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Facial nerve neuritis (Bell's palsy, post-traumatic neuropathy)

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warning Attention! Please do not confuse the diagnosis of "facial nerve neuritis" described in this article with the diagnoses of "trigeminal neuralgia" and "trigeminal neuritis".

Facial nerve neuritis (Bell's palsy, post-traumatic neuropathy)

Neuritis of the facial nerve is inflammation with an impaired integrity of the facial nerve or its myelin sheath with motor, sensory and autonomic changes in the area of innervation of facial muscles and facial distortion.

Neuritis of the facial nerve occurs due to damage to the sheath of the facial nerve or an impaired integrity. This damage or inflammation of the facial nerve can occur anywhere:

  • in the cranial cavity
  • when passing through the bone canal (in the styloid opening)
  • on the face

Superficial branches of the facial nerve - temporal, zygomatic, buccal, mandibular and cervical.

Neuritis of the facial nerve occurs with inflammation as a result of infection (herpes, otitis media), with trauma to the bones of the base of the skull as a result of TBI, compression by a tumor of the cerebellar angle (brain, cranial nerves) or aneurysm of the vertebral artery, poisoning, etc.

According to the mechanism of occurrence of facial nerve neuritis, one can distinguish:

  • post-traumatic neuritis of the facial nerve (fracture of the temporal bone pyramid during TBI, brain surgery, plastic surgery for a circular facelift)
  • neuritis of the facial nerve as a result of compression of the nerve by a brain tumor in the cranial cavity
  • infectious neuritis of the facial nerve (Bell's palsy caused by the influenza or herpes virus)
  • toxic neuritis of the facial nerve

Most often in neurological practice, there is neuritis of the facial nerve caused by a viral infection. Such a virus that causes a picture of paresis or paralysis of the facial muscles of the face with neuritis of the facial nerve is the herpes virus. In this case, most often, neuritis of the facial nerve and the paralysis of the muscles of the face itself is one-sided.

The tendency to develop neuritis of the facial nerve with a viral infection (cold, hypothermia, general depletion of the body) is primarily due to the anatomical feature of its location - the narrowness of the bony canal, in which the facial nerve runs on the way out of the cranial cavity.

Paresis or paralysis of facial muscles with neuritis of the facial nerve occurs on the side of the nerve damage.

The herpes virus nests in the myelin sheath of the facial nerve. In the active phase of its division, the herpes virus damages the myelin sheath of the facial nerve, causing its edema (part of the inflammatory response to a viral infection of the body as a whole) - this condition is called facial nerve neuritis or Bell's palsy.

As a result of neuritis of the facial nerve, there is an impaired conduction of a nerve impulse from the brain to the muscles of the face, which is manifested by paresis or paralysis of these muscles.

Depending on the level and type of damage to the facial nerve, the patient with neuritis of the facial nerve will have the following manifestations and complaints: movement disorders (paresis, paralysis) in one or another facial muscle or muscle group with the inability to close the eyes, numbness of the lateral surface of the tongue.

With neuritis of the facial nerve, the patient cannot close the eye (the eyeball turns upward, exposing the sclera (Bell's phenomenon) because the eyelids do not close), wrinkle the forehead, and show teeth (when trying to smile) on the affected side. In this case, the lower eyelid and lower lip will be slightly lowered.

 

Diagnostics of the neuritis of the facial nerve

When diagnosing, to establish the type of damage to the facial nerve in neuritis of the facial nerve, a clear diagnosis of the level of its damage is required. Therefore, a patient with suspected facial neuritis may sometimes also require the following diagnostic procedures:

  • neurological examination of the patient
  • electroneurography (ENG)
  • electromyography (EMG)
  • MRI scan of the brain
  • CT scan of the brain and skull bones

Diagnosis of the level of nerve damage in neuritis of the facial nerve, like any other nerve, is performed using electroneurography (ENG) (shown using the example of the sural nerve).

 

Treatment of facial nerve neuritis

Treatment for neuritis of the facial nerve is selected individually in each case. It includes a set of conservative outpatient procedures:

  • acupuncture
  • stimulation of the facial nerve and facial muscles
  • UHF at the exit point of the facial nerve
  • vitamins of group "B", "C" and "E"
  • antiviral and hormonal drugs homeopathic remedies, etc.

Acupuncture is very effective in treating neuritis of the facial nerve.

The duration of treatment for neuritis of the facial nerve and its frequency is dictated in the future by the state of restoration of conduction along the nerve and motor activity of facial muscles (elimination of facial distortion due to the asymmetry of the nasolabial fold, weakness of the eyelid muscles covering the eyes).

Treatment of a patient with neuritis of the facial nerve does not require hospitalization. All treatment procedures are easily performed on an outpatient basis in a well-equipped polyclinic. Hospitalization in the neurological department for neuritis of the facial nerve only aggravates the negative emotional background in a patient with such a pronounced cosmetic defect in the form of asymmetry in the work of facial muscles (the appearance of a "skewed face" is perceived by sick women very dramatically).

Physiotherapy is very effective in treating neuritis of the facial nerve.

For some patients, one course (10-12 procedures performed daily) of outpatient treatment of facial nerve neuritis in the clinic is enough to completely restore the lost functions of the nerve and weakened facial muscles. Some patients may require longer treatment when outpatient courses of treatment (the same standard 10-12 procedures performed daily in the clinic) are performed several times throughout the year until complete recovery.

Transcutaneous Electrical Nerve Stimulation (TENS) is used in treating of the facial nerve neuritis.

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