The need to treat facial neuropathy is faced by patients of different ages. This disease is a violation of the innervation of nerve endings, as a result of which the tone of the facial muscles is lost, paresis develops. Such a pathological condition, as a rule, occurs on the one hand, but isolated cases are known when the disease spread to the entire face.
Disease Description
The facial nerve is localized in a vulnerable, unprotected place in which it is easy to influence. Facial neuropathy can occur for a number of reasons, so this disease can be considered very common. It can not be considered an independent disease. As a rule, its occurrence is a consequence of the course of a more serious ailment.
In ICD-10, facial neuropathy is indicated by the code G51. It is not divided into right-handed and left-handed. However, according to statistics, neuropathy of the right facial nerve is more common. Depending on the individual characteristics and the cause of the defeat, a more accurate cipher is selected. The refinement code for facial neuropathy in the International Classification of Diseases of the Tenth Revision may be:
- G51.0 - Bell palsy (facial paralysis);
- G51.1 - inflammation of the knee node, with the exception of the postherpetic form;
- G51.2 - Rossolimo-Melkerssson-Rosenthal syndrome;
- G51.3 - clonic hemifacial spasm;
- G51.4 - facial myokimia;
- G51.8 - other lesions of the facial nerve;
- G51.9 - Unspecified forms of the disease.
In addition, any neuritis is primary or secondary. Despite the fact that this classification of facial neuropathy in the ICD is absent, the exact definition of the form of pathology for doctors plays an important role in the diagnosis.
In the first case, neuritis develops as a result of the direct exposure of an infectious agent to nerve roots. Primary neuropathy can be the result of hypothermia, while the secondary form occurs against the background of other ongoing pathological processes during which the nerve receptor is infected.
Causes and pathogenesis of neuritis
To date, the causes of this pathology are not fully understood. The only thing that was able to prove to doctors is that acute facial neuritis never acts as an independent link in the pathological process. The trigger for the development of this disease can be one of the following factors:
- traumatic brain injury, especially damage to the bones of the temporal lobe, the base of the skull or mastoid process;
- surgical interventions (plastic surgery on the face, surgical treatment of brain tumors, etc.);
- infections of viral and bacterial etiology (meningoencephalitis, mumps, flu);
- complicated course of acute respiratory viral infections, mastoiditis;
- hypothermia or prolonged exposure to a draft;
- ischemic stroke, which is characterized by blockage of cerebral vessels in acute circulatory disorders.
The neuropathy of the facial nerve indicated under code G51.0 in the ICD-10 is diagnosed in patients more often than other types of the disease. The pathogenetic mechanism of Bell's palsy is determined by the root cause of the disease. Paresis of facial muscles and loss of sensitivity of the facial receptors due to a stroke is called ischemic neuropathy of the facial nerve. Violation of tissue innervation occurs due to damage to motor neurons due to sudden oxygen starvation. A similar condition can be observed with hypertensive crisis.
A subspecies of Bell's ischemic paralysis is compression neuropathy of the facial nerve. Treatment of the disease is carried out in a similar way. Its main goal is to restore the transmission of nerve impulses to neurons affected as a result of impaired blood supply due to compression of nearby receptor structures. The cause in this case is facial injuries, and bone fragments, hematomas, lymph congestion and other factors that prevent full innervation have a direct effect on the facial nerve.
Regardless of the cause, treatment of facial neuropathy should be started as soon as possible. At the advanced stage of the inflammatory process, it is much more difficult to eliminate paralysis and restore facial sensitivity, normal muscle mobility.
What is this disease dangerous?
Acute neuropathy of the facial nerve cannot be ignored. If you miss the time and do not start treatment after the first symptoms appear, the risk of developing mimic contracture will increase. In severe cases, patients' faces are literally compressed with paralysis. It seems as if a person is wearing a mask, as his face freezes with an unchanging expression.
In general, treatment of facial neuropathy is a long process. In the later stages, it is very difficult, almost impossible to eliminate the consequences of such a disease. In addition, over time, the patient will completely lose facial sensitivity. The more time passes from the moment of the occurrence of this pathology, the more difficult it will be to cure it and help a person return full facial expressions, sensitivity of the skin of the face, tongue. In addition, we must not forget that with improperly selected treatment or its complete absence, neuritis can recur.
Basic principles of traditional treatment
Therapy of facial neuritis is carried out exclusively under the supervision of specialists. Self-medication in most cases is ineffective, and sometimes even exacerbates the situation and leads to serious complications.
At the first symptoms of acute facial neuropathy, it is urgent to visit a neurologist. The doctor will prescribe the passage of diagnostic procedures and competent treatment. The standard therapeutic tactics for facial neuropathy is a course of special procedures and medications, massage and therapeutic and mimic gymnastics.
Prednisolone
For the treatment of facial neuropathy, drugs are selected based on the severity of paralysis and the reasons that provoked it or paresis. First of all, the patient is prescribed anti-inflammatory and decongestants. The most effective is the prednisolone glucocorticoid. It must be taken according to a certain scheme:
- during the first two days, an introductory dose of 20-30 mg of the active substance per day is recommended;
- then a maintenance dosage is prescribed (5-10 mg per day).
The duration of the course of use of Prednisolone is determined by a specialist. Usually, hormonal treatment lasts no more than 10 days, but in complicated cases it can be extended. When taking corticosteroid drugs, which include Prednisolone and its analogues (Sherizolon, Decortin, Medopred), you must strictly adhere to medical prescriptions, since hormonal drugs, if used improperly, can affect the adrenal glands and provoke a number of adverse reactions of the body . The symptom complex that occurs in this case is called cushingoid syndrome.
Berlition
With symptoms of facial neuropathy, treatment involves the use of drugs to restore the conductivity of peripheral nerve impulses. The fundamental substance of this drug is alpha-lipoic acid - this vitamin-like component takes part in the natural biochemical processes of cell and tissue oxidation, has a pronounced antioxidant effect, and improves trophism of nerve receptors.
Berlition is produced in two forms: tablet and infusion. The optimal dose in the treatment of facial neuritis is 600 mg of alpha lipoic acid, which equals two tablets. The medicine is taken in the morning on an empty stomach.
The solution for intravenous drip is used in combination with an isotonic sodium chloride solution, which acts as a solvent. The drug should be administered at a low speed, within half an hour.
As a rule, "Berlition" is favorably tolerated by patients. In cases of individual intolerance to the active substance, the likelihood of developing an allergic reaction in the form of skin itching, urticaria, mild nausea, and dizziness is not excluded.
Additional drugs
Regardless of which side the facial nerve neuropathy occurred, on the right or left, the patient is prescribed medication for blood circulation and antispasmodics. Most often, “Eufillin”, “Sermion”, nicotinic acid preparations, and B vitamins are used for this purpose.
To normalize blood flow in the affected areas, “Eufillin” is prescribed to the patient. This tool effectively removes the tone of blood vessels and improves the elasticity of their walls. Sometimes this drug is used as a diuretic to relieve swelling. “Eufillin” is produced in the form of oral tablets in a dosage of 0.15 g (you need to take 1-2 tablets in the morning and evening after eating) or a solution for intramuscular injection. Analogues of the drug are Durofilin, Neoteopec, Retafil.
"Sermion" refers to the group of cerebral circulation correctors - alpha-blockers. Drugs from this category are prescribed to patients with the aim of conducting rehabilitation therapy after traumatic brain injuries, past strokes, meningitis, as well as acute and chronic pathologies of a viral or bacterial nature. This tool has a positive effect on the cognitive functions and mood of the patient, helps to improve innervation and restore the sensitivity of facial tissues. The average dosage is 30 mg, so much active substance is contained in one tablet (taken in the morning half an hour before a meal or 10 mg three times a day). The course of treatment for this disease is on average 2-4 months.
Useful for neuritis of any location is nicotinic acid (vitamin PP). Drugs with its content are involved in redox processes. Vitamin PP is present in many enzymes produced by the pancreas. Synthetic analogues of nicotinic acid contribute to filling its lack in the body, as a result of which it is possible to improve cerebral and peripheral blood circulation, normalize carbohydrate metabolism and reduce the content of triglycerides in the blood.
Nicotinic acid preparations are used as a secondary drug in addition to the main therapy. Vitamin PP is not used in tablets - the substance is administered intramuscularly. With facial neuritis, the course of treatment is at least one month.
Physiotherapy
Comprehensive procedural treatment of facial neuropathy, the symptoms of which are manifested in the form of immobility and the absence of facial expressions on one or both sides of the face, is recommended to be carried out in order to directly affect the affected area. Due to the physiotherapeutic effect, blood circulation gradually returns to normal and tissue trophism improves.
By themselves, medical procedures, as a rule, do not give the desired result. From the first days, therapy should be carried out comprehensively, using anti-inflammatory drugs. So, for example, patients are often prescribed electrophoresis using a 0.02% Dibazol solution, which has antispasmodic and vasodilating properties, improves impulse conduction and facial nerve sensitivity. Also, potassium and vitamin B1 preparations can be used for the procedure.
In order to improve the mobility of the facial muscles and relieve increased muscle tone, electrophoresis is prescribed with a solution of "Sodium oxybutyrate" in the cervical-collar zone. Recently, as an alternative to electrophoresis, electromagnetic wave treatment is increasingly being prescribed, which has a stimulating effect on the facial nerve with paresis and complete paralysis.
Therapeutic exercise complex
Gymnastics with facial neuropathy is an indispensable element in the treatment of this disease. It helps to improve blood circulation in the vessels of the face and neck, starts recovery processes and helps to restore normal facial expressions to the patient. Exercises must be carried out in front of the mirror. If the weakened muscles are not able to perform simple actions (for example, smile, put your lips in a tube, raise eyebrows, etc.), at first the patient should help himself with his hands.
With neuropathy of the facial nerve on the left or right, it is important to perform all the exercises alternately, separately. No need to simultaneously try to smile and frown forehead, raise eyebrows, otherwise muscle tissue can remember the combination of such actions, and they will involuntarily appear even after recovery. Facial exercises with neuritis should be as natural as possible. It is desirable to combine the restoration of facial expressions with the manifestation of emotions. For example, while training to smile, it is advisable for the patient to listen to something fun. This will activate the extinct natural reflex in response to the stimulus.
Facial massage and acupuncture
This type of treatment for facial neuritis is very effective. Massage sessions for facial neuropathy are recommended not earlier than one and a half weeks after the onset of pathology. Unlike the medical course and physiotherapeutic procedures, which must be started as early as possible, mechanical action on the affected area in the acute period is contraindicated.
If the patient experiences discomfort when touching the left or right neuropathy of the facial nerve, it is most likely accompanied by an inflammatory process, which may be a sign of the spread of infection as a result of trauma or ENT disease. In this case, massage is contraindicated, since under such circumstances, even a minimal force effect can aggravate the situation and provoke further spread of the infection. Most neurologists are of the opinion that it is advisable to prescribe a massage only after the cause of the disease has been completely eliminated.
The technique of performing therapeutic massage is quite simple: with warm hands you need to make light circular grindings, stroking clockwise, from the neck itself to the scalp.
Acupuncture sessions (acupuncture) for facial neuritis should be carried out exclusively by an experienced specialist. It is important to understand the risk of such a procedure, since it is a direct effect on special points on the face and projection points of the facial nerve. As a rule, first medical needles are placed on a healthy part of the face. With the help of an acupuncture session, the patient manages to achieve a relaxing effect, to get rid of the feeling of tension and hypertonicity of the facial muscles.
In the affected areas in the immediate area of stimulation, the needle should be at least 15 minutes. The essence of this technique is to balance the innervation of the face and stabilize the conduction of impulses along nerve fibers. This type of treatment is possible in the absence of an infectious focus some time after the onset of symptoms of facial neuropathy.
Home treatment
With neuritis, folk remedies help strengthen the effect of medications and physiotherapy. Alternative methods can only be used after consultation with your doctor. Treatment of facial neuropathy with folk remedies gives good results with mild to moderate disease severity. You can reduce the severity of symptoms using several methods described below:
- Warming with salt. For the procedures you will need a small bag made of natural materials (you can sew it yourself from linen, cotton, dense chintz). Pour ordinary table salt onto a preheated dry frying pan and heat it, then pour it into a bag, tie it tightly and attach to the immobilized part of the face. During the day, you need to perform this procedure three times. If you believe the feedback from patients, then improvement occurs literally in a few days, but treatment should be continued until complete recovery. .
- . . - . .
- . . , . , 20 , . .
, . , .
The first remedy worth mentioning is an infusion from the root of the marshmallow. To prepare the product, you need 40 g of dry root. The plant is crushed, pour 300 ml of boiling water, covered with a lid and left to infuse for 2-4 hours. After this time, the root is removed from the container, carefully squeezed through cheesecloth, and the healing fluid is poured into a separate glass dish and sent to the refrigerator.
Before use, the infusion should be heated to +30 ° C and drink on an empty stomach. At one time, 50 ml of infusion is enough. You can use the treatment solution not only inside, but also externally. To make a compress, it is enough to moisten the fabric dressing in the infusion and attach it to the sore spot for half an hour. Repeat the procedure for a month.
Effective in the treatment of neuropathy is chamomile decoction. A handful of medicinal flowers is used for its preparation. Plant materials are poured into a glass of warm water and placed in a water bath. After 60 minutes, you need to squeeze the flowers, and pour the broth into a jar. The product must be drunk 100 ml three times a day and rinsed with an oral cavity, retaining a warm solution on the side of the affected facial nerve.
Another herb that can be used to treat facial neuropathy is sage. At 3 tbsp. l herbs require 2 cups boiling water. You need to cook and take sage broth according to the same scheme as chamomile. It has a calming, analgesic, antispasmodic, bactericidal, anti-inflammatory and decongestant effect.
Homeopathy for Bell Paralysis
For the treatment of facial neuropathy, representatives of alternative medicine recommend the use of a glomerular, granular, powdered thuja, magnesium chloride fighter. These components are prescribed for neuralgia and neuritis of various etiologies.
The chronic form of neuropathy requires long-term treatment with drugs in small doses, while the acute stage of the disease is stopped with high doses. For example, the glomerular wrestler is recommended to take homeopaths at a 30-minute interval until the patient perspires, which will indicate a decrease in body temperature. This plant is poisonous, and at the wrong dosage it can cause serious damage to health. Tincture should be taken under the strict supervision of a specialist.
Homeopathic remedies, which are based on magnesium chloride, have anti-allergic, antimicrobial and analgesic effects. Magnesium-containing drugs are often used in the treatment of diseases of the central and peripheral nervous systems.
A good addition to the main treatment will be thuja. In homeopathic pharmacies, you can purchase granules or powder from this plant. Dosage depends on the age and weight of the patient. Typically, adults are prescribed 6-8 granules half an hour before a meal. You need to take thuja three times a day. In case of overdose or side effects, you should stop taking homeopathic medicines and consult a doctor. The main signs of individual intolerance to these drugs are nausea, abdominal pain, dizziness, allergic rashes.
Operation with complete immobility
In complicated cases, a decision may be made to restore the anatomical integrity of the nerve by surgical intervention. The operation involves stitching the affected root with a healthy one. The main indication for surgical treatment is swelling and swelling of the nerve, hematoma of nearby structures and serious injuries sustained by bone fragments.
Surgical intervention for facial neuropathy on the left and right sides can be performed by various methods. For example, we give the most popular treatment options:
- The complex of operations (decompression, stitching of the damaged root, neurolysis and plastic) is carried out in order to restore the lost functions of the facial nerve.
- Treatment of the sympathetic nervous system with surgical intervention, which allows you to regain control over the functions of the facial muscles.
- Stitching the immobilized nerve with other motor nerves (sublingual, additional, diaphragmatic) to restore the reinnervation of the facial muscles.
- Prolonged suspension of paralyzed parts of the face of a dynamic and static type.
- Corrective surgery (myotomy, neurotomy).
Most often, surgeons resort to a combined approach in the treatment of facial neuritis.
If paresis or paralysis is present in the history for several years, tendon plastic will not give any result, since facial muscles have time to atrophy over this period. In case of unilateral facial paralysis, an autotransplantation is used, involving the transplantation of a muscle fragment (as a rule, the material is taken from the inner surface of the patient's thigh). You can use this method only if you have the appropriate microsurgical equipment.
Features of the disease in children
At an early age, neuritis is usually the result of serious damage. In children, facial neuropathy can occur both during intrauterine development and at the time of birth.
In newborn babies, neuritis is often caused by an uncomfortable position in the womb for a long time. In the last stages of pregnancy, the face of the baby is in close contact with the soft tissues and bones of the maternal pelvis. The nerve can be compressed especially strongly at the termination of attempts during patrimonial activity. It is at this moment that muscle tissue is damaged, as a rule, only on one side of the face.
At an older age, viral infections, systemic lupus erythematosus, hypothermia and drafts, poisoning with harmful toxins can provoke facial neuritis. Nerve damage is sometimes the result of a severe blow to the face, the growth of benign or malignant tumors, injuries to the skull and auricles.
The principles of treatment of facial neuropathy in children do not differ much from the treatment of this disease in adults. Medications for neuritis are used taking into account age restrictions. Children of any age are contraindicated in acupuncture and homeopathy. Medicines, physiotherapy and folk remedies should be prescribed only by the attending physician.