characterized by the presence of several types, which are recommended in mandatory determine for the appointment of effective therapy.

The degree and symptoms of the disease

With paresis of the facial nerve, patients experience pronounced symptoms. It manifests itself in accordance with the severity of the pathological process, which can be:

Lightweight. Facial paresis is characterized by mild symptoms. In some cases, a slight misalignment of the mouth from the side of the lesion is diagnosed. The patient closes his eyes and frowns with effort.
Average. With paresis of the facial nerve of this degree, the appearance of lagofalm is observed. In humans, there is a significant decrease in the mobility of the facial muscles. Patient cannot move lips or puff out cheeks.
Heavy. With facial paresis, there is a pronounced asymmetry of the face. In patients, the mouth is severely skewed. From the side of the lesion, the organ of vision does not completely close.

With paresis of the trigeminal nerve, the appearance of common features... In patients, the nasolabial fold is smoothed and the corner of the mouth is lowered. On the affected side, the eye swings open strongly and unnaturally. During the period of food intake, it is observed to fall out from the side of the lesion of the mouth.

A sick person does not succeed in wrinkling the forehead much. Patients complain that with paresis of the facial nerve, they have a decrease or complete absence of taste. The disease is accompanied by an exacerbation of the auditory function.

With pathology, lacrimation is observed, the intensification of which is noted during meals. If a person is asked to fold his lips into a tube, then he will not be able to do this. The appearance of pain syndrome is observed behind the ear.

With facial paresis, pronounced symptoms are observed, which allows the patient to independently determine the disease. At the first signs of illness, he should consult a doctor. Only an experienced specialist, after diagnostics, can prescribe an effective treatment.

Treatment of the disease

With paresis of the facial nerve, the diagnosis is made in accordance with its symptoms. The patient is advised to consult with an otolaryngologist, which will provide an opportunity to exclude the course of pathological processes in the ear. To determine the cause of facial paresis, it is recommended to conduct laboratory analyzes blood, electromyography, head scan.

The effectiveness of the treatment of paresis of the facial nerve directly depends on the timeliness of the patient's request for medical help... If the disease acquires chronic form, then he will not be able to get rid of the asymmetry of the face.

Drug therapy

If the patient is leaking acute form pathological process, then it is recommended to treat it using medications... The causes of the disease, the elimination of which the therapy is directed to, are preliminarily determined. With its help, puffiness and inflammation are removed, and the regeneration process is also activated. nerve cells. Treatment of paresis of the facial nerve is carried out:

Analgesics. Drugs are used for severe pain syndrome. Treatment of the disease is carried out with Ketorol, Baralgin, Spazgan.
Corticosteroids. Medicines of this group are used if the patient has severe or moderate paresis of the facial nerve. The therapy is carried out with Prednisolone, with the help of which the removal of inflammation and edema is ensured as soon as possible.
Decongestant medicines. To combat puffiness, the use of Triampur or Furosemide is recommended.
Vasodilator drugs. The drugs help to restore blood circulation in the damaged area and speed up the treatment process. Patients are recommended to receive nicotinic acid or Complamin.
Sedative medicines. Taking the drug is recommended if the patient has high anxiety. It can be eliminated with the help of Relanium or Sibazon. They have a calming effect, which ensures relaxation of the patient.
Vitamin and mineral complexes. During the course of the pathological process, patients are prescribed B vitamins.
Artificial tears. The use of medications is recommended in case of damage to the organs of vision. They are used to exclude the possibility of developing a secondary infection and help moisturize the mucous membrane.

With paresis of the facial nerve, the selection of medications is carried out by the doctor in accordance with the causes and severity of the pathological process.

Surgical intervention

To achieve high therapeutic effect surgical intervention is recommended within 12 months after the onset of the disease. If you delay the operation, it will lead to atrophy of the muscles that the nerve cannot control.

In the event of a rupture during the operation, the nerve is sutured. In congenital pathology, autotransplantation is recommended. During surgical intervention A graft is taken from the patient's leg and sutured into the face. At the next stage, the branches of the nerve are sutured to a healthy area. Thanks to the operation, one nerve will control facial expressions. After the surgery, only a small scar is observed behind the ear.

Physiotherapy

At early diagnosis of the pathological process, Sollux is used for its treatment, which is a special lamp. With the help of the device, phototherapy is carried out. After completing the course, patients are assigned UHF, phonophoresis and paraffin therapy.

Acupuncture is characterized by a high effect of influence in the fight against the disease. This technique is based on the introduction of special needles into the area of the affected nerve and others acupuncture points on the body. With the help of manipulation, an improvement in blood circulation in the affected area is ensured.

The use of homeopathy is recommended as an aid in pathology. The most commonly used drug is Heklsemium. Its use is permitted only after prior consultation with a doctor. otherwise, facial distortion may occur.

When paresis is wide psychotherapy is used... This is due to the fact that the symptoms of the pathological process negatively affect the psychoemotional state of a person. This leads to a decrease in self-esteem and the development of depression. If it is not possible to eliminate it with the help of sedative drugs, then the patient is advised to seek help from a psychotherapist.

To improve muscle function in case of illness, massage is recommended. The use of the technique is allowed only after a week after the onset of the disease. To ensure the maximum effectiveness of therapy, it is recommended to consult a specialist. Also, with paresis, it is allowed self-massage.

Initially, the neck and the back of the head are massaged, and then gradually move to the face. Simultaneous massage from the healthy and the sick side is recommended. In the area of the lymph nodes, massage is not performed. If the patient has muscle soreness, then a light and superficial massage is recommended. It is recommended to pay special attention to the mastoid process during the manipulation.

It is a serious pathological process that negatively affects a person's appearance, which leads to the occurrence of psychoemotional disorders. That is why, when the first symptoms of the disease occur, the patient is advised to seek help from a specialist. Only a doctor, after conducting appropriate examinations, will make the correct diagnosis and determine the type of disease. This will allow the development of an effective treatment regimen, taking into account individual characteristics the patient and the severity of the disease.

This pathology, in essence, is an inflammation of nerve fibers that are responsible for the work of facial muscles. This condition affects the patient's ability to adequately express emotions: he is not able to laugh, frown, and even chew food.

Facial nerve paresis is more often diagnosed in the cold season. It can take about 6 months to fully recover, and in 5% of cases, the disease is not cured.

Causes of paresis of the trigeminal nerve - what can provoke pathology

The entire list of factors that lead to the appearance of the ailment in question is divided into two large groups:

Idiopathic (primary) lesion

It occurs due to hypothermia of the area around the ear - or a certain part of the head.

This phenomenon often happens when you are under an air conditioner for a long time, or near open window in transport.

Secondary defeat

It occurs against the background of injury or inflammation.

Risk factors are the following diseases:

The harmful effects of paramyxovirus in mumps.
Spinal paralysis.
Alcohol abuse.
Tuberculosis.
The period of bearing a child. The first three months of pregnancy are accompanied by sharp hormonal changes in a woman's body, which can negatively affect the nervous system.
Violations of the integrity of the facial nerve with certain dental procedures: tooth extraction, root canal therapy, etc.
Syphilis.
Surgical manipulations in the face area.
Injury to the head or ear. In newborns, such an injury is possible with prolonged pressing of the face against the bony protrusions of the pelvis in the process generic activity... This scenario is possible if a woman carrying a child has too narrow birth canals, and the birth itself is delayed for a long time.
Herpes.
Regular stay in stressful situation... Stress not only negatively affects the functioning of the nervous system, but also helps to reduce defense reactions organism.
Atherosclerosis. Blockage of blood vessels can lead to a limited supply of oxygen to the nerve fibers, which leads to their death.
Pathological neoplasms in the brain. It is extremely rare that they can provoke the indicated ailment, but this factor should not be ruled out. Squeezing the trigeminal nerve by the tumor leads to the impossibility of full impulse conduction.
Upper respiratory tract infection: sinusitis, sinusitis, etc.

In addition, the ailment in question may develop due to degenerative processes associated with the blood supply to the face.

Such negative phenomena often occur against the background of the following diseases:

Diabetes. It is a consequence of the formation of foci of inflammation.
Leads to oxygen starvation of the brain, the death of nerve cells.
Multiple sclerosis.
Sharp rise blood pressure... Capable of provoking an increase intracranial pressure, which harms the nuclei of the facial nerve.

Signs and symptoms of facial nerve paresis in newborns, children and adults

The clinical picture of this pathology will be determined by the affected area of the facial nerve:

Inflammatory foci that concentrate in the nucleus of the trigeminal nerve are manifested by weakness muscle tissue faces.
With the simultaneous pathology of the auditory nerve, the patient complains of hearing impairment.
If the degenerative process affects the root of the trigeminal nerve, as well as the nucleus of the abducens nerve, paralysis of the muscle tissue of the face is complemented by strabismus.

In addition, the general symptomatology will be determined by the disease that provoked paresis of the facial nerve:

1. If the main "culprit" is herpes DNA, the patient complains about:

Painful sensations inside the ear, which spread to the back of the head, neck.
Rash on the mucous membrane of the mouth, in the area of the external auditory canal.
Partial loss of sense of taste.
Tinnitus.
Dizziness.
Decreased hearing acuity.

2. If neuritis has developed against the background of "mumps", the following symptoms will occur:

Increased body temperature.
Prostration.
Regular pain in the head.
Enlargement of soft tissues in the behind-the-ear area.

3. If otitis media is the cause of facial nerve paresis:

There are regular shooting pains in the ears, which are combined with impaired facial expressions.

4. In Melkerson-Rosenthal's disease, in addition to trigeminal neuritis, the patient is diagnosed with:

An increase in the parameters of the language, its lumpy structure. It is a congenital defect and does not cause discomfort to the patient.
Dense swelling of the face.

In general, regardless of the ailment, against the background of which paresis of the facial nerve has developed, the following phenomena will be noted in the affected area:

Lack of clear contours in the area of the nasolabial fold.
Descent of the corner of the mouth.
Inability to close the eyelids in the affected area. When trying to do this, the eye suddenly begins to turn upward.
Hearing hypersensitivity: loud sounds cause discomfort to the patient.
Slurred speech against the background of the inability of the mouth to fully participate in the articulation of sounds.
Failure to act on facial muscles. All attempts to smile, raise an eyebrow, fold lips into a tube remain unsuccessful. In addition, food and liquid flows out from the slightly open corner of the lips.
Constant dryness of the eyes. In some cases, lacrimation is noted when eating.
Regular cheek biting while eating. This is due to the fact that nerve impulses do not go to the muscles of the cheek - the patient is not able to control them.
Increased salivation (not always). Often a person experiences constant thirst, he is tormented by dry mouth. This is due to twisted impulses that travel from the brain to the salivary glands.

In newborn babies, this pathology makes itself felt especially clearly when screaming, crying, or laughing. During the feeding process, the affected area of the mouth does not completely cover the breast, which leads to the flow of milk.

In a similar way, saliva, lacrimal fluid can drain.

Depending on the severity of the symptoms of the ailment in question, doctors distinguish three degrees of it:

Easy... The manifestations of pathology are often limited to a slight distortion of the mouth, difficulties in moving the eyebrows, and closing the eyes.
Average. Characteristic feature This stage is the inability to move lips or puff out cheeks. The patient cannot close the eyelids completely. Forehead skin movement is limited.
Heavy... There are no elementary movements in which the mimic muscles are involved. The forehead remains motionless, the mouth is noticeably skewed. Attempts to close the eye are accompanied by raising the pupil upward. In some cases, the muscles of the neck, forehead, and wings of the nose may be involved in the pathological process.

Types of paresis of the facial nerve in the medical classification - features of the clinical picture and symptoms

There are three main types of the disease in question:

Peripheral (Bell's palsy). The most common type of neuritis of the trigeminal nerve today. Occurs as a result of extensive inflammation that leads to swelling nerve structures... Patients initially complain about pain in the behind-the-ear region. During palpation of the specified area, the doctor determines the weakness of the muscle tissue. Peripheral paresis of the facial nerve can affect children and the older generation.
Central. Distinctive features is the patient's ability to fully move the forehead skin, to distinguish taste. Visual function are also saved. However, in general, this form of trigeminal neuritis is characterized by a rather aggravated course and complex treatment... Against the background of muscle tissue atrophy, sagging of the skin occurs, which are located below the nose. Possible unilateral and bilateral lesions in both children and adults.
Congenital... It is diagnosed extremely rarely, and therapeutic measures are often limited to gymnastics and massage. If the disease manifests itself in a severe degree, they resort to surgical procedures.

Based on the area of the lesion, the indicated ailment may be:

Unilateral... Affects the right or left side of the face.
Bilateral. It occurs in 2% of cases.

What is the danger of trigeminal paresis in children and adults - the prognosis for paresis of the facial nerve in children and adults

It can take a lot of time and effort to treat the ailment in question, however, if all the doctor's orders are followed in 75% of cases, complete recovery occurs.

In cases where the pathology has not receded after 3 months of therapy, the prognosis is less optimistic.

Inadequate - or untimely - treatment can cause a number of complications:

Contracture of facial muscles. It can develop in the absence of any improvement one month after the onset of the disease. In this case, the muscle tissue contracts, which is accompanied by soreness and distortion of the shape of the eye and nasolabial fold. For preventive purposes, it is recommended to warm up the affected area, as well as daily self-massage.
Muscle tissue atrophy. Similar negative phenomenon develops a year after the defeat of the trigeminal nerve as a result of muscle inactivity and oxygen starvation. This process is irreversible, therefore, in order to exclude atrophy, the patient should do special exercises and massage every day.
Uncontrolled contraction of the eye muscles.
Inflammation of the conjunctiva - or the cornea. This is due to the strong drying out of the eye shell as a result of a violation of the process of tear production.
Disorders associated with the isolation of electrical impulses in the branch of a nerve, which contributes to the propagation of electrical impulses along the wrong fibers. This condition is called facial synkinesis. This can manifest itself in different ways: "crocodile tears", raising the corner of the mouth when closing the eyelids, deformation of the wings of the nose when chewing, etc.

The human nervous system has a huge number of nerve endings and branches that tend to inflame and cause a person inconvenience and suffering. This article will focus on paresis of the facial nerve, the symptoms and treatment of which will be considered in more detail, however, everything in order ...

Facial nerve paresis is a condition that changes appearance the patient (due to the skewing of the facial muscles, for which the nerve is responsible), impaired sensitivity, and in some cases, problems with salivation, tears and taste.

Do not confuse facial and trigeminal nerves since they have nothing to do with each other. The trigeminal has three branches, while the facial has two. It should be noted that paresis often develops on one side.

This disease, in most cases, is a consequence of the ongoing infectious process. It cannot be classified as rare, although it cannot be said that it is found everywhere either. On average, one hundred thousand healthy people there are up to twenty patients.

In terms of gender, the disease has no preferences; both men and women suffer from it equally. To a greater extent, the disease occurs in persons over forty years of age, but it can also occur in a child. There is evidence of the occurrence of such a disease not only in older children, but also in a newborn.

In the case of a newborn, the main reason for the development of paresis is not an infection, but a birth trauma, for example, the use of forceps to remove the baby or careless actions of medical personnel, etc.

Infectious diseases can also cause the development of this pathology, however, usually such diseases are transferred by the mother, during the period of bearing the child.

Types of paresis of the facial nerve

Depending on the severity of the injury, its location or the nature of its occurrence, there are three subspecies of paresis, including:

Peripheral paresis.
Central paresis.
Congenital paresis.

Peripheral paresis

Peripheral paresis of the facial nerve is the most common form of the disease, which occurs in more than 60% of the total number of patients.

It is characterized by pain behind one of the ears, on one side of the face. On palpation of the muscles, their weakness is clearly diagnosed.

Most famous name this violation-. The cause of the occurrence is an inflammatory process that causes an edematous state of the nerve fiber. As a result, the nerve impulses that the brain sends to this part of the face pass weakly, with a delay, or do not pass at all.

This type of disease can be found equally often in both an adult and a child.

Central paresis

The name central paresis (central prosoparesis) does not make you think for a long time where this type of disease is located. It was called central for a reason. Everything that is located below the nose, as a rule, has a saggy shape, with palpation, the muscles are tense. However, despite the not entirely aesthetic appearance, the taste buds are not affected. The patient is able to distinguish between tastes.

The peculiarity of this species is that it is difficult to treat. It will take a long time to treat it and use it. a large number of options.

It is also worth noting that anything above the nose is not damaged. The patient can calmly strain the facial wrinkles of the forehead, the eye muscles also do not suffer. The eye closes completely (there is no evidence of a loose eyelid closure). The patient, as well as with the previous type of the disease, does not have a loss of taste.

Central paresis of the facial nerve usually develops on one side, however, bilateral damage is not excluded.

The cause of central paresis is damage to the neurons of the brain, which, in turn, can occur under the influence of all sorts of factors (inflammation, swelling, trauma, etc.).

The disease develops more often in adults, but there are cases of the development of the disease in children.

Congenital paresis

This type of ailment is typical for a newborn. nursing baby, because before reaching an older age, the inconveniences caused by paresis, one way or another, will force the parents to eliminate this pathology.

Congenital paresis has three options:

Mild (the patient has to make an effort to perform a simple frown).
Moderate (trouble puffing out the cheeks, lip or lips not moving).
Severe degree (pronounced skewing of the face to one side, inability to completely close the eyes).

With the first two subspecies, the appointment of a facial massage in conjunction with remedial gymnastics, which parents can independently perform at home.

Congenital paresis in a baby

To heal a child from severe congenital paresis of the facial nerve of a severe degree, simple exercises Exercise therapy and massage will, alas, not be enough. In the vast majority of cases, an operation will be required.

You should not be afraid of this procedure, in modern conditions it is carried out professionally and without consequences for the appearance of the baby.

Causes

As mentioned earlier, the main cause of damage to the facial nerve is the inflammatory process, which leads to paralysis and the development of these symptoms. However, inflammation is already a consequence, and there may be several reasons.

First, let's figure out the nature of development, so paresis can be:

Idiopathic (of unknown origin).
Secondary (arising from provoking factors).

Secondary, in turn, can arise as a result of:

hypothermia of a person, especially his face (this can happen, in any situation, when walking in the cold, being long time in a cold room and even when driving with an open window);
otogenic nature or otogenic neuropathy (develops as a result of parotid diseases and ear diseases, as well as complications after surgery);
the influence of herpetic lesions (the most rare provoking factor).

In addition, paresis can be provoked by:

polio;
mumps;
allergy;
Acute respiratory infections of the upper respiratory tract;
traumatic brain injury;
syphilis;
the presence of tumor processes inside the base of the skull (cyst, benign tumor etc.);
tuberculosis.

Also, as a result of the development of certain diseases, there are problems with the blood supply to the face, which is also the cause of neuritis of the facial nerve. Diseases provoking such a violation:

multiple sclerosis;
ischemic stroke;
hypertensive crisis;
diabetes.

Even a banal tooth extraction can lead to the development of paresis.

Symptoms

Paresis of the facial nerve is marked by a rather specific symptomatology, which is characteristic only of him. Depending on the severity of the disease, the disease may not manifest itself at all, but as the severity increases, it may show symptoms.

There are three types of the course of the disease:

The acute stage, which is characterized by a maximum exacerbation of symptoms (last no more than two weeks).
Subacute (lasts about a week).
Chronic (put in the case when the symptoms do not go away for more than a month).

The main symptoms of the disease:

smoothing of the nasolabial septum;
omission of the corner of the mouth (if we are talking about peripheral paresis);
inability to close the eyes to the end (white is visible);
violation of taste buds (partial or complete loss occurs);
problems with watery eyes (it can stop completely, resulting in dry eyes or watery eyes when chewing food);
weakness of the labial muscles (for example, when you try to fold your lips with a tube, food falls out);
the face may acquire a semblance of a mask (wrinkles are smoothed out and when you try to frown, nothing happens).

At the very beginning of the disease, an exacerbation occurs. ear pain, and also a painful condition develops behind the ears.

Diagnostics

For precise definition ailment will require consultation of three specialists:

Neurologist.
Otolaryngologist.
Therapist.

The main doctor is a neuropathologist, who is directly involved in the examination and the appointment of diagnostic procedures, which include additional consultations with an ENT doctor and a therapist.

Such advisory measures are necessary to exclude pathologies of the ear cavity, diseases of the nose and throat, as well as to exclude the definition of concomitant diseases.

The basis of the diagnosis is the examination of the patient and his questioning, since the nature of the visual examination makes it possible to make the correct diagnosis with an accuracy of up to 80%.

Paresis severity assessment scale

In addition to an external examination, hardware diagnostics can be assigned, including:

Electromyography.
MRI of the head.
CT of the head.

Treatment

Treatment of paresis of the facial nerve directly depends on how much the patient pulled before seeking help. The longer the disease progressed, the more chances that the patient will have the disease forever and it will not be possible to return to the previous condition without surgery.

There are the following types of therapy:

drug therapy (pills, injections);
physiotherapy;
massage;
surgical intervention.

Drug treatment is the main way to eliminate the disease and includes measures to eliminate the cause of paresis and relieve symptoms. For these purposes, the patient can be prescribed:

pain relievers (analgesics or antispasmodics);
decongestants (triampur, furosemide);
corticosteroid drugs (prednisone, used to relieve pain in severe cases);
drugs that dilate blood vessels (nicotinic acid);
sedative medications (needed to calm the patient down);
complex of vitamins.

If there are problems with lacrimation, the patient is recommended to use special ophthalmic drops - "artificial tear".

Girl on physiotherapy treatment

Physiotherapy treatment helps to restore the sensitivity of the muscles on the face, which includes:

paraffin therapy;
phonophoresis;
application of the Sollux lamp.

It is worth noting that treatment with physiotherapeutic agents begins with the use of a Sollux lamp, for one week, and after the end of this course, they switch to the use of other methods.

Also for babies, massage will have a good effect, which is indicated for mild to moderate illness. In the case of a severe degree, massage will be useless.

The main condition for massage is not to cause even more pain to the patient, therefore, massage actions should be light and without sudden movements.

It should be understood that any massage procedures should begin with a warm-up of the cervical spine and gradually move to the painful area.

It is necessary to massage not only the diseased part of the face, but also the healthy one. Everything massage movements should pass in the direction of movement of the lymph.

Gym exercises are an integral part of the treatment. It should be understood that with paresis, careless and abrupt movements can lead to pain, therefore, a gymnastic set of exercises should be selected and prescribed by the attending physician.

Gymnastics options for the face:

Raising and furrowing eyebrows.
Swelling of the cheek from the side of the lesion, in addition, it is necessary to provide external resistance to swelling with the help of the hand.
Pulling the lips forward.
Open and close your eyes tightly.

Without fail, in the patient's daily routine, there must be exercise, which is better done daily.

Daily exercise and exercise have never harmed the body.

In the event that medications, classes and massage do not help, or the development of a severe pathology is observed, surgical intervention is indicated.

Gymnastic exercises

There are several types of operation:

elimination of pinching;
Suturing the torn nerve (rupture can occur due to trauma);
replacement of the affected area with a healthy one.

As for the first two options, everything is clear here, the doctor either eliminates the cause of the pinched facial nerve, or connects the damaged nerve.

In the case when the affected area is no longer possible to resuscitate, doctors may resort to replacing it.

In this situation, the patient himself acts as a donor, or rather, the nerves lower limbs... The neural process of the required length is removed from the patient's leg and sewn in instead of one of the facial sections.

Surgical intervention is performed with back side ear, and no scars that can affect the appearance will remain.

In addition, surgery may be required to eliminate the cause of the paresis, as a rule, this happens when there are disorders in the brain. Trepanation of the skull and other related procedures occur.

How to restore the facial nerve after surgery? This question is heard by many doctors when they make a diagnosis that does not imply the elimination of the cause of paresis, even surgically... In this situation, plastic surgery is indicated.

The achievements in this area are pretty good. Doctors return the patient to the opportunity to smile, but, naturally, disturbances in the facial nerve make themselves felt and it is difficult to fully recover in any case.

It is worth noting that psychotherapy is required for the patient in 80% of cases, since the patient begins to get nervous about his appearance, the load on the psyche increases many times over, the patient becomes nervous, irritable, his self-esteem falls. The basis of psychological rehabilitation is treatment with pills ( sedatives). If this is not enough, it is possible to use a counseling psychotherapeutic technique.

In addition to these treatment options, acupuncture and treatment with folk remedies are widely used in therapy.

Prevention and prognosis

Prepare for the emergence this disease it is extremely difficult, since it appears suddenly and for no apparent reason. However, there are several guidelines that can help you reduce your risk of developing the disease, including:

prevent the onset of the disease will help timely therapy with acute respiratory infections and acute respiratory viral infections;
timely protection against hypothermia, drafts and cold;
compliance with safety requirements in Everyday life will avoid TBI, and will reduce the risk of developing paresis.

The prognosis for this disease is quite favorable, however, a complete cure in a short period of time occurs in persons who started treatment immediately after the onset of the first symptoms.

In the event that the patient dragged on, there is a risk of contractures, which are eliminated only with the help of surgery. Regression of the disease is also noted when the patient quits treatment.

So, paresis of the facial nerve is a harmless, but unpleasant disease that causes the patient a lot of inconvenience, primarily of a psychological nature. Do not hesitate to see a doctor, thereby you will reduce the risk of complications and save more than one nerve cell.