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Etiology

Primary neuritis - the most common cause of facial neuritis of the facial involves a primary idiopathic inflammatory process in connection with a cold, toxic and/or infectious factor.

Therefore, the disease is most common during the colder months of the year, and after exposure to cold weather impact. An additional contributing factor appears can be a narrowing of the bone canal of the facial nerve (canalis n. Facialis).

The primary cold-realted neuritis of the facial nerve is the most common and basically has no age limits. Regardless of the provoking factor, inflammation of the nerve is expressed as a complex syndrome due to damage to various function of nerve fibers.

Secondary symptomatic neuritis - appears as an possible complication of infectious diseases (influenza, herpes simplex, polio, diphtheria, HIV infection), inflammation (otitis of the middle ear, basal meningitis), cranial neuropathies (acute inflammatory demyelinating polyradiculoneuropathy, diabetic neuropathy, Lyme disease, vasculitis) or tumor formation (neurinoma, basal tumors). The disease can occur as part of the clinical picture of multiple sclerosis.

Wasting syndromes:

1. Peripheral lesion n. facialis - experienced as damage to the core, the root or trunk of the nerve. Depending on the location of the damage along the nerve it can produce different clinical syndromes, which can determine the whole process:

A.Syndrome of damage to the facial nerve in the separation of chorda tympani - receives peripheral paresis of the muscles of the face side damage.

B.Syndrome involvement of the facial nerve over the release of chorda tympani and under n. stapedius - the upper display added taste decrease in the front 2/3 of the tongue (hypogeusia) and reduced salivary secretion.

V.Syndrome of damage to the facial nerve over the release of n. stapedius - characterized by addition of hyperacusis to the syndromes mentioned above.

G.Syndrome of damage to the facial nerve over the release of n. petrosus superficialis major - further gets dry eye of the side due to decreased tear secretion.

D.Syndrome of involvement nucleus of the facial nerve - is similar to the syndrome of damage to the trunk of the nerve after the release of chorda tympani. An isolated lesion of the nucleus can be encountered in case of polio.

2. Central lesion n. facialis - sets the unilateral damage to the pyramid route, and in particular tr. corticonuclearis. It affects only the opposite lower branch of the nerve due to unilateral innervation of the lower part of the core.

Most often it is combined with hemilateralna lesion n. hypoglossus, whose core also has sided central innervation.

Clinical picture

Paralysis of the facial nerve is one of the few diseases whose recognition can happen very quickly. Symptoms are easily detectable and clear. Depending on the cause of the paralysis, they may occur more quickly or gradually. The clinical picture depends on the level of involvement of n. facialis and the extent of damage. The disease begins sharply - often after a cold time, but sometimes without a provoking factor. Most frequent location of the lesion is in the bone canal nerve (canalis n. Facialis). Usually the patient wakes up with a facial paralysis or it develops for about 24 hours.

The most typical symptoms of paralysis of the facial nerve are:

• inability of wrinkling of the forehead
• extended eye slit
• inability to close the eye of the affected side; in this case a Bell syndrome is often observed - in an attempt to close the eye the eyeball is rotated upwards, between the eyelids and only the white sclera can be seen
• verbal angle of affected side is suspended
• inability to display the teeth of the side
• inability to inflate the cheek or the mouth
• damaged part remains expressionless when trying to smile

Depending on the damage to the nerve following degrees of paralysis of the nerve can be formed:

normal - normal coordinated movements of the face
slight - deformation and slight asymmetry with preserved forehead mimics
moderate - obvious facial asymmetry, Bell symptom
significant - movements of the forehead are dropped
severe – asymmetry, impossibility of closing the eye, speech impairment
total - impossible speech

First aid for neuritis of the facial nerve 

Bell’s Palsy or neuritis of the facial (VII cerebral) nerve is acute inflammatory illness of the facial nerve. It usually occurs with unilateral paresis of mimic muscles and is more common during the cold months of the year, sometimes associated with cold winter conditions, exposure of the head to cold air flow and others.

This condition often ends with a full functional recovery but in approximately 3% of patients, the damage may be permanent and sometimes irreversible.

At the first symptoms seek immediate medical attention. You can easily and quickly navigate through a constantly updated database of MediKa.bg and find the most appropriate specialist for you.

See more about symptoms and treatment of this disease in MediKa.bg

If you have any of the symptoms listed below, you need a neurologist, but in many cases your GP will be able to treat or prescribe appropriate therapy, until you can see a specialist (neurologyst).

Neurological symptoms are generally caused by disorders in the nervous system. The appearance of these symptoms can vary within relatively wide limits. Symptoms are determined depending on the type of neurological disorder and the specific area of the body that is affected.

Neurological symptoms include:

• stiffness
• partial or complete paralysis
• muscle weakness
• strengthened or weakened reflexes
• partial or complete loss of sensation
• seizures
• difficulty in reading and writing
• unexplained pain
• paresthesia
• other

If you suffer from any of these symptoms, immediately contact a doctor.

Kinesiotherapy (kinesitherapy, kinesiatrics – all terms derived from the Greek kinēsis - "movement" - literally movement therapy) is the therapeutic treatment of various diseases by passive and active muscular movements (massage) and of exercise. It is the core element of physiotherapy/physical therapy.

The tasks of kinesitherapy and rehabilitation are to promote a more rapid removal of motor and sensory disorders, strengthen blood circulation of the affected facial half, helping restoration conduction of nerve stimulation of innervated muscles, decreased reflex, increased muscle tone of healthy face, preventing synkinesis and subsequent contractures, reducing vasomotor disturbances.

Medication is applied after the diagnosis of the disease, which includes anti-oedematous and vasodilator agents, cortisone, Nivalin injections. After the resolution of the acute event treatment passes to functional treatment (kinesitherapy) which includes: medical massage, medical gymnastics of the affected facial part/side and physiotherapy factors that apply no earlier than the 25th day of illness .

Purpose of the massage:

• Regeneration of nerves
• Energizing mimic muscles
• Improvement of motor function of mimic muscles
• Improved chewing
• Removal of the cosmetic defect

Technique of the massage:

At the beginning only neck massage is applied, which aims to induce a relaxing effect. The procedure takes about 10-15 minutes. Facial massage is performed with the patient lying down. In the early stages (7-10 day) the procedure starts with a slight caress of the patient. Stroke is aimed at frontal and submandibular lymph nodes in the axillary wells. Gentle rubbing takes care of hyperextension of the underlying tissues.

Massage is stimulating, but it must be very gentle and considerate. If you identify signs of muscle contracture, massage should be discontinued.

Massage is preparing the muscles for exercise, which plays a major role in functional recovery. The duration is about 5-10-15 minutes. In one treatment course 10-15 procedures are applied.

Remedial gymnastics

Depending on the situation of the patient, gymnastics can be passive and active. Gymnastics is performed for each muscle separately while not allowing synkinesis. Some examples are: opening and closing of the eyes, wrinkling of the forehead, saying the different vowels with mouth wide open, etc. Gymnastics is carried out very carefully in order not to cause a reflex increase.

Kinesitherapeutical methods should be initiated in the early stages of recovery. These are held within a complex rehabilitation that includes kinesitherapeutic methods, tailored to the individual needs & characteristics of the patient.

1. Passive exercises of the muscles
2. Active gymnastics for a healthy facial musculature
3. Massages and neck massages
4. Ultrasound - labile methods
5. Sound gymnastics

Purpose of kinesiotherapy

The purpose of kinesiotherapy is to contribute to the rapid removal of motor and sensory disorders of the affected facial side.

Major tasks of kinesitherapy

1. Strengthening blood supply of the affected facial half.
2. Supporting recovery conduction of nerves.
3. Stimulating the muscles innervated by n. facialis
4. Lowering reflex increased muscle tone of the face
5. Prevention of synkinesis and subsequent contractures
6. Reduction of vasomotor disturbances
7. Increasing the confidence and overall mental state of the patient

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