Neuritis of a facial nerve
Neuritis of a facial nerve (paralysis Bella) is an inflammatory damage of the nerve innervating mimic muscles of one half of the face. As a result in these muscles the weakness leading to decrease (paresis) or to total absence (paralysis) of mimic movements and to emergence of asymmetry of the person develops. Symptoms of neuritis of a facial nerve depend on what site of a nerve was involved in pathological process. In this regard distinguish the central and peripheral neuritis of a facial nerve. The typical clinic of front neuritis does not raise doubts in diagnosis. However the exception of secondary nature of a disease requires carrying out tool inspection.
Neuritis of a facial nerve
Neuritis of a facial nerve (paralysis Bella) is an inflammatory damage of the nerve innervating mimic muscles of one half of the face. As a result in these muscles the weakness leading to decrease (paresis) or to total absence (paralysis) of mimic movements and to emergence of asymmetry of the person develops.
The facial nerve passes in the narrow bone channel where its infringement (a tunnel syndrome) at inflammatory processes or violation of blood supply is possible. People with anatomic narrow channel or with features of a structure of a facial nerve are more predisposed to developing of neuritis of a facial nerve. Overcooling of area of a neck and ear, especially under the influence of a draft or the conditioner can become the reason of development of front neuritis.
Distinguish primary neuritis of a facial nerve, developing at healthy people after overcooling (catarrhal front neuritis), and secondary — as a result of other diseases. Treat diseases at which neuritis of a facial nerve can develop: herpetic infection, epidemic parotitis ("mumps"), otitis (inflammation of a middle ear), Melkersona-Rosenthal's syndrome. Perhaps traumatic injury of a facial nerve, its defeat at violation of brain blood circulation (an ischemic or hemorrhagic stroke), tumors or neuroinfections.
Symptoms of neuritis of a facial nerve
Usually neuritis of a facial nerve develops gradually. At the beginning there is pain behind an ear, in 1-2 days asymmetry of the person becomes noticeable. On side of the affected nerve the nasolabial fold smoothes out, the corner of a mouth falls and the person warps in the healthy party. The patient cannot close eyelids. When he tries to make it, his eye turns up (a symptom Bella). Weakness of mimic muscles is shown by impossibility to carry out the movements by them: to smile, grin, frown or raise an eyebrow, to extend lips a tubule. At the patient with neuritis of a facial nerve on the sick party eyelids are widely opened and it is observed ("a hare eye") - a white strip skler between an iris of the eye and a lower eyelid. There is a decrease or total absence of flavoring feelings on the forward part of language which is also innervated by a facial nerve. Emergence of dryness of an eye or dacryagogue is possible. In certain cases the symptom of "crocodile tears" develops - against the background of constant dryness of an eye the patient during meal has a dacryagogue. The salivation is observed. On the party of neuritis of a facial nerve acoustical sensitivity (giperakuziya) can increase and usual sounds seem to the patient with louder.
The clinical picture of neuritis can be various depending on the place of damage of a facial nerve. So at pathology of a kernel of a facial nerve (for example, at a stem form of poliomyelitis) at patients only weakness of face muscles is observed. At localization of process in the bridge of a brain (for example, a stem stroke) not only the back of a facial nerve, and and a kernel of the taking-away nerve innervating an external muscle of an eye that is shown by a combination of paresis of facial muscles to the meeting squint is involved in it. A hearing disorder in combination with symptoms of front neuritis is observed at damage of a facial nerve at the exit from a brain trunk as there is an accompanying damage of an acoustical nerve. Such picture is often observed at a nevrinoma in the field of an internal acoustical entrance.
If pathological process is in the bone channel of a pyramid of a temporal bone to the place of an exit of a superficial stony nerve, then mimic paralysis is combined with dryness of an eye, violation of taste and salivation, a giperakuziya. When developing neuritis on the site from the place of an otkhozhdeniye of a stony nerve to an otkhozhdeniye of a stremyanny nerve instead of dryness of an eye dacryagogue is observed. Neuritis of a facial nerve at the level of its exit from a shilosostsevidny opening of a skull to the person is shown only by motive violations in face muscles.
Allocate Hunt's syndrome — herpetic defeat cranked a gangliya through which there passes the innervation of external acoustical pass, a drum cavity, auricle, the sky and almonds. Nearby motive fibers of a facial nerve also are involved in process. The disease begins with the severe pains in an ear giving to a face, a neck and a nape. Herpes rashes on an auricle, in external acoustical pass, on a mucous membrane of a throat and in a forward part of language are observed. Are characteristic paresis of mimic muscles on the party of defeat and violation of perception of taste on a forward third of language. Emergence of a ring in ears, a hearing impairment, developing of dizzinesses and a horizontal nistagm is possible.
Neuritis of a facial nerve at epidemic parotitis is followed by symptoms of the general intoxication (weakness, a headache, an ache in extremities), temperature increase and increase in salivary glands (emergence of a swelling behind an ear). Neuritis of a facial nerve at chronic otitis results from distribution of infectious process of a middle ear. In such cases paresis of mimic muscles develops against the background of the shooting ear pains. Melkersona-Rosenthal's syndrome is a hereditary disease with a pristupoobrazny current. In its clinic neuritis of a facial nerve, characteristic folded language and a dense face edema is combined. Bilateral neuritis of a facial nerve meets only in 2% of cases. Perhaps recidivous course of neuritis.
Complications of neuritis of a facial nerve
In some cases, especially in the absence of adequate treatment, neuritis of a facial nerve can lead to development of contractures of mimic muscles. It can come in 4-6 weeks from the disease moment if motive functions of mimic muscles completely were not restored. Contractures pull together the struck side of a face, causing discomfort and involuntary muscular contractions. At the same time the face of the patient looks so as if muscles on the healthy party are paralyzed.
Diagnosis of neuritis of a facial nerve
Clinical picture of neuritis of a facial nerve so bright that the diagnosis does not cause difficulties in the neurologist. Additional inspections (brain MPT or KT) are appointed for an exception of the secondary nature of neuritis, for example tumoral or inflammatory processes (abscess, encephalitis)
The elektroneyrografiya, electromyography and the caused potentials of a facial nerve for definition of the location of pathological process, extent of damage of a nerve and dynamics of its restoration is applied during treatment.
Treatment of neuritis of a facial nerve
In an initial stage of neuritis of a facial nerve appoint glucocorticoids (Prednisolonum), antiedematous means (furosemide, ), vasodilating medicines (nicotinic acid, , a ksantinola ), group B vitamins. For knocking over of a pain syndrome analgetics are shown. At secondary neuritis of a facial nerve carry out treatment of the main disease. Within the first week of a disease the affected muscles have to be in rest. The physical therapy in the form of not contact heat () can be applied from the first days of a disease. From the 5-6th day — UVCh (a course from 8-10 procedures) and contact heat in the form of a parafinoterapiya or ozokeritovy applications.
Massage and physiotherapy exercises for the affected muscles are begun with the second week of a disease. Loading is gradually increased. For improvement of conductivity since the end of the second week appoint antikholinesterazny medicines (, ) and . Ultrasound or a hydrocortisone is applied. At slow restoration of a nerve appoint the medicines improving exchange processes in nervous tissue (). Carrying out electroneurostimulation is in some cases possible.
If the complete recovery of a facial nerve within the first 2-3 months did not occur, appoint a gialuronidaza and biostimulators. At emergence of contractures make cancellation of antikholinesterazny medicines, appoint .
Surgical treatment is shown in case of congenital neuritis of a facial nerve or a complete separation of a facial nerve as a result of a trauma. It consists in sewing together of a nerve or carrying out a nevroliz. In the absence of effect of conservative therapy in 8-10 months and detection of electrophysiological data on regeneration of a nerve it is also necessary to resolve an issue of carrying out operation. Surgical treatment of neuritis of a facial nerve makes sense only within the first year as further there comes the irreversible atrophy of the mimic muscles which were left without innervation and they cannot be restored.
Carry out plasticity of a facial nerve by autotransplantation. As a rule, the transplant is taken from the patient's leg. Through it on the struck half of the face hem 2 branches of a facial nerve from the healthy party to muscles. Thus the nervous impulse from a healthy facial nerve is transferred on both sides of a face at once and causes the natural and symmetric movements. After operation there is a small hem about an ear.
Forecast and prevention of neuritis of a facial nerve
The forecast of neuritis of a facial nerve depends on its localization and existence of the accompanying pathology (otitis, parotitis, herpes). In 75% of cases there is an absolute recovery, but lasting disease more than 3 months the complete recovery of a nerve meets much less often. The forecast is most optimistical if damage of a facial nerve came at its exit from a skull. Recurrent neuritis has the favorable forecast, but each next recurrence proceeds more hard and is long.
The prevention of injuries and overcoolings, adequate treatment of inflammatory and infectious diseases of an ear and nasopharynx allow to avoid development of neuritis of a facial nerve.