It often happens that people with dissimilar facial features still have a lot in common in their appearance. For example, they may have the same smile, or they both wrinkle their foreheads when upset. This similarity is given to us by the same facial expressions, which are determined by the facial muscles of the face and the facial nerves by which these muscles are innervated. The site has prepared an article on the anatomy of the face, its muscles, nerves, blood vessels and the anatomical structure in general. It will help you learn more about your own physiology, structure and location of muscles, their contraction, and will also be useful for cosmetologists when studying muscles to perform a rejuvenating facial massage.
Anatomical structure of the face
The face is considered to be the section of the head, the upper border of which runs along the upper orbital edge, the zygomatic bone and the zygomatic arch to the auditory opening, and the lower border is the branch of the jaw and its base. To simplify this medical definition, it can be noted that the face is the region of the head, the upper part of which is the eyebrows, and the lower part is the jaw.
The following areas are concentrated on the face: the orbital (including the infraorbital region), nasal, oral, chin and lateral regions. The latter consists of: buccal, parotid-chewing and zygomatic regions. It also contains receptors for the visual, gustatory and olfactory analyzers.
Human face skeleton
No matter how well developed the facial muscles are, it is the skeleton that determines its appearance. Representatives of the stronger sex are characterized by a powerful bone skeleton, small size of the eye sockets and strongly pronounced superciliary arches, while women are distinguished by less pronounced facial bones, rounded eye sockets and wide short noses.
The skull can be divided into two sections: the bones of the skull and the bones of the face. The brain, eyes, organs of hearing and smell are located directly in the skull. The facial region of the skull or bones of the face - forms the skeleton of the face.
The human face consists of paired and unpaired bones. These include:
- upper jaw;
- palatine bone;
- cheekbone.
Unpaired:
- lower jaw;
- hyoid bone.
All bones are connected motionlessly to each other by sutures and cartilaginous joints. The only movable part is the lower jaw, which is connected to the skull by the temporomandibular joint. At birth, a person has a rounded face, since the bone skeleton is very poorly developed. Over time, it transforms, some cartilage is replaced by bone tissue. The formation of the face ends at 16-18 years for women and at 20-23 for men.
It happens that people are born with defects in facial bones and cartilage - their deformation due to various factors: birth trauma, or, for example, a genetic disease. The quality of life of such people is greatly deteriorating not only aesthetically, but also physiologically. With improper fusion of bones and nasal cartilage, breathing problems arise. Sometimes a person, having difficulty breathing in / out, begins to breathe through the mouth, which leads to negative consequences. This kind of problem is solved by plastic surgery, namely rhinoplasty.
Nerve branches on the human face
There are twelve pairs of cranial nerves in total. Each of them is designated in order of arrangement by Roman numerals. There are many nerve branches on the face, the functioning of which is closely related to the facial muscles. Inflammation of these nerves can lead to various changes in facial appearance and disruption of facial symmetry. Nerve fibers go from the nuclei to the musculature:
- olfactory nerve - to the organs of smell;
- visual - to the retina;
- oculomotor - to the eyeballs;
- block - to the superior oblique muscle;
- trigeminal - to the chewing muscles;
- abductor - to the lateral rectus muscle;
- facial nerve - to the facial muscles;
- vestibular-cochlear - to the vestibular section;
- glossopharyngeal - to the stylopharyngeal muscle, parotid gland, pharynx and posterior third of the tongue;
- wandering - to the muscles of the pharynx, larynx and soft palate;
- additional - to the muscles of the head, shoulder and scapula;
- the hypoglossal nerve innervates the muscles of the tongue.
1. The olfactory nerve.
Responsible for olfactory sensitivity. On the surface of the nasal mucosa are neurons of special sensitivity - olfactory. Sensorineural cells transmit information through the neural circuit to the anterior parahippocampal gyrus, which is the associative zone of the olfactory system. So, pleasant smells inevitably simultaneously cause the reflex of salivation, and unpleasant ones - vomiting, nausea. Perception is also closely related to the formation of the taste of food.
2. Optic nerve.
The fibers of the optic nerve begin in the neurons of the retina, pass through the vascular, white membrane of the eye and the orbit, forming the beginning of the optic nerve and the orbital part of the nerve in the fatty body, entering the optic canal. The fibers end in the occipital lobe. The optic nerve transmits impulses (the photochemical reaction of the rods and cones of the retina) to the visual center in the occipital cortex, where this information is processed.
3. Oculomotor nerve.
It is a mixed nerve with two types of nuclei. Proceeding from the lining of the legs of the brain, lying on the same level with the upper mounds of the roof of the midbrain, the nerve fibers are divided into two branches, the upper of which approaches the muscle lifting the upper eyelid, and the lower, in turn, is divided into three more branches, innervating the medial line the muscle of the eye, the lower rectus muscle and the oculomotor root, heading to the ciliary node. The nuclei of the oculomotor nerve provide adduction, lifting, lowering and rotation of the eyeball, innervating 4 of the 6 oculomotor muscles.
4. Block nerve.
Its nuclei emanate from the lining of the pedicles of the brain at the level of the lower mounds of the roof of the midbrain. It bends around the leg of the brain from the lateral side, leaves the gap near the temporal lobe, following to the wall of the cavernous sinus, enters the orbit through the superior orbital fissure. It innervates the superior oblique muscle of the eye. Provides eye rotation to the nose, outward and downward abduction.
5. The trigeminal nerve.
It is a mixed nerve, combining sensory and motor intermediate nerves. The former transmit information about the sensitivity of the facial skin (tactile, pain and temperature), nasal and oral mucous membranes, along with impulses from the teeth and temporomandibular joints. Motor fibers of the trigeminal nerve innervate the masseter, temporal, maxillary-hyoid, pterygoid muscles, as well as the muscle responsible for the tympanic membrane.
6. Abducens nerve.
Its nucleus is located at the back of the brain, projecting into the facial tubercle. The fibers exit in the groove between the bridge and the pyramid, through the dura mater of the brain, entering the cavernous sinus, enters the orbit, lying under the oculomotor nerve and innervating only one oculomotor muscle - the lateral rectus muscle, which ensures the retraction of the eyeball outward.
7. Facial nerve.
It belongs to the group of cranial nerves and is responsible for the innervation of the facial muscles of the face, the lacrimal gland, as well as the gustatory sensitivity of the anterior part of the tongue. It is motor, however, at the base of the brain, intermediate nerves are attached to it, which are responsible for taste and sensory perception. Damage to this nerve causes peripheral paralysis of the innervated muscles, which leads to a violation of the symmetry of the face.
8. The vestibular cochlear nerve.
It consists of two different roots of special sensitivity: the first carry impulses from the semicircular ducts of the vestibular labyrinth, the second - conduct auditory impulses from the spiral organ of the cochlear labyrinth. This nerve is responsible for the transmission of auditory impulses and our balance.
9. Lingopharyngeal nerve.
This nerve plays a very important role in the anatomy of the face. It is responsible for the motor innervation of: the peri-pharyngeal gland (thereby ensuring its secretory function), the muscles of the pharynx, the sensitivity of the soft palate, tympanic cavity, pharynx, tonsils, soft palate, Eustachian tube, as well as for the taste perception of the back of the tongue. In addition to the motor fibers of the sensory fibers inherent in the above-described nerves, the lingopharyngeal nerve also has parasympathetic ones. With fractures of the base of the skull, aneurysm of the vertebral and basilar arteries, meningitis and a number of other disorders, damage to the lingual nerve can occur, which leads to such consequences as loss of taste perception of the posterior third of the tongue and sensation of its position in the oral cavity, absence of pharyngeal and palatal reflexes, such as and other deviations.
10. The vagus nerve.
Contains the same set of nerve fibers as the lingopharyngeal: motor, sensory and parasympathetic. It innervates the laryngeal and striated muscles of the esophagus, as well as the muscles of the soft palate and pharynx. It carries out parasympathetic innervation of the smooth muscles of the esophagus, intestines, lungs and stomach, heart muscle, along with the sensitive innervation of a part of the external auditory canal, eardrum and skin behind the ear, as well as the mucous membrane of the lower part of the pharynx and larynx. Affects the secretion of the stomach and pancreas. Unilateral damage to this nerve causes sagging of the soft palate from the side of the lesion, deviation of the uvula to the healthy side and paralysis of the vocal cord. With bilateral complete paralysis of the vagus nerve, death occurs.
11. Accessory nerve.
Consists of two types of cores. The first is a double nucleus, located in the posterior parts of the medulla oblongata, and it is also the motor nucleus of the glossopharyngeal and vagus nerves. The second - the nucleus of the accessory nerve, is located in the posterolateral part of the anterior horn of the gray matter of the spinal cord. It innervates the sternocleidomastoid muscle, which provides a tilt towards the cervical spine, raises the head, shoulder, shoulder blade, rotates the face in the opposite direction, and brings the shoulder blades to the spine.
12. Hyoid nerve.
The main function of this nerve is the motor innervation of the tongue, namely: the styloid, chin-lingual and hyoid-lingual muscles, along with the transverse and rectus muscles of the tongue. With a unilateral lesion of this nerve, the tongue shifts to the healthy side, and when protruding from the mouth deviates towards the lesion. In this case, atrophy of the muscles of the paralyzed part of the tongue occurs, which practically does not affect speech and chewing functions.
The listed nerves of the face, in the process of innervation of the facial muscles, set the facial expressions of the individual.
Facial muscles
The muscles of the face, contracting, displace certain areas of the skin, giving the face all sorts of expressions, which is why they are called "mimic". The mobility of certain areas of the facial skin is due to the fact that the mimic muscles begin on the bones of the cranium, connecting to the skin; they are also devoid of fascia. Most of them are concentrated around the eye, mouth and nasal openings. There are such mimic muscles:
- Supracranial (occipital-frontal) - pulls the scalp back, raises eyebrows, forms transverse folds on the forehead;
- The muscle of the proud - is responsible for the formation of transverse folds over the bridge of the nose, with muscle contraction on both sides;
- The muscle wrinkling the eyebrow - contracting, forms vertical folds on the bridge of the nose, brings the eyebrows to the midline;
- Muscle lowering the eyebrow - lowers the eyebrow downward and slightly inward;
- The orbicular muscle of the eye - ensures the closing and closing of the eyes, narrowing the palpebral fissure, smoothes the transverse folds on the forehead, closes the palpebral fissure, expands the lacrimal sac;
- The orbicularis muscle of the mouth - is responsible for narrowing the mouth and pulling the lips forward;
- Muscle lifting the corner of the mouth - pulls the corner of the mouth up and out;
- Laughter muscle - pulls the corner of the mouth to the lateral side;
- Muscle lowering the corner of the mouth - closes the lips, pulls the corner of the mouth downward and outward;
- The cheek muscle - determines the shape of the cheeks, presses the inner surface of the cheeks to the teeth, pulls the corner of the mouth to the side;
- The muscle that lifts the upper lip - forms the nasolabial fold during contraction, raises the upper lip, expands the nostrils;
- Large and small zygomatic muscles - forms a grin, lifting the corners of the mouth up and to the sides, can also cause dimples on the cheeks;
- Lower lip muscle - pulls the lower lip downward;
- The chin muscle - wrinkles the skin of the chin, pulls it up, forming pits on it, pulls out the lower lip;
- Nasal muscle - slightly lifts the wings of the nose;
- Anterior ear muscle - displaces the auricle forward and upward;
- Upper ear muscle - pulls the ear up;
- Posterior ear muscle - pulls the ear back;
- The temporo-parietal muscle - with its help we can chew food.
All of them can be divided into two large groups according to their performing function: squeezers - allow you to close your eyes, mouth, lips and dilators - are responsible for opening them.
The main role in the blood supply to the face is played by the carotid artery - all facial arteries originate in it. Two arteries are responsible for blood flow to the face, tongue and other organs of the oral cavity: lingual and facial.
Lingual artery takes the base from the anterior wall of the external carotid artery, a few centimeters above the superior thyroid artery. Its trunk is located in the submandibular region and serves as a reference point for determining it during surgical interventions. After the lingual artery passes into the root of the tongue and provide blood supply to the muscles, mucous membrane and tonsils. Also, separate branches of this artery supply the diaphragm of the mouth, the sublingual and mandibular glands.
Facial artery begins a centimeter higher from the lingual, originating from the anterior surface of the external carotid artery. It rises up the face, touching the posterior surface of the submandibular gland, and then bends around the lower edge of the lower jaw. Its route runs to the corner of the mouth, then goes to the side of the nose to the medial angle of the eye between the superficial and deep facial muscles. This section of the facial artery is commonly called the angular artery. The palatine, chin, lower-labial and upper-labial arteries also branch off from it.
A large role in the blood supply to the face is played by the mass of capillaries and the lower ophthalmic vein. The latter does not have valves; blood enters it from the eye muscles and the ciliary body. Sometimes the blood passes through it into the pterygoid plexus if it leaves the orbit through the infraorbital fissure.
We hope our article was useful for you and you learned the most important thing about the location of the facial muscles, blood vessels and nerves. And the site site has opened for you the curtain of that part of the body that is hidden from our eyes under the skin.
The facial nerve is the seventh pair of twelve cranial nerves, which includes motor, secretory, and proprioceptive fibers; he is responsible for the work of the facial muscles of the tongue, innervates the glands of external secretion and is responsible for the sensations of taste in the region of the anterior 2/3 of the tongue.
Location and zones of innervation
The topographic anatomy of the facial nerve is rather confusing. This is due to its complex anatomy and the fact that along its length it goes through the facial canal of the temporal bone, gives and receives processes (branches).
The facial nerve begins not from one, but simultaneously from three nuclei: the nucleus motorius nervi facialis (motor fibers), the nucleus solitaries (sensory fibers) and the nucleus salivatorius superior (secretory fibers). Further, the facial nerve penetrates through the auditory opening into the thickness of the temporal bone directly into the internal auditory canal. At this stage, the fibers of the intermediate nerve join.
With various TBIs in the facial canal of the temporal bone, the nerve is pinched. Also in this anatomical formation is a thickening called the geniculate ganglion.
Then the facial nerve exits to the base of the skull through an opening near the styloid process, where such branches are separated from it: the posterior ear nerve, stylohyoid, lingual and digastric branches. They are so named because they innervate the corresponding muscles or organs.
After the facial nerve leaves the canal, it travels through the parotid gland, where it divides into its main branches.
Each branch sends nerve signals to its own “site” of the head and neck region.
Branches that extend in front of the parotid salivary gland
Branches that branch off in the thickness of the parotid salivary gland
| Branch | Innervation zone |
|---|---|
| Temporal | It is subdivided into back, middle and front. Responsible for the work of the circular muscle of the eye, the frontal abdomen of the supracranial muscle and the muscle that raises the eyebrow. |
| Zygomatic | Ensures the correct functioning of the zygomatic muscle and the circular muscle of the eye. |
| Cheek branches | It transmits impulses to the circular muscle of the mouth, the muscles that raise and lower the corner of the mouth, the muscle of laughter and the large zygomatic bone. They almost completely control facial expressions. |
| Marginal ramus of the lower jaw | When it is pinched, the lower lip stops dropping and the chin muscle does not work. |
| Cervical | It goes down and is a part of the cervical plexus, which is responsible for the work of the neck muscles. |
Knowing the function of the individual branches of the facial nerve and their topography, it is possible to determine the location of the lesion. It is very useful for diagnostics and treatment tactics.
Diseases
According to the ICD, the 10 most common diseases of the facial nerve are neuropathy and neuritis. According to the localization of damage, peripheral and central lesions of the facial nerve are distinguished.
Neuritis or paresis is a pathological condition of an inflammatory nature, and neuropathy of the facial nerve has a different etiology.
The most common cause of these diseases is hypothermia. Everyone knows that if the nerve is chilled, then it starts to hurt, and the facial muscles become disobedient. Also, the etiological factors include infections (poliomyelitis, herpes virus, measles), craniocerebral trauma and pinching of certain parts of the nerve (especially in the places where the nerve exits), vascular disorders of the brain (ischemic and hemorrhagic stroke, atherosclerotic changes), inflammatory diseases of nearby areas of the head and neck.
Damage to the facial nerve is primarily accompanied by paresis or paralysis of the facial muscles. These symptoms are due to the large predominance of motor fibers.
If the facial nerve is damaged in the peripheral parts, then the patient has a pronounced asymmetry of the face. It is more pronounced with various facial movements. The patient has a lowered corner of the mouth; the skin in the forehead area does not fold into a fold on the damaged side. Symptom of "sailing" of the cheek and Bell's symptom are pathognomonic.
In addition to movement disorders, patients complain of intense pain that occurs first in the area of the mastoid process, and then "moves" along the course of the facial nerve and its branches.
From vegetative disorders, there is a decrease or pathological increase in the detachable lacrimal gland, transient hearing disorder, taste disturbances in the innervation of the lingual branch and impaired salivation.
Most often, the defeat of the facial nerve is unilateral and in such cases the asymmetry is very noticeable.
With the central localization of damage, the mimic muscles stop working on the side that is opposite to the pathological focus. The muscles of the lower face are most commonly affected.
Therapy methods
Treatment of various diseases of the facial nerve includes medical, surgical, and sometimes alternative methods. The fastest results are obtained by a combination of all these areas of treatment.
If you seek medical help in the early stages of the disease, the chances of a full recovery without relapse are quite high. In the case when the patient tries to heal himself without any effect, in most cases the disease becomes chronic.
It is also important to establish the etiological factor for the choice of treatment tactics and the prospective prognosis. If, for example, neuritis of the facial nerve is caused by the herpes simplex virus, then etiotropic therapy will be zovirax, acyclovir. In case of pinching as a result of traumatic brain injury, surgical treatment should be considered first.
Conservative therapy
Medical treatment is more symptomatic than radical.
In order to relieve inflammation, it is necessary to prescribe non-steroidal anti-inflammatory drugs (diclofenac, meloxicam, nimesulide) or hormonal glucocorticosteroids (prednisolone, dexamethasone).
To reduce edema and, as a result, reduce pressure on the nerve, diuretics (furosemide, spironalactone) are used. With prolonged use of non-potassium-sparing diuretics, potassium preparations should be prescribed to maintain electrolyte balance.
To improve blood circulation and nutrition of the damaged area, neuropathologists prescribe vasodilator drugs. For the same purpose, various warming ointments are used.
To restore the structure of the nerve fiber after pinching it, you can 
use preparations of B vitamins and metabolic agents.
Physiotherapy belongs to general therapeutic methods of treatment. Its various techniques are prescribed as early as a week after the start of medication. UHF of low thermal intensity is used as a source of dry heat. To improve the local penetration of drugs, electrophoresis with dibazol, B vitamins, proserin is used. The electrodes can be placed directly on the skin or in the nasal passages (intranasally).
The facial nerve is a rather complex anatomical formation and its complete restoration can take a long time.
Surgical methods
Surgical treatment is indicated when conservative therapy does not bring the expected results. Most often, it is resorted to in cases where there is a complete or partial rupture of the nerve fiber. But good results from surgery can be expected for those patients who sought help within the first year.
In many cases, facial nerve autotransplantation is performed, that is, the doctor takes a part from a large nerve trunk and replaces the damaged tissue with it. Most often, this is the femoral nerve, since its anatomy and topography are convenient for this procedure.
Also, they resort to surgical treatment if conservative therapy has not yielded results within ten months.
In case of pinching due to the progression of the oncological process, maxillofacial surgeons first of all remove the tumor or enlarged lymph nodes.
Folk ways
Various inflammatory processes, including pinching of the facial nerve, can also be treated with traditional medicine. Not desirable 
use only this type of treatment, but folk methods work very well as additional means.
To restore muscle function and improve the conduction of nerve impulses, you can do an acupressure Chinese massage. Stroking movements should be performed in three directions - from the zygomatic bone to the nose, upper jaw and eyeball.
It should be remembered that neuropathy of the facial nerve is well treated with dry heat. To this end, it is recommended to tie a knitted woolen scarf at night or attach a bag to the affected area in salt or fine sand heated in a pan.
It is imperative to carry out therapeutic exercises several times a day - to raise eyebrows, puff out cheeks, frown, smile, pull lips into a tube.
Chamomile infusion can be applied as compresses. Chamomile is anti-inflammatory and pain relief. For the same purpose, fresh horseradish or radish juice is used.
Which is manifested by rapid, suddenly arising and often repetitive contractions of certain muscle groups that occur against the will of a person. Muscle contractions during a nervous tic resemble ordinary voluntary movements, although in fact a person does not control their appearance and is not able to restrain them.
With a nervous tic, a person has an irresistible desire to make a certain movement or make a sound. Attempts to suppress this desire by an effort of will only increase psycho-emotional stress. Having made a tic movement, a person feels a short psychological relief, after which the need to make this movement arises again.
According to various sources, 0.1 - 1% of the adult population of the Earth suffers from a nervous tic. Most often, this disease occurs among residents of large cities with a population of more than 1 million people. Men get sick 1.5 - 2 times more often than women. A nervous tic in an adult, as a rule, indicates serious disorders of the nervous system and, in the vast majority of cases, requires specialized medical care.
Interesting Facts
- Usually, a nervous tic begins in childhood. The first appearance of tics after the age of 18 is less common and is often caused by other diseases.
- Most often, a nervous tic affects the area of the facial muscles of the face. Much less commonly, the muscles in the arms, legs, or trunk are affected.
- A nervous tic can be both motor ( eye blinking, hand twitching) and vocal ( sniffing, hissing, up to the uttering of individual words).
- Outwardly, a nervous tic is indistinguishable from a normal voluntary movement. The disease betrays only the inappropriateness and frequent repetition of tick movements.
- The frequency of nervous tics among the urban population is higher than in rural areas, which is associated with the intense rhythm of life in the city.
- A nervous tic can manifest itself in movements of different nature - from single muscle contractions ( simple tick) to certain gestures ( difficult tick).
- Alexander the Great, Mikhail Kutuzov, Napoleon, Mozart and other prominent personalities suffered from a nervous tic.
Muscle innervation
With a nervous tic, various mechanisms of regulation of skeletal muscle contraction are disrupted ( muscles, the contraction of which is controlled by the human mind). A certain knowledge of the anatomical and physiological characteristics of the nervous and muscular systems will help to better understand the causes and mechanisms of the occurrence of nervous tics.Brain
The brain is a collection of nerve cells ( neurons), which control the activity of the whole organism. Each area of the brain is responsible for a specific function of the body - for sight, hearing, feeling, and so on. Voluntary movements are also controlled by specific areas of the brain.Areas of the brain responsible for voluntary movements are:
- pyramidal system;
- extrapyramidal system.
The pyramidal system is a certain group of nerve cells ( motor neurons), located in the precentral gyrus of the cortex of the frontal lobe of the brain. In the nerve cells of the pyramidal system, motor impulses are formed that control subtle, purposeful movements.
Extrapyramidal system
This system is a collection of nerve cells located in the cortex of the frontal lobe and in the subcortical structures. The main chemical mediator ( a substance that ensures the transmission of a nerve impulse between neurons) of the extrapyramidal system is dopamine. Recent studies have established a link between the appearance of nervous tics and an increased sensitivity of extrapyramidal structures to dopamine.
The neurons of the extrapyramidal system are closely connected with each other, as well as with the neurons of the pyramidal system, which allows them to function as a whole.
The extrapyramidal system controls:
- coordination of movements;
- maintaining muscle tone and body posture;
- stereotyped movements;
- facial expressions of emotions ( laugh, cry, anger).
Nerves that innervate the muscles of the face
The nerve cells of the precentral gyrus of the brain have a long process ( axon). Axons, leaving the brain, combine into groups and form nerves that innervate certain muscles. The function of motor nerve fibers is to conduct nerve impulses from the brain to the muscles.Most often, a nervous tic is localized in the area of facial muscles, therefore, the nerves that innervate the muscles of the face are described below.
The facial muscles are innervated:
- facial nerve ( nervus facialis);
- trigeminal nerve ( nervus trigeminus);
- oculomotor nerve ( nervus oculomotorius).
- frontal muscles;
- muscles puckering eyebrows;
- circular muscles of the eye;
- zygomatic muscles;
- cheek muscles;
- ear muscles;
- circular muscle of the mouth;
- muscles of the lips;
- muscle of laughter ( not all people have);
- subcutaneous muscle of the neck.
- chewing muscles;
- temporal muscles.
Neuromuscular synapse
The nerve impulse cannot go directly from the nerve to the muscle. For this, in the zone of contact of the nerve ending with the muscle fiber, there is a special complex that ensures the transmission of a nerve impulse and is called a synapse.Under the action of a nerve impulse, the neurotransmitter acetylcholine ( chemical that mediates nerve impulses from nerve to muscle). The mediator has a specific chemical structure and binds to specific sites ( receptors) on the muscle cell.
When acetylcholine interacts with the receptor, a nerve impulse is transmitted to the muscle.
Skeletal muscle structure
Skeletal muscle is an elastic, elastic tissue that can contract ( shorten) under the influence of a nerve impulse. Each muscle is made up of many muscle fibers. Muscle fiber is a highly specialized muscle cell ( myocyte), which has a long tuyere and is almost completely filled with parallel threadlike structures ( myofibrils), providing muscle contraction. Between the myofibrils there is a special network of cisterns ( sarcoplasmic reticulum), which contains a large amount of calcium, which is necessary for muscle contraction.
Myofibrils are an alternation of sarcomeres - protein complexes that are the main contractile unit of muscle. The sarcomere consists of proteins - actin and myosin, as well as troponin and tropomyosin.
Actin and myosin are filaments parallel to each other. On the surface of myosin, there are special myosin bridges, through which the contact between honey myosin and actin is carried out. In a relaxed state, this contact is prevented by the protein complexes of troponin and tropomyosin.
The mechanism of muscle contraction
The nerve impulse formed in the brain is carried along the motor nerve fibers. Having reached the synapse level, the impulse stimulates the release of the neurotransmitter acetylcholine, which interacts with specific receptors on the surface of muscle cells, ensuring the transmission of a nerve impulse to the muscle.The nerve impulse quickly spreads deep into the muscle fibers and activates the sarcoplasmic reticulum, as a result of which a large amount of calcium is released from it. Calcium binds to troponin and releases the active sites on the actin filaments. Myosin bridges attach to the released actin filaments and change their position, ensuring mutual convergence of actin filaments. As a result, the length of the sarcomere decreases and the muscle contracts.
The process of muscle contraction described above requires a significant amount of energy, which is used to change the position of the myosin bridges. The source of energy in myocytes is ATP ( adenosine triphosphate), synthesized in mitochondria ( special intracellular structures located between myofibrils in large numbers). ATP, with the help of magnesium ions, ensures the process of drawing together the actin filaments.
Causes of a nervous tic
The immediate cause of a nervous tic is a dysfunction of the extrapyramidal system. As a result, its activity increases and an excessive, uncontrolled formation of nerve impulses occurs, which, according to the mechanisms described earlier, causes rapid, uncontrolled contractions of certain muscles. Depending on the duration of the disease, nervous tics are:
- Transient- a milder form of the disease lasting up to 1 year.
- Chronic- lasting more than 1 year.
- primary nervous tic;
- secondary nervous tic.
Causes of primary nervous tics
Primary nervous tic ( synonym - idiopathic - arising for unknown reasons) develops against the background of a relatively normal state of the central nervous system of a person and is the only manifestation of a violation of its function. Other disorders of the nervous system ( increased fatigue, irritability) may be the result of a nervous tic.A genetic predisposition to nervous tics with an autosomal dominant mode of inheritance has been proven, transmitted from generation to generation from a sick parent with a 50% probability. If both parents are sick, then the probability of having a child with a predisposition to a nervous tic ranges from 75% to 100%.
People of choleric temperament are prone to the occurrence of primary nervous tics. They are distinguished by their hot temper, emotionality, pronounced manifestations of feelings. In such people, the central nervous system is especially sensitive to the influence of external factors, which contributes to the occurrence of nervous tics.
The appearance of a primary nervous tic may be preceded by:
- overwork;
- eating disorders;
- alcohol abuse;
- abuse of psychostimulants.
Stress is understood as a pronounced emotional experience of any life situation ( acute stress) or long-term presence of a person in an unfavorable ( tense, annoying) setting ( chronic stress). At the same time, all compensatory reserves aimed at overcoming a stressful situation are activated in the human body. An increase in the activity of many areas of the brain is noted, which can lead to excessive occurrence of impulses in the neurons of the extrapyramidal system and the appearance of a nervous tic.
Overwork
Long-term work in unfavorable, stressful conditions, violation of the regime of work and rest, chronic lack of sleep - all this leads to dysfunction of the central nervous system ( central nervous system). The nervous system begins to work for wear and tear, while activation occurs, and then the depletion of the body's reserves. As a result, various malfunctions of the nervous system may appear, manifested by irritability, nervousness, or the appearance of a nervous tic.
Eating disorder
As mentioned above, muscle contraction requires ATP energy and a sufficient supply of calcium and magnesium ions. An insufficient intake of calcium from food can lead to hypocalcemia ( a decrease in the concentration of calcium in the blood), in which the excitability of muscle and nerve cells sharply increases, which can be manifested by muscle twitching and cramps.
Alcohol abuse
Alcohol, getting into the human body, has an exciting effect on the neurons of the central nervous system, while reducing the processes of inhibition in the cerebral cortex and disrupting the functioning of the entire nervous system of the body. In addition, alcohol causes the emancipation of the emotional state of a person, causing an excessive emotional reaction to any stimulus. As a result, any psycho-emotional shock can lead to an even greater increase in the activity of the brain with the involvement of the extrapyramidal system and the appearance of nervous tics.
Psychostimulant abuse
Psychostimulants ( coffee, strong tea, energy drinks) increase the activity of the cerebral cortex with the possible involvement of neurons of the extrapyramidal system. This can directly lead to the onset of nervous tics, and also increases the sensitivity of the extrapyramidal system to psycho-emotional overload and stress.
The use of psychostimulants leads to the activation of the body's energy reserves, as a result of which all systems ( including the nervous system) operate under increased load. If the intake of psychostimulating drinks continues for a long time, the body's reserves are depleted, which can manifest itself in various neurological disorders, including nervous tics.
Causes of secondary nerve tics
Secondary tics are symptoms of other diseases affecting the central nervous system. An important distinguishing feature of secondary tics, in addition to the tic movements themselves, is the presence of previous symptoms of the underlying disease.Do not forget that any disease is a kind of stress from a psychological point of view, leads to depletion of the body's reserves and overwork, which can contribute to the occurrence of nervous tics through the mechanisms described earlier.
The occurrence of a secondary nervous tic may be due to:
- head trauma;
- brain tumors;
- infectious brain lesions;
- diseases of the gastrointestinal system;
- mental illness;
- some medicines;
- drug use;
- trigeminal neuralgia.
Traumatic brain injury can be accompanied by damage to the medulla ( traumatic object, skull bones, as a result of hemorrhage). If at the same time the neurons of the extrapyramidal system are damaged, then a focus of increased activity can form in them, which will manifest itself as nervous tics.
Brain tumors
Tumors, growing, can compress adjacent structures of the brain, including the extrapyramidal system zones. Being a kind of irritant for neurons, a tumor can create a focus of increased activity in the extrapyramidal system, which will lead to the appearance of nervous tics. In addition, the tumor can compress blood vessels in the brain, resulting in malnutrition and malfunction of nerve cells.
Infectious lesions of the brain
If pathological bacteria ( streptococcus, meningococcus) or viruses ( herpes virus, cytomegalovirus) into the brain tissue, an infectious and inflammatory process can develop in it ( encephalitis). Infectious agents cause damage to cerebral vessels and neurons of various structures of the brain, including the subcortical zones of the extrapyramidal system, which causes the appearance of nervous tics.
Diseases of the gastrointestinal system
Inflammatory diseases of the stomach and intestines ( gastritis, duodenitis), as well as helminthic diseases ( helminthiasis) can lead to disturbances in digestion and absorption of nutrients from the intestines, including calcium. The resulting hypocalcemia ( decrease in blood calcium) is manifested by involuntary muscle contractions ( more often than fingers) or even convulsions.
Mental illness
With some mental illness ( schizophrenia, epilepsy) organic and functional changes occur in various areas of the brain. With a long course of such diseases, concentration of attention, voluntary movements, and emotional reactions are impaired. If the centers of the extrapyramidal system are involved in the pathological process, excess impulses can form in them, which will manifest itself as nervous tics.
The use of medicines
Some medicines ( psychostimulants, anticonvulsants) can lead to nervous tics.
The mechanism of action of psychostimulant medications is similar to the action of energy drinks, but is stronger.
Some anticonvulsants ( e.g. levodopa) are precursors of dopamine ( neurotransmitter of the extrapyramidal system of the brain). The use of these drugs can lead to a significant increase in the content of dopamine in the brain and increased sensitivity of extrapyramidal centers to it, which can be manifested by the occurrence of nervous tics.
Drug use
Herbal and synthetic narcotic drugs are special psychostimulating substances that increase the activity of the entire nervous system and lead to the appearance of nervous tics. In addition, narcotic drugs have a destructive effect on the neurons of the brain, disrupting their structure and function.
Trigeminal neuralgia
The trigeminal nerve conducts pain sensitivity from the skin of the face. Trigeminal neuralgia is characterized by a decrease in the threshold of pain sensitivity, as a result of which any, even the smallest touch, causes an attack of severe pain. At the peak of a painful attack, twitching of the muscles of the face, which have a reflex character, may be noted.
Diagnosis of a nervous tic
A nervous tic that appears in an adult indicates the presence of disturbances in the functioning of the central nervous system. With a few exceptions ( mild primary nervous tics) this disease requires qualified medical care from a neuropathologist. At a visit to a neurologist, the patient expects:
- survey and assessment of the state of the nervous system;
- laboratory research;
- instrumental research;
- consultations of other specialists.
Interview and assessment of the state of the nervous system
The first thing that awaits a patient at an appointment with a neurologist is a detailed survey about his disease.When questioned, the neuropathologist specifies:
- time and circumstances of the onset of a nervous tic;
- the duration of the existence of a nervous tic;
- transferred or existing diseases;
- attempts to treat a nervous tic and its effectiveness;
- Whether family members or immediate family members suffer from nervous tics.
A visit to a doctor can in a certain way affect the psychoemotional state of a person, as a result of which the manifestations of nervous tics can decrease for a while or disappear altogether. In such cases, the doctor may ask you to demonstrate exactly which movements are uncomfortable for the person.
Usually, the diagnosis of nervous tics does not cause difficulties and the diagnosis is made on the basis of a survey and examination of the human nervous system. However, additional diagnostic measures may be required to establish the cause of the disease and prescribe appropriate treatment.
Laboratory research
Laboratory tests help to identify violations of the internal environment of the body and to suspect some diseases.For a general blood test in the morning on an empty stomach, take 1 - 2 milliliters of capillary blood ( usually from the ring finger).
With a nervous tic, a neurologist may prescribe:
- computed tomography of the bones of the skull;
- magnetic resonance imaging of the brain;
- electroencephalography ( EEG);
- electromyography.
This is a research method prescribed for secondary nervous tics, the appearance of which is associated with traumatic brain injury. This method allows you to obtain a layer-by-layer image of the bones of the skull and determine the presence and localization of fractures, intracranial hemorrhages. In addition, computed tomography can be useful for diagnosing bone tumors that can compress the substance of the brain, causing nerve tics.
Magnetic resonance imaging
This is a more accurate method for diagnosing lesions of the brain substance. It is prescribed for suspected brain tumors, lesions of cerebral vessels, trauma and various systemic diseases. Also, with the help of MRI, brain changes in mental illness can be determined ( with schizophrenia).
Electroencephalography
This is a simple and safe method for assessing the functional state of various areas of the brain by examining its electrical activity. Also, EEG allows you to determine the reaction of various areas of the brain to the action of certain stimuli, which can help to establish the cause of a nervous tic.
It is not recommended to consume coffee, tea and other psychostimulating substances 12 hours before the study. The EEG procedure is safe and painless. The patient sits in a comfortable chair and closes his eyes. Special electrodes are installed on the scalp, which read the electrical activity of the brain.
During the performance of the EEG, the patient may be asked to perform certain actions ( open and close your eyes, close your eyes tightly, or reproduce a tic movement) and determine changes in activity in different areas of the brain.
Electromyography
This is a method for recording the electrical potentials of skeletal muscle, designed to study the functional state of muscles and nerves at rest and during muscle contraction.
The essence of the method is as follows. Special electrodes ( cutaneous or needle-intramuscular) are installed in the area of the muscle under study. Needle electrodes are inserted directly into the muscle under study. The electrodes are connected to a special device - an electromyograph, which records electrical potentials in the muscle. Next, the person is asked to make some kind of movement of the muscle under study and changes in activity are recorded during muscle contraction. In addition, the speed of conduction of a nerve impulse along the nerves that innervate the muscle under study is investigated.
With the help of electromyography, it is possible to identify increased excitability of muscle fibers and various disorders at the level of impulse conduction along nerve fibers, which can be the cause of a nervous tic.
Consultation of other specialists
If the neuropathologist, during the diagnosis process, determines that the occurrence of a nervous tic is due to another disease or pathological condition, he can refer the patient for consultation to another doctor specializing in the required field.To diagnose a nervous tic, you may need to consult the following specialists:
- Traumatologist- if the onset of a nervous tic was preceded by a head injury.
- Psychiatrist- if you suspect a mental illness.
- Oncologist- if you suspect a brain tumor.
- Narcologist- if there is a suspicion that the occurrence of a nervous tic is due to the intake of any medications, narcotic drugs or chronic alcohol use.
- Infectionist- if you suspect a brain infection or helminthic diseases.
First aid for a nervous tic
There are certain exercises and recommendations that can temporarily eliminate or reduce the manifestations of tic movements. Like treats like
If you have involuntary contractions of any muscles ( facial, arm or leg muscles), try to tense the affected muscle for a few seconds. This can for some time eliminate the symptom of the disease - muscle twitching, but it will not in any way affect the cause of the disease, therefore, the tic movements will reappear soon.This technique is contraindicated in nervous tics caused by trigeminal neuralgia. In this case, it is recommended to minimize the influence of irritating factors as much as possible, avoiding any touching of the teak area.
First aid for a nervous tic of the eye
Quite often, a twitching eye indicates that the body needs rest. Involuntary contractions of the muscles of the eye can appear during prolonged work at the computer, when reading books in a poorly lit room, or simply from extreme fatigue.To quickly eliminate the nervous tic of the eye, it is recommended:
- Close your eyes and try to relax for 10 to 15 minutes.
- Moisten cotton swabs with warm water and apply to the eye area for 5 to 10 minutes.
- Try to open your eyes as wide as possible, then close your eyes tightly for a few seconds. Repeat this exercise 2-3 times.
- Blink quickly with both eyes for 10 - 15 seconds, then close your eyes for 1 - 2 minutes and try to relax.
- Press lightly on the middle of the browbone above the twitching eye. In this case, there is a mechanical stimulation of the branch of the trigeminal nerve, which emerges in this place from the cranial cavity and innervates the skin of the upper eyelid.
Treatment of nervous tics
The appearance of nervous tics in adulthood indicates serious disorders of the nervous system, therefore, the issue of their treatment should be taken very seriously. You should definitely make an appointment with a neurologist, since a nervous tic can be just a manifestation of another, more serious and dangerous disease.
For nervous tics, apply:
- drug treatment;
- non-drug treatment;
- alternative therapies.
Medication for nerve tics
The main task of drug therapy for nervous tics is to eliminate the manifestations of the disease. For this purpose, drugs are used that affect the central nervous system and the psychoemotional state of the patient.With primary nervous tics, preference should be given to sedatives and only if they are ineffective, switch to other groups of drugs.
Secondary nerve tics often do not respond to sedation. In such cases, it is recommended to start with antipsychotic and anti-anxiety drugs used in complex therapy, along with the treatment of the underlying disease that caused the appearance of a nervous tic.
Medications Used to Treat Nervous Tics
| Group of drugs | Drug name | Effects | Mode of application |
| Sedatives | Valerian tincture |
| Inside, half an hour before meals, 20-30 drops, diluted in half a glass of boiled water. Take 3-4 times a day. |
| Motherwort tincture |
| Inside, 30 minutes before meals, 40 drops of tincture. Take 3 times a day. | |
| Novo-Passit |
| Take orally, 30 minutes before meals, 1 teaspoon ( 5 ml) three times per day. | |
| Antipsychotics (antipsychotics) | Thioridazine |
| Inside, after meals, 50 - 150 mg three times a day ( the dosage is set by the doctor depending on the severity of the nervous tics). The course of treatment is 3 - 4 weeks. Maintenance therapy 75 - 150 mg once at bedtime. |
| Haloperidol |
| Take by mouth after meals with a full glass of water or milk. The initial dose is 5 mg 3 times a day. The course of treatment is 2 - 3 months. | |
| Tranquilizers (anxiolytics) | Phenazepam |
| Take orally after meals. In the morning and at lunchtime, 1 mg, in the evening before bedtime - 2 mg. It is not recommended to take phenazepam for more than 2 weeks, as drug dependence may develop. The drug should be withdrawn gradually. |
| Calcium preparations | Calcium gluconate | Replenishes the lack of calcium in the body. | Inside, 30 minutes before meals, 2 - 3 grams of crushed drug. Drink with a glass of milk. Take 3 times a day. |
Non-drug treatment of nervous tics
Along with the drug treatment of nervous tics, it is also necessary to pay attention to activities aimed at strengthening the body as a whole. Non-drug treatment should be used for both primary and secondary nervous tics, as it helps to normalize the psychoemotional state and restore the impaired functions of the central nervous system.Non-drug treatment for nervous tics includes:
- observance of the regime of work and rest;
- full sleep;
- balanced diet;
- psychotherapy.
The appearance of a nervous tic is one of the signals that the central nervous system needs rest. The first thing to do if a nervous tic develops is to revise the daily routine, if possible, exclude certain activities and devote more time to rest.
It has been proven that constant overwork at work, lack of proper rest for a long time leads to depletion of the body's functional reserves and an increase in the sensitivity of the nervous system to various stimuli.
- wake up and go to bed at the same time;
- exercise in the morning and throughout the day;
- comply with the work schedule ( eight hour day);
- observe the rest regimen ( 2 days off per week, mandatory vacation throughout the year);
- avoid overwork at work, work at night;
- spend at least 1 hour daily in the fresh air;
- reduce the time of working at the computer;
- restrict or temporarily exclude TV viewing.
It has been scientifically proven that a lack of sleep for 2 - 3 days increases the sensitivity of the nervous system to various stress factors, reduces the body's adaptive responses, and leads to irritability and aggressiveness. Prolonged sleep deprivation leads to even greater disturbances in the function of the central nervous system and the whole organism, which can be manifested by an increase in nervous tics.
- Wake up and go to bed at the same time. This contributes to the normalization of the biological rhythms of the body, facilitates the processes of falling asleep and awakening, contributes to a more complete restoration of body functions during sleep.
- Observe the required duration of sleep. An adult needs at least 7 to 8 hours of sleep per day, and it is desirable that sleep should be uninterrupted. This contributes to the normalization of the structure and depth of sleep, providing the most complete recovery of the central nervous system. Frequent night awakenings disrupt the structure of sleep, as a result of which by the morning, instead of the expected surge of vigor and strength, a person may feel tired and "overwhelmed", even if he slept for a total of more than 8-9 hours.
- Create a satisfactory sleep environment at night. Before going to bed, it is recommended to turn off all light and sound sources in the room ( light bulbs, tv, computer). This facilitates the process of falling asleep, prevents nighttime awakenings and ensures a normal depth and structure of sleep.
- Do not consume psychostimulating drinks ( Tea coffee) before bedtime. These drinks cause the activation of various parts of the brain, making it difficult to fall asleep, disrupting the integrity, depth and structure of sleep. As a result, a person can lie in bed for a long time, unable to fall asleep. This leads to lack of sleep, increased nervous tension and irritability, which can adversely affect the course of nervous tics.
- Do not eat protein foods before bed. Proteins ( meat, eggs, cottage cheese) have a stimulating effect on the central nervous system. The consumption of these products immediately before bedtime, in addition to the negative effect on the gastrointestinal system, can negatively affect the process of falling asleep and the structure of sleep.
- Do not engage in vigorous mental activity before bedtime. For 1 - 2 hours before bedtime, watching TV, working at a computer, scientific and computing activities is not recommended. Evening walks in the fresh air, airing the room before going to bed, meditation have a beneficial effect on the structure of sleep.
A complete balanced diet includes the intake of qualitatively and quantitatively balanced food ( containing
The daily requirement for magnesium is:
- in men - 400 milligrams per day;
- in women - 300 milligrams per knock;
- in women during pregnancy - up to 600 mg per day.
Magnesium-rich foods
| Product | Magnesium content in 100 grams of product |
| Rice bran | 780 mg |
| Sesame seeds | 500 mg |
| Wheat bran | 450 mg |
| Almond | 240 mg |
| Buckwheat | 200 mg |
| Walnut | 158 mg |
| Beans | 100 mg |
Psychotherapy
Psychotherapy is understood as a method of therapeutic influence on the human body through its psyche. Psychotherapy is indicated for all types of primary nervous tics, as well as as part of complex therapy for secondary nervous tics.
Psychotherapy is carried out by a specialist psychotherapist. In the course of treatment, the doctor helps a person to understand the causes of a stressful situation or emotional stress, to find ways to resolve internal conflicts. In addition, a psychotherapist can teach patients methods of self-control, correct behavior under stress.
After completing a course of psychotherapy, a significant decrease in psychoemotional tension is noted, sleep is normalized, and the manifestations of nervous tics decrease or completely disappear.
Alternative treatments for nerve tics
Certain treatments can have beneficial effects on tics by acting on different levels of the neuromuscular system.Alternative treatments for nerve tics include:
- relaxing massage;
- acupuncture ( acupuncture);
- electrosleep;
- injections of botulinum toxin A.
Today there are many types of massage ( relaxing, vacuum, thai and so on) that have a beneficial effect on the human body. A relaxing massage is considered the most effective in terms of affecting the nervous system.
For nervous tics caused by overwork and chronic fatigue, a relaxing massage of the back, arms and legs, and scalp is considered the most effective.
A relaxing massage has the following effects:
- eliminates fatigue;
- has a relaxing and calming effect;
- reduces the excitability of the nervous system;
- eliminates increased muscle tone;
- improves blood circulation in muscles.
Relaxing massage of the facial area is contraindicated, especially with trigeminal neuralgia, since mechanical irritation of the areas of increased sensitivity will be accompanied by severe pain and increased nervous tics.
Acupuncture
Acupuncture is a method of ancient Chinese medicine, which consists in the impact of needles on specific points in the human body ( points of concentration of vital energy), responsible for the functioning of certain systems and organs.
Through acupuncture, you can achieve:
- reducing the severity of tic movements;
- reduction of nervous and muscle tension;
- reducing the excitability of the nervous system;
- improving blood supply to the brain;
- elimination of psycho-emotional stress.
Electrosleep
Electrosleep is widely used in the treatment of conditions associated with increased activity of the central nervous system. The method is safe, harmless and inexpensive, which makes it accessible to almost anyone.
The essence of the method consists in conducting weak low-frequency impulses through the eye sockets to the brain, which enhances the inhibition processes in it and causes the onset of sleep.
The electrosleep procedure is performed in a specially equipped office. The patient is offered to take off his outer clothing, lie on the couch in a comfortable position, cover himself with a blanket and try to relax, that is, an environment is created that is as close as possible to natural sleep.
A special mask with electrodes is put on the patient's eyes, through which an electric current will be supplied. The frequency and current strength is selected individually for each patient and usually does not exceed 120 hertz and 1 - 2 milliamperes, respectively.
After applying the electric current, the patient usually falls asleep within 5 to 15 minutes. The whole procedure lasts from 60 to 90 minutes, the course of treatment is 10 to 14 sessions.
After completing the electric sleep course, it is noted:
- normalization of the psycho-emotional state;
- normalization of natural sleep;
- decrease in the excitability of the nervous system;
- decrease in the severity of nervous tics.
Botulinum toxin A injections
Botulinum toxin is a powerful organic poison produced by anaerobic bacteria - clostridia ( Clostridium botulinum).
For medicinal purposes, botulinum toxin type A is used. When injected intramuscularly, botulinum toxin penetrates into the end of the motor neuron involved in the formation of the neuromuscular synapse, and blocks the release of the mediator acetylcholine, which makes muscle contraction impossible and leads to muscle relaxation in the injection area. Thus, the nerve impulses generated during a nervous tic in the extrapyramidal zone of the brain cannot reach the skeletal muscles, and the manifestations of a nervous tic are completely eliminated.
After blocking the transmission of the nerve impulse from the end of the motor neuron, new processes begin to form, which reach the muscle fibers and innervate them again, which leads to the restoration of neuromuscular conduction on average 4-6 months after the injection of botulinum toxin A.
The dose and place of administration of botulinum toxin A is determined by the attending physician individually for each patient, depending on the severity of the manifestations of the nervous tic and the muscles involved.
Prevention of recurrence of a nervous tic
With timely and qualified medical care, a nervous tic can be healed. After treatment, certain rules should be followed to prevent relapse ( re-exacerbation) diseases. At the same time, factors that can provoke a recurrence of a nervous tic should be limited or completely excluded.| Recommended | Not recommended |
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Facial skin includes sweat and sebaceous glands, hair, muscle fibers, nerve endings, blood and lymph vessels. Its structure has its own characteristics, the knowledge of which is especially important for surgeons. At the same time, it will be interesting for an ordinary person to get acquainted with these features. Facial injuries are also possible in everyday life, especially in car collisions. After car accidents, it is often the person who suffers. Frightening bleeding occurs, which frightens both the patient himself and those close to him.
Nevertheless, it is precisely the structural features of the facial skin, its muscles, innervation and blood supply that allow us to hope for a successful outcome with timely professional surgical assistance. Next, we will consider the methods of providing first aid before the arrival of doctors for facial injuries. Accidentally read, maybe even not remembered text, in a critical situation will pop up in memory and will help to avoid mistakes in car accidents and other injuries.
Not so few people in our country, in addition to doctors, have primary medical training with the skills to provide first aid. These are pharmacists, nurses, orderlies, police officers and employees of the Ministry of Emergency Situations, a medical officer after urgent service, sorry if someone has forgotten. In acute injuries, there are the main principles of first surgical aid, they allow you to save life and avoid dangerous consequences for the victim. Don't be intimidated by specialized medical terms. Even a simple presentation of the basic features of the structure of the body and its physiology helps in difficult times. At the same time, the awareness of the threat of complications during exacerbation of dental diseases of the surgical profile will help to make the right decision.
The outer layer of the skin forms a multinucleated squamous keratinizing epithelium, which adheres tightly to the underlying layer in the skin itself. The latter consists of two not clearly demarcated layers - subepithelial papillary and reticular. The papillary layer consists of loose connective tissue, it contains the vessels and nerve endings that determine the sensitivity of the skin.
On the face, the papillae are low and even, so the skin on the face is thin and smooth. The scars on it are clearly visible. However, experienced surgeons achieve amazing aesthetic results by connecting the edges of the wound with intradermal sutures and masking the sutures in the anatomical folds.
Collagen, denser, skeletal fibers and elastic elastic and reticular fibers, as well as cellular elements, lie in the papillary layer, then it passes into a denser mesh layer, which is characterized by a large number of collagen and elastic fibers and a relatively small number of cellular elements.
The presence of elastic and collagen fibers of the connective part of the skin of the face determines the ability of the skin to stretch during facial expressions and conversation, and a large number of elastic fibers in the mesh layer creates a constant physiological tension of the skin, which decreases with age. These lines also define the areas of the face, cuts and information of the edges of the wound are made relative to them. It is because of the presence of elastic fibers that facial injuries look so frightening - the edges of the wound diverge to the sides. At the same time, the face regains its appearance after the correct edges are closed and the sutures are applied.
The reticular layer passes into the mobile connective tissue, which differs from the skin by its considerable thickness and loose arrangement of fibrous tissue bundles, as well as by the lesser development of subcutaneous adipose tissue (in comparison with other parts of the body).
Subcutaneous fatty tissue forms an elastic lining, is a plastic support layer that softens mechanical stress from the outside. In the region of the superciliary arches and eyebrows, the subcutaneous layer is a direct continuation of the tissue of the aponeurosis of the skull, but is devoid of a characteristic cellular structure. With the transition to the eyelids and nose, the subcutaneous fat layer acquires the character of a delicate connective tissue.
Such a structure of the subcutaneous layer in some areas of the face contributes to the rapid spread of hemorrhages, edema, and inflammatory processes along its length. An example of this is boxers during fights. Facial edema and hepatomas reach significant sizes, especially in those who neglect protective mouth guards.
The ways of penetration of pus from the primary focus are known both to maxillofacial surgeons and ordinary dentists. Such conditions are formidable complications, life-threatening, and yet their root cause may be a complication of caries - exacerbation of chronic periodontitis or sometimes a festering hematoma.
The cheek portion of the face is rich in fatty tissue. The fatty body of the cheek, isolated from the surrounding tissue by a thin fascia, runs along the anterior edge of the masseter muscle. In the area of the upper and lower lips, the subcutaneous fatty tissue is much less developed, mainly these formations are formed by the circular muscle of the mouth.
A large number of striated muscle fibers ends in the skin of the face, which together make up the facial muscles of the face. A feature of facial muscles is their attachment at one end to the inert skeleton of the face, the other is woven into the connective tissue structures of the skin itself, which determines the mobility of the skin under the action of facial muscles.
In the places of the greatest accumulation of muscle fibers, elastic fibers are especially developed. Depressions form on the skin in the areas of connection of the elastic network with under the epithelial layer. Their sequential arrangement leads to the formation of skin grooves and folds, which are the guiding lines along which it is recommended to make incisions when cutting out and matching skin flaps. The scar located along the folds, due to the constant contraction of the facial muscles, quickly stretches in length, becomes thinner and becomes little noticeable.
As a result of the constant contraction of the facial muscles, the elastic skeleton of the skin wears out, tears of elastic fibers are formed, characteristic wrinkles of the face appear, and the contractility of the skin decreases. The contractility of the facial skin is lower than the contractility of the skin of other parts of the body. This ability of the structure of the skin of the face is of great importance in skin grafting. When it is necessary to decide which part of the body skin is most suitable in terms of its structure for the full replacement of soft tissue defects, the surgeon must take these areas into account.
Mimic muscles determine the individual characteristics and expressiveness of the face, emotions inherent in a person, and also carry out the movement of the lips, eyelids, nostrils.
Blood supply to the soft tissues of the face Arteries and veins of the head
Anatomy and topography of the temporal and facial regions
The passage of blood vessels in the soft tissues of the face has its own characteristics. It is carried out by a powerful highway - the system of the external carotid artery, as well as through the ophthalmic artery, by some branches of the internal carotid artery, then it splits into the facial, superficial temporal and other arteries. An extensive network of blood vessels and powerful blood flow allows an always open face to withstand the most severe environmental factors. In case of injuries and damage to one vessel, the blood supply is duplicated through the flow of blood from another line. All arteries are paired.
The main arterial trunk of the anterior part of the face arteria facialis is the facial artery.
It anastomoses (connects) with the frontal arteries and on its way gives many branches to the surrounding tissues, of which the largest are the chin, superior and inferior labial arteries. 
Cranial topography diagram
The largest diameter of the arteries is at the sites of attachment of the facial muscles of the skin. Smaller arteries are evenly distributed throughout the skin. In places of the greatest mobility of the skin, the arteries and veins are more tortuous. In most cases, the arteries and veins run parallel.
It is the presence of a large number of vascular anastomoses that makes it possible to widely use the soft tissues of the face when replacing defects. Taking into account the direction of the main arterial trunks as well as their combinations with venous lymphatic vessels makes it possible for various defects of the soft tissues of the face to use skin grafts taken in certain directions, if possible without disturbing their blood circulation.
The venous system is well developed in the soft tissues of the face. The veins of the face are widely anastomosed, connected to each other, as well as to the veins of the orbit. The veins of the middle ear and nose are connected to the veins of the base of the skull and to the superior sagittal sinus, through the veins of the orbit with the dura mater. The veins of the face are arranged in two layers with the exception of the veins of the forehead. The venous network is expressed in the area of the wings of the nose and lips. In the event of purulent inflammatory processes on the face, increased vascularization and anastomosis can act as an aggravating factor in the course of the disease. A breakthrough of the infection into the vessels of the face or along these vessels leads to damage to the orbit and the cerebral part of the head, which is practically a sentence. That is why dentistry is such a developed field of medicine.... Complications of caries - periodontitis, periostitis, abscess and phlegmon sometimes lead to lightning death of the patient. Here a hand with phlegmonous lesion can be amputated in critical situations, but the person will remain alive. And the infected cavernous sinus does not give us this opportunity.
Lymphatic system of the face Vessels of the lymphatic system
The extensive lymphatic network and the lymph node barrier determine the lymph circulation of the facial tissues and in many ways distinguishes the maxillofacial region from other areas. Almost every area of the face has its own group of regional lymph nodes - powerful analytical laboratories and producers of local immunity factors. Also, each section of the mucous membrane of the nasopharynx and oral cavity has its own accumulation of lymphoid tissue.
The lymphatic system forms two networks in the skin of the face - superficial and deep.
The connection of superficial and deep veins with the meninges
The superficial lymphatic network is finely looped and located under the papillary layer of the skin itself. A deep looped net lies in the reticular corium layer.
In view of the characteristic attachment of the facial muscles of the facial skin and the absence of fascia on the face, the lymphatic vessels of the facial skin have their own characteristics.
Arising from a deep capillary network, they form a plexus in the surface layers of the subcutaneous fatty tissue. The larger drainage lymphatic vessels are directed to regional lymph nodes located on top of the facial muscles, or to the deep layers of subcutaneous fat, passing under several facial muscles.
The main lymphatic collectors in the form of large lymphatic vessels that penetrate under the muscles or their fascia, as a rule, join along the main arterial and venous trunks and follow them to regional lymph nodes, which are divided into three sections.
Innervation of soft tissues of the face Nerve trunks of the face
The innervation of the face is carried out by the facial nerve and
The facial nerve leaves the corresponding bone canal and enters the tissue of the parotid gland, splits into numerous branches that form the plexus parotideus nerve plexus. Fan-shaped diverging branches of the facial nerve go to all facial muscles and provide their contraction. There is a certain individual variability in the structure of the facial nerve, but in general, these are two types of structure. But in any case, the main branches of the facial nerve are present.
- Marginal ramus of the lower jaw
- Buccal branch
- Zygomatic branch
- Temporal branch
These branches are fanned out according to the basic principle - from the tragus of the ear (where the nerve begins on the face) to the corner of the mouth, along the lower edge of the lower jaw, to the tip of the nose and to the outer corner of the eye.
Trauma to the branches of the facial nerve leads to paralysis of the facial muscles. To avoid damage to the branches of the facial nerve, deep cuts on the face are made only relative to the lines connecting the ear with the outer corner of the palpebral fissure, the tip of the nose, the corner of the mouth and parallel to the edge of the lower jaw, retreating one and a half to two cm higher from it. Surgeons know these lines by heart; a layman may not need this information. But you never know what knowledge is required in life. Suppose, in addition to acute injuries, there are also chronic ones. The facial nerve, before beginning to innervate the face, passes through the temporomandibular joint and the parotid gland. In both regions, problems and inflammatory processes are possible, mainly associated with the teeth. As luck would have it, the facial nerve is mixed, and is responsible for both facial muscles and sensitivity in the oral cavity and facial areas. Moreover, it also communicates with other nerves through nerve nodes.
People perceive problems with teeth as something commonplace and everyday, as an annoying hindrance. But problems with facial expressions and disturbances in taste cannot but disturb, or rather, lead to panic.
And this is where the problems begin. It is very, very difficult to identify the source of the problem even for a qualified and experienced doctor, dentist, surgeon. The innervation of the head is too complex, in which many nerves and plexuses are involved.
But even this is not sad. People with impaired sensitivity and facial expressions often turn to a neuropathologist. He prescribes treatment based on his baggage of knowledge and his pharmacological arsenal, most often these are severe highly specialized drugs with psychotropic side effects. People are treated for years to no avail. Meanwhile, the root cause of the disease, bad teeth, may not be eliminated, therefore, the treatment will be ineffective.
This problem takes place. For those interested, here's some background information.
"Emergency care in neurostomatology".
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Deep face area
The sensitive innervation of the face is complex. It involves sensitive trunks and all three branches of the trigeminal nerve, as well as the branches of the cervical plexus. The rich innervation and blood supply to the face allows multiple duplication of innervation and blood circulation of each head area, promotes tissue stability in case of injuries, and accelerates the healing of injuries on the face. Even extensive head injuries will heal in most cases. At the same time, if the disease does arise, it creates certain difficulties in diagnosis and treatment. Over the past 20 years, the problem of innervation has become urgent again, which is associated with the massive use of implants for dental prosthetics. No matter how the examination is carried out before implantation operation, but statistically, injuries or compression of the nerve trunks during the installation of implants occur, and this suggests that anatomy as a science should continue to develop, revealing cases of anatomical variability and atypism.
As for facial injuries, it's amazing what situations happen in life. Wanting only the best, people sometimes make serious mistakes when providing first aid. At the same time, the correct solutions have long been described, you just need to know and implement them. But more on that in our next article.
It is responsible for the mobility of the facial muscles of the face, provides the ability to chew and bite off food, and also gives sensitivity to the organs and skin of the anterior head zone.
In this article, we will understand what the trigeminal nerve is.
Layout diagram
The branched trigeminal nerve, which has many processes, originates in the cerebellum, emanates from a pair of roots - motor and sensory, envelops all facial muscles and some parts of the brain with a web of nerve fibers. The close connection with the spinal cord allows you to control various reflexes, even those associated with the respiratory process, for example, yawning, sneezing, blinking.
The anatomy of the trigeminal nerve is as follows: thinner branches begin to separate from the main branch approximately at the level of the temple, in turn branching and thinning further and lower. The point at which the separation occurs is called the Gasser, or trigeminal, knot. The processes of the trigeminal nerve pass through everything on the face: eyes, temples, mucous membranes of the mouth and nose, tongue, teeth and gums. Thanks to impulses sent by nerve endings to the brain, feedback occurs, providing sensory sensations.
This is where the trigeminal nerve is.
The thinnest nerve fibers, literally piercing all parts of the facial and parietal zone, allow a person to feel touches, experience pleasant or uncomfortable sensations, move the jaws, eyeballs, lips, and express various emotions. Intelligent nature has endowed the nervous network with exactly the degree of sensitivity that is necessary for a calm existence.
Main branches
The anatomy of the trigeminal nerve is unique. There are only three branches of the trigeminal nerve, from which there is a further division into fibers leading to the organs and skin. Let's consider them in more detail.
1 branch of the trigeminal nerve is the optic or orbital nerve, which is only sensory, that is, transmitting sensations, but not responsible for the work of motor muscles. With its help, information is exchanged between the central nervous system and the nerve cells of the eyes and orbits, the sinuses and the mucous membrane of the frontal sinus, the muscles of the forehead, the lacrimal gland, and the meninges.
Three more subtle nerves branch off from the optic:
Since the parts that make up the eyes must move, and the orbital nerve cannot provide this, a special vegetative node called the ciliary nerve is located next to it. Thanks to the connective nerve fibers and the additional nucleus, it provokes contraction and straightening of the pupillary muscles.
Second branch
The trigeminal nerve on the face also has a second branch. The maxillary, zygomatic or infraorbital nerve is the second major branch of the trigeminal nerve and is also intended to transmit only sensory information. Through it, sensations go to the wings of the nose, cheeks, cheekbones, upper lip, gums and dental nerve cells of the upper row.
Accordingly, a large number of medium and thin branches depart from this thick nerve, passing through different parts of the face and mucous tissues and combined for convenience into the following groups:
Here, too, there is a parasympathetic vegetative node, called the wing-palatine ganglion, which facilitates salivation and mucus secretion through the nose and maxillary sinuses.
Third branch
The third branch of the trigeminal nerve is called the mandibular nerve, which performs both the provision of sensitivity to certain organs and areas, and the function of movement of the muscles of the oral cavity. It is this nerve that is responsible for the ability to bite off, chew and swallow food, stimulates the movement of the muscles necessary for conversation and located in all parts of which the mouth area consists.
There are such branches of the mandibular nerve:
- buccal;
- lingual;
- lower alveolar - the largest, giving off a number of thin nerve processes that form the lower tooth node;
- ear-temporal;
- chewing;
- lateral and medial pterygoid nerves;
- maxillary-sublingual.
The mandibular nerve has the most parasympathetic formations that provide motor impulses:
This branch of the trigeminal nerve transmits sensitivity to the lower row of teeth and the lower gum, lip and jaw as a whole. The cheeks also receive sensations in part with the help of this nerve. The motor function is performed by the chewing branches, pterygoid and temporal.
These are the main branches and exit points of the trigeminal nerve.
Reasons for defeat
Inflammatory processes of various etiologies affecting the tissues of the trigeminal nerve lead to the development of a disease called "neuralgia". According to its location, it is also called "facial neuralgia". It is characterized by a sudden paroxysm of sharp pain piercing different parts of the face.
This is how the trigeminal nerve is damaged.
The causes of this pathology are not fully understood, but many factors are known that can provoke the development of neuralgia.
The trigeminal nerve or its branches are compressed under the influence of the following diseases:
- cerebral aneurysm;
- atherosclerosis;
- stroke;
- osteochondrosis, provoking an increase in intracranial pressure;
- congenital defects of blood vessels and bones of the skull;
- neoplasms that arise in the brain or on the face at the places where the branches of the nerve pass;
- trauma and scarring of the face or joints of the jaw, temples;
- the formation of adhesions caused by infection.
Diseases of a viral and bacterial nature
- Herpes.
- HIV infection
- Polio.
- Chronic otitis media, mumps.
- Sinusitis.
Diseases affecting the nervous system
- Meningitis of various origins.
- Epilepsy.
- Cerebral palsy.
- Encephalopathy, hypoxia of the brain, leading to a lack of supply of substances necessary for full-fledged work.
- Multiple sclerosis.
Surgical intervention
The trigeminal nerve on the face can be damaged as a result of surgery in the face and oral cavity:
- damage to the jaws and teeth;
- the consequences of improperly done anesthesia;
- incorrectly performed dental procedures.
The anatomy of the trigeminal nerve is truly unique and therefore this area is very vulnerable.
Characteristics of the disease
Pain syndrome can be felt only on one side or affect the entire face (much less often), can affect only the central or peripheral part. In this case, the features often become asymmetrical. Attacks of varying strength last a maximum of several minutes, but can deliver extremely unpleasant sensations.
This is the kind of discomfort that the trigeminal nerve can cause. A diagram of possible affected areas is presented below.
The process is able to cover different parts of the trigeminal nerve - branches separately or some together, the sheath of the nerve or all of it. Most often, women suffer as they grow older. Paroxysms of pain in severe neuralgia can be repeated many times throughout the day. Patients faced with this disease describe attacks as electric shocks, while the pain can be so severe that a person temporarily becomes blind and ceases to perceive the world around him.
The muscles of the face can become so sensitive that any touch or movement triggers another attack. Nervous tics, spontaneous contractions of the facial muscles, mild convulsions, saliva, tears or mucus from the nasal passages appear. Constant seizures significantly complicate the life of patients, some try to stop talking and even eat food, so as not to touch the nerve endings once again.
Quite often, for a certain time before the paroxysm, facial paresthesia is observed. This feeling is reminiscent of pain in a sitting leg - goosebumps, tingling and numbness of the skin.
Possible complications
Patients who postpone going to the doctor run the risk of getting many problems after a few years:
- weakness or atrophy of the masticatory muscles, most often from the side of trigger zones (areas that irritate them causes pain attacks);
- asymmetry of the face and the raised corner of the mouth, reminiscent of a grin;
- skin problems - peeling, wrinkles, dystrophy;
- loss of teeth, hair, eyelashes, early gray hair.
Diagnostic methods
First of all, the doctor collects a full anamnesis, finding out what diseases the patient had to endure. Many of them are capable of provoking the development of trigeminal neuralgia. Then the course of the disease is recorded, the date of the first attack and its duration are noted, the accompanying factors are carefully checked.
It is necessary to clarify whether the paroxysms have a certain periodicity or come, at first glance, chaotically and whether there are periods of remission. Further, the patient shows the trigger zones and explains what effects and what force must be applied in order to provoke an exacerbation. This also takes into account the anatomy of the trigeminal nerve.
The localization of pain is important - one or both sides of the face are affected by neuralgia, and whether pain relievers, anti-inflammatory and antispasmodic drugs help during an attack. In addition, the symptoms that can be described by a patient observing a picture of the disease are specified.
The examination will need to be carried out both during a quiet period and during the onset of an attack - so the doctor will be able to more accurately determine the state of the trigeminal nerve, which parts of it are affected, give a preliminary conclusion about the stage of the disease and a prognosis for the success of treatment.
How is the trigeminal nerve diagnosed?
Important Factors
Typically, the following factors are evaluated:
- The state of the patient's psyche.
- The appearance of the skin.
- The presence of cardiovascular, neurological, digestive disorders and pathology of the respiratory system.
- The ability to touch the trigger areas on the patient's face.
- The mechanism of the onset and spread of pain syndrome.
- Patient behavior - numbness or active actions, attempts to massage the nerve zone and the affected area, inadequate perception of the people around, absence or difficulty with verbal contact.
- The forehead becomes covered with perspiration, the pain zone turns red, there is strong discharge from the eyes and nose, swallowing of saliva.
- Cramps or tics in the muscles of the face.
- Change in breathing rhythm, pulse, blood pressure.
This is how the trigeminal nerve study is done.
You can temporarily stop the attack by pressing on certain points of the nerve or by blocking these points with injections of novocaine.
Magnetic resonance imaging and computed tomography, electroneurography and electroneuromyography, as well as electroencephalogram are used as certifying methods. In addition, a consultation with an ENT specialist, a neurosurgeon and a dentist is usually prescribed to identify and treat diseases that can provoke the appearance of facial neuralgia.
Treatment
Complex therapy is always aimed primarily at eliminating the causes of the disease, as well as relieving the symptoms that cause pain. Typically, the following drugs are used:
- Anticonvulsants: Finlepsin, Difenin, Lamotrigine, Gabantin, Stazepin.
- Muscle relaxants: "Baklosan", "Liorezal", "Midocalm".
- Vitamin complexes containing group B and omega-3 fatty acids.
- Antihistamines, mainly Diphenhydramine and Pipalfen.
- Medicines that have a sedative and antidepressant effect: "Glycine", "Aminazin", "Amitriptyline".
With severe lesions of the trigeminal nerve, it is necessary to use surgical interventions aimed at:
- to alleviate or eliminate diseases that provoke attacks of neuralgia;
- a decrease in the sensitivity of the trigeminal nerve, a decrease in its ability to transmit information to the brain and central nervous system;
The following types of physiotherapy are used as additional methods:
- irradiation of the neck and face with ultraviolet radiation;
- exposure to laser radiation;
- treatment with ultra-high frequencies;
- electrophoresis with drugs;
- diadynamic current of Bernard;
- manual therapy;
- acupuncture.
All methods of treatment, drugs, course and duration are prescribed exclusively by the doctor and are selected individually for each patient, taking into account his characteristics and the picture of the disease.
We examined where the trigeminal nerve is located, as well as the causes of its damage and methods of treatment.
Anatomy and pathology of the facial nerve
Facial nerve, seventh pair of thirteen cranial nerves. Brings sensitivity to the facial muscles of the face. The topography follows from the nuclei to the muscles, from the opening of the hearing aid, it passes to the temporal bone. Then it flows into the internal auditory canal and the tunnel of the facial nerve. From the temporal bone to strive to the parotid gland. Then it breaks up into small processes, they transmit sensitivity to the forehead, wings of the nose, cheekbones, as well as the circular muscles of the eyes and mouth.
Anatomy
The anatomy of the nervous system is quite complex and "tortuous". The nerve trunk comes from processes covered with a special tissue - neuroglia. With the defeat of neuroglia, the symptomatology is not very acute, in comparison with the infringement or damage to it itself.
The facial nerve consists of:
- areas of the cerebral cortex, which are responsible for the work of facial muscles;
- nuclei are located between the medulla oblongata and the bridge. There are three nuclei responsible for facial expressions; single path regulatory core
salivation ends giving a sense of taste, corrects the salivary glands;
- directly the nerve trunk, or rather its processes;
- capillary network and lymph nodes, due to which the nerve cells are nourished.
Also, the sensitivity of the face is due to the fact that the trigeminal nerve is located nearby. The eye branch comes from the trigeminal branch. Basically, this it serves as a sensor transmitter, that is, it transmits data from various receptors. Thinner nerve branches also diverge from the eye branch and they innervate the orbit. Accordingly, the orbital fissure is supplied by the trigeminal innervation, and from it, in turn, branches depart to the frontal, lacrimal and nasal ciliary.
The maxillary branch also consists only of sensitive cells and transmits information from receptors. In the orbit itself, this branch branches, getting there already through the lower optic fissure. The maxillary branch rejects the nerve plexus, its main task is the interaction of the nervous system with the receptors of the gums and teeth. As soon as the supradental nerve fibers pass into the infraorbital region, the eyelid is immediately innervated. And only one single branch regulates the sensitivity of the cheekbones and cheeks - this is the zygomatic nerve, which subsequently enters through the upper slit into the orbit itself.
The mandibular branch, in contrast to the above, not only carries information between the central nervous system and nerve cells, but also carries out a motor function. This is a large branch that starts from the foramen ovale and immediately gives off three branches. Sensitivity is applied to the gums, dental nerve endings of the lower jaw and cheeks. The pterygoid, chewing and temporal branches are responsible for motor functions.
Functions
The most basic function of the facial nerve is motor function. Before branching into small parts, it is intertwined with the intermediate, and performs part of the duties along with it. Through the internal auditory opening, they tend to the tunnel of the facial nerve. After that, the knee begins to form, which provides the sensing of the intermediate nerve.
Coming out of the parotid gland, the branches of the facial nerve are divided into a powerful upper and more graceful lower. They also branch out into smaller processes. Which create the parotid plexus, then the nerve provides motor activity to almost all facial muscles. But although this function is the main one, due to the intermediate nerve, it has secretory and taste fibers.
The intermediate, located in the thickness of the temporal bone, discards the nerve processes: the large stony, stapedius, the branches connecting it and the tympanic plexus, all this ends with a drum string.
Clinical lesions
If there is a malfunction or infringement of the canal of the facial nerve, it is fraught with paralysis of the motor facial muscles. The asymmetry of the face is visually diagnosed. The relaxed part of the face and motionless, creates the effect of a mask, the eye does not close on the side of the lesion, lacrimation increases. It occurs due to irritation of the mucous membrane of the eye with air, dust, therefore, it leads to inflammation and conjunctivitis. Wrinkles on the forehead and nasolabial area are straightened. The corners of the mouth "look" down, the victim cannot wrinkle his forehead on his own. Paralysis of the circular muscle of the eye and the non-adjacent part of the eyelid to the eyeball lead to a violation of the formation of the capillary gap. Because of this, there are problems with tearing.
Peripheral lesions
If for some reason the motor function is affected, then we can talk about peripheral paralysis. The clinical manifestations are as follows: complete asymmetry of the face, paralysis of facial muscles, limited intake of liquids, impaired speech apparatus. If a nerve is damaged when it is located in the pyramidal bone, then it is observed: lack of taste, deafness and all of the above signs are observed.
Neuritis
A neurological disorder characterized by inflammation. Neuritis can be located in the central part of the face and peripheral. Symptoms depend on which part of the nerve is involved. As a rule, there are no erroneous diagnoses in differentiation and statement. The development of the disease can be due to hypothermia, the so-called primary neuritis, and secondary, manifested due to any other diseases.
The clinical picture is described as an acute onset. The pain syndrome radiates behind the ear, and after a few days the asymmetry of the face is noticeable. Symptoms may differ depending on the affected part. If the nucleus of the facial nerve suffers, then the person suffers from muscle weakness of the face. The process of infringement located in the area of the pons of the brain leads to strabismus and paralysis of almost all of the facial muscles. If the infringement occurs at the exit, then this can bode well for impairment and short-term hearing loss.
Neuritis can be concomitant, for example, in chronic otitis media. And it occurs due to the ongoing process of inflammation in the middle ear. Therefore, paresis of the face manifests itself with concomitant "shooting" in the ear. With the concomitance of mumps, a general intoxication of the body occurs - temperature, chills, body aches.
The treatment regimen for inflammation and infringement should be comprehensive and timely. Drug therapy necessarily includes:
- glucocorticosteroid drugs;
- diuretics that remove fluid from the capillary network;
- drugs that promote vasodilation;
- vitominotherapy, as a rule, of group B.
Further, comprehensive treatment of this nerve includes exclusion and treatment of the underlying cause. Since neuralgia is the result of a disease or a secondary disease. Usually, nervous diseases are accompanied by sufficient pain; analgesics are prescribed to reduce or stop them. For a more effective and quicker treatment, the muscles of the face must remain completely at rest. Physiotherapy measures also adjoin complex treatment. From the second week of the diagnosed disease, you can connect face massages and physiotherapy exercises. In this case, the load increases gradually.
Surgical intervention is performed in rare cases if neuralgia is congenital or the nerve is severely damaged by mechanical injury. Such an operation consists in stitching torn or incorrectly fused endings. Another case that provokes surgical intervention is the ineffectiveness of drug therapy for 6-8 months. If you do not resort to such methods of treatment or strongly start the process of the disease, then this leads to complete atrophy of the muscles of the face, which can no longer be restored. You can also resort to surgical plastic surgery of the face, the material for this is taken from the leg of the operated person.
Forecast
When you turn to medical help and proper treatment, the process of recovery and recovery is quite long, but at the same time favorable. Also, the burden depends on concomitant diseases. Relapses are successfully cured, but are much harder and longer.
In order to avoid these pathologies, you should take care of your health, do not overcool the body, timely treat various inflammatory processes, such as ARVI, flu, tonsillitis.
The information on the site is provided solely for popular informational purposes, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Please consult your healthcare professional.
Anatomy of the trigeminal nerve: a diagram of the location of branches and exit points on a human face with a photo
The nervous system is usually divided into two sections - peripheral and central. The brain and spinal cord are referred to as the central, the nerves of the back and head are connected directly with the central nervous system and represent the peripheral section. Nerve impulses from all parts of the body are transmitted through the central nervous system to the brain, and feedback is also carried out.
Trigeminal anatomy
There are twelve pairs of cranial nerves in the human body. The trigeminal nerve system is a fifth pair and is divided into three branches, each of which is directed to a specific area - the forehead, lower jaw and upper. The main branches are divided into smaller ones, which are responsible for transmitting signals to parts of the face. The anatomy of the ternary nerve looks like a system of nerve endings that originates from the pons varoli. The sensory and motor roots form the main trunk directed towards the temporal bone. The branches are arranged like this:
- orbital;
- a branch of the upper jaw;
- mandibular;
- node of the trigeminal nerve.
Where is the nerve: the layout on the face
Originating in the cerebellum, the trigeminal nerve has many small branches. They, in turn, connect all the muscles of the face and the parts of the brain responsible for them. The various functions and reflexes are controlled by a close connection with the spinal cord. The trigeminal nerve is located in the temporal region - smaller branching endings diverge from the main branch in the temple region. The branch point is called the trigeminal node. All small branches connect the organs of the front of the head (gums, teeth, tongue, mucous membranes of the nasal and oral cavities, temples, eyes) with the brain. The location of the nodes of the trigeminal nerve on the face is shown in the photo.
Functions of the facial nerve
Sensory sensations are provided by impulses that are transmitted by nerve endings. Thanks to the fibers of the nervous system, a person is able to feel touches, feel the difference in ambient temperatures, control facial expressions, carry out various movements of the lips, jaws, eyeballs.
If we consider in more detail what the trigeminal nerve system is, you can see the following picture. The anatomy of the trigeminal nerve is represented by three main branches, which are further divided into smaller ones:
- The orbital (optic) nerve is only responsible for transmitting information from the nerve endings of the meninges, forehead muscles, sinuses, lacrimal glands, eye sockets and eyes from the central nervous system. The tertiary visual process is not involved in the work of the muscles and carries out only sensory communication.
- The maxillary is also responsible only for transmitting information from the nerve endings of the upper teeth and gums, lips, cheekbones, cheeks, wings of the nose to the central nervous system.
- The mandibular is responsible for the motor function of the muscles of the lower part of the face, the oral cavity and provides the sensitivity of the facial organs. The jaw process of the trigeminal nerve provides the ability to talk, chew and swallow food, and also gives motor impulses to the ear, submandibular and hypoglossal muscles. The main branches and exit points can be seen in the photo.
Neuralgia, as the main pathology of the nerve
What is trigeminal inflammation? Neuralgia, or as it is also commonly called - facial neuralgia, denote the development of inflammatory processes in the tissues of the trigeminal nerve.
The exact factors of the onset of pathology have not yet been studied, although the main causes of the disease are known:
- infectious diseases that provoke the formation of adhesive processes in the tissues;
- the formation of scars on the skin, on the temporal and jaw joints as a result of injuries;
- the development of tumors at the points of passage of nerve branches;
- congenital defects in the location and structure of the vessels of the brain or cranial bones;
- multiple sclerosis, which leads to partial replacement of nerve cells with connective tissue;
- spinal pathologies (for example, osteochondrosis), provoking an increase in intracranial pressure;
- dysfunction of the blood circulation of the vessels of the head.
Inflammation symptoms
The inflammatory process of the branches of the trigeminal nerve affects the nerve fibers individually or several together, the pathology can affect the entire branch or only its sheath. The facial muscles become oversensitive and react even to light touch or movement with bouts of burning, acute pain. Common symptoms of inflammation of the trigeminal facial nerve are:
- exacerbation of pain and increased frequency of attacks in the cold season;
- attacks most often start suddenly and last from two to three to thirty seconds;
- pain syndrome occurs in response to various stimuli (brushing teeth, chewing movements, touching);
- the frequency of attacks can be the most unpredictable - from one or two a day to the onset of severe pain every 15 minutes;
- a gradual increase in pain and an increase in the occurrence of attacks.
The most common is unilateral inflammation of the trigeminal nerve. With the rapid growth of wisdom teeth, pressure is exerted on nearby tissues, the result may be neuralgia. There is an involuntary profuse salivation, mucus from the sinuses, convulsive contractions of the facial muscles. Patients try to avoid eating or talking so as not to provoke the onset of another attack. In some cases, its onset is preceded by a feeling of numbness and tingling of the facial muscles, paresthesia occurs.
Complications
If you ignore the signs of the onset of trigeminal nerve disease, over time, you can get a number of complications:
- development of weakness or atrophic processes of the muscles responsible for chewing is possible;
- violation of the proportions of the face - asymmetry of the corners of the mouth and facial muscles;
- dystrophic changes in the skin on the face (early wrinkles, peeling);
- the development of alopecia (loss of eyelashes, eyebrows);
- loosening and loss of wisdom teeth.
Diagnostics
Diagnosis of inflammation of the trigeminal nerve is carried out by a specialist and includes anamnesis and examination with an assessment of the localization of pain. Based on the results of the initial examination, the doctor decides on the need for a comprehensive examination, directing the patient to undergo computer diagnostics and MRI (magnetic resonance imaging). Electroneuromyography or electroneurography may be prescribed. It is recommended to consult an ENT specialist, dentist and surgeon.
The frequency of the onset of attacks is important, as well as the actions, focus and strength of their provoking. The place where the main nerve passes plays the most important role. Examination is carried out by a doctor both during remission and during an exacerbation. This is done to more accurately determine the state of the trigeminal, dental and other nerves of the face, which branches of the trigeminal nerve are most affected. An important factor is the assessment of the patient's mental state, the condition of the skin, the presence or absence of muscle cramps, pulse and blood pressure readings. Painful and traumatic wisdom tooth extraction can provoke neuralgia.
Methods for treating neuralgia
To successfully treat inflammation of the trigeminal nerve, a comprehensive, holistic approach must be followed. It is necessary not only to eliminate the symptoms, but also to get rid of the factors that provoked the onset of the pathology. The package of measures includes medication treatment, massage therapy and a course of physiotherapy.
- Drug therapy involves blockade - intramuscular injections that reduce muscle spasm.
- With the viral nature of inflammation of the trigeminal nerve, antiviral pills are prescribed.
- To reduce discomfort and relieve pain, the doctor prescribes pain relievers.
- The complex of medication therapy includes the use of non-steroidal anti-inflammatory drugs that affect the process of inflammation.
- To relieve convulsive syndrome and other unpleasant sensations, anticonvulsant pills, muscle relaxants, antihistamines, antidepressants and sedatives are used.
- We must not forget about the support of the immune system, weakened by the disease and the central nervous system. It is necessary to take a complex of vitamins, special attention is paid to B vitamins, which have a strengthening effect on the nervous system.
The physiotherapy course is carried out using the following procedures:
- electrophoresis;
- magnetic therapy;
- UHF therapy;
- laser irradiation;
- acupuncture.
With the help of the influence of magnetic fields and high-frequency currents, the circulatory function is restored, muscles are relaxed. The use of electrophoresis with drugs has proven itself well in the fight against inflammation of the trigeminal nerve.
In addition to physiotherapy and drug therapy, the specialist may decide that a therapeutic massage is needed. The massage course makes it possible to restore the lost tone to the muscles and achieve their maximum relaxation. A massage course for inflammation of the trigeminal nerve consists of procedures that should be carried out every day.
Traditional medicine offers its own methods of treatment in the event that inflammation has occurred. An inflamed triple (ternary) nerve node causes the patient not only discomfort, but can also lead to the development of various complications. The scheme of treatment with folk remedies is the use of compresses, rubbing, therapeutic applications on the affected area. It is not recommended to heat the triple inflamed area, therefore, all products should be cooled to room temperature before use. Warming up is recommended only during the period of remission. To do this, heat the salt in a tissue bag and apply it to the site of inflammation.
For the preparation of medicinal products, fir oil, marshmallow root, chamomile flowers are used. If the dental chewing muscles are inflamed, during the period of remission, the method of treatment with the help of a chicken egg is used. It should be understood that the treatment of serious diseases should be carried out under the supervision of a specialist; the use of traditional medicine is possible as an auxiliary method.
Recently I have experienced on myself what neuralgia of the facial nerve is. After the treatment of the wisdom tooth, the pain not only did not stop, on the contrary, in the evening it intensified so much that it was impossible to open the mouth. At the next visit to the doctor, it turned out that the dental nerve was pinched.
This doctor is incompetent. I have 3 times wisdom teeth - 2 times at my dentist and 1 time at another. My dentist-surgeon removed it without consequences, everything healed quickly and almost did not hurt. And after a visit to the would-be doctor, I lay for two days with pain and fever.
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