Facial Nerve Neuritis - Neurologist About Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Facial nerve neuritis: symptoms and treatment

Neuritis of the facial nerve is a disease characterized by inflammation of the 7th pair of cranial nerves. Another disease is called Bell's palsy. Because of this disorder, the patient suffers from facial expressions, but cannot express his emotions, is not even able to chew food normally. The face becomes asymmetrical.

It is the facial nerve that suffers more often than others, since it stretches along the narrow canals of the facial bones. Therefore, even a slight inflammation can lead to its compression. The nerve is exposed to hypoxia, which leads to the corresponding symptoms. Most often, neuritis is a unilateral lesion, but in about 2% of people, the face becomes inflamed on both sides.

Facial neuritis is widespread, affecting 25 out of 100,000 people every year. Gender does not matter. The disease develops mainly in winter.

The disease does not go away quickly. People have to spend 3-4 weeks in the hospital. It may take about six months for the nerve to fully recover. On average, 5% of people never cope with the disease, that is, the nerve does not begin to function as before. This situation is typical for those cases when neuritis is the result of an injury, or a consequence of a growing brain tumor. In about 10% of cases, the disease recurs.

Content:

• Causes of facial nerve neuritis
• Classification of facial neuritis
• The mechanism of development of neuritis
• Symptoms of facial nerve neuritis
• Diagnostics of the neuritis of the facial nerve
• Treatment of facial nerve neuritis
• Complications of facial nerve neuritis

Causes of facial nerve neuritis

The following factors can provoke neuritis of the facial nerve:

• Postponed herpes. This virus infects nerve fibers, causing them to swell and become inflamed. Mumps viruses, poliomyelitis, adenoviruses and enteroviruses are also capable of provoking neuritis.
• Hypothermia of the body. It is especially dangerous if the face is exposed to cold. Its muscles and blood vessels spasm, which can lead to inflammation of the facial nerve.
• Alcohol abuse. Alcohol poisons the nervous system, causing inflammation of the nerve fibers. In addition, the brain suffers greatly.
• Arterial hypertension. With this disease, intracranial pressure rises, the nuclei of the facial nerve suffer. Another danger of high blood pressure is stroke. If a hemorrhage occurs near the facial nerve, then it is damaged.
• Pregnancy. In terms of the development of neuritis, the 1st trimester is especially dangerous, when a hormonal surge occurs in the body.
• A brain tumor. If it pinches the nerve fibers, then they are not able to transmit signals normally, which causes the development of neuritis.
• Postponed craniocerebral and ear injuries. In this case, the nerve can be severely damaged or even torn.

• Treatment of dental diseases. If a nerve is damaged during the manipulation of tooth extraction or caries elimination, this can lead to its inflammation.
• Otitis media and sinusitis. When the pathogenic flora spreads to tissues adjacent to the nasal sinuses or to the internal structures of the ear, inflammation of the nerves located in them develops, which can become the basis for the development of neuritis.
• Diabetes. Disruptions in metabolic processes often cause inflammation of nerve fibers.
• Atherosclerosis of the vessels. Those collaterals that feed the facial nerve become clogged with plaque. Hypoxia of the nerve develops with the gradual death of its cells.
• Depression, stress. Any emotional shock leads to the fact that a person's immunity is weakened. This becomes the cause of the development of neuritis.
• Multiple sclerosis. In this disease, the myelin sheath, which surrounds the nerve, suffers. Plaques form on it. In patients with multiple sclerosis, the optic and facial nerves are often inflamed.

Classification of facial neuritis

The neuritis of the facial nerve can be primary and secondary. The primary form of the disease can manifest itself against the background of hypothermia or other external factors. Secondary neuritis is a consequence of another medical condition, such as otitis media.

In addition, the following forms of neuritis are distinguished:

• Hunt's syndrome. This neuritis develops against the background of shingles. A person has not only symptoms of neuritis, but also other signs of the underlying infection: spots on the tongue, on the mucous membrane of the oral cavity, in the pharynx, on the auricles. Neuritis develops due to the fact that the herpes virus damages the ganglion, from which the palate, hearing aid and tonsils are innervated. Branches of the facial nerve are located next to this ganglion. The first symptoms of the disease are painful sensations like a lumbago. The pain is concentrated in the ear. As the pathology progresses, facial asymmetry develops, taste suffers, since sensitivity in the front of the tongue disappears. The patient may feel dizzy, he is worried about tinnitus, involuntary oscillatory movements of the eyeballs may be observed.

• Neuritis in mumps. In a person with mumps, neuritis can affect one or both parts of the face. At the same time, his body temperature rises to high levels, his head hurts, the salivary glands increase in size.
• Neuritis with borreliosis. With this disease, the face always suffers from both sides. A person's body temperature rises, erythema develops, and neurological symptoms appear.
• Neuritis with otitis media. At the same time, a person is worried about severe pain in the ear, it is impossible to endure them. Neuritis develops when an infection from the middle ear spreads to the branches of the facial nerve.
• Merkelsson-Rosenthal syndrome. This is a disease that is inherited by humans. It rarely develops and is accompanied by an undulating course. In the acute phase, the face becomes edematous, signs of neuritis appear, the tongue becomes folded.

The mechanism of development of neuritis

Due to the influence of a pathological factor, arterial spasm occurs, blood stagnation develops, small vessels expand. Plasma sweats through their wall, accumulates in the intercellular space. The tissues swell, put pressure on the veins and lymph vessels, which leads to disruption of lymph flow.

The nerve begins to suffer from the fact that its nutrition is deteriorating, it does not receive oxygen. The affected trunk swells, blood vessels burst in it, which leads to a deterioration in the transmission of impulses. Thus, neuritis develops.

Symptoms of facial nerve neuritis

The neuritis of the facial nerve always has an acute onset. Other symptoms are presented in the table.

Symptoms of neuritis	Disease manifestations	Main reasons
Pain behind the auricle, which occurs 1-2 days before the first violations of facial expressions.	The pain radiates to the face and back of the head. After a few days, the eye begins to hurt.	The discomfort is due to the swelling of the nerve. It will be compressed at the exit from the auditory opening, which is located in the temporal bone.
The symmetry of the face is lost, it begins to resemble a mask.	The eye on the side of the lesion is wide open, the corner of the mouth is lowered down, the nasolabial fold is smoothed, as are the frontal folds. If a person tries to express some emotions, then the asymmetry becomes even more noticeable.	There is no brain control over the facial muscles on one side.
The eye on the side of the lesion remains open.	If a person wants to close his eyes, then he does not succeed, the eye does not close, a gap remains. In this case, the eye turns up, and through the slit, the white is visible.	The circular muscle of the eye is not fully innervated, the muscles of the eyelid do not obey the commands of the brain.
The corner of the mouth is down.	Liquid food flows out from the side of the lesion, but the patient can move the jaw and chew.	The buccal branches extending from the facial nerve do not control the muscles of the mouth.
Cheek muscles cease to obey.	During a meal, a person constantly bites the inner surface of the cheek, products fall behind it.	The facial nerve does not transmit signals from the brain to the cheek muscles.
The mouth dries up all the time.	A person constantly wants to drink, little saliva is released, it is not enough to chew food. Sometimes, on the contrary, profuse salivation is observed.	The brain sends signals to the salivary glands, but the facial nerve does not transmit them in full.
Speech deteriorates, it may become slurred.	One half of the mouth does not take part in the articulation of sounds. The consonants suffer to a greater extent: b, c, f.	The facial nerve does not fully support the work of the cheeks and lips.
The eye dries up.	The lacrimal fluid is released in insufficient volumes, and the eye itself does not close completely, the person rarely blinks it.	The branch of the facial nerve that is responsible for tear production is damaged.
Lachrymation.	Sometimes, on the other hand, too much tear fluid is produced. Tears do not drain into the lacrimal canal, but are released outside.	The lacrimal gland is working too hard.
One half of the tongue does not taste.	From the side of the lesion, the tongue loses its sensitivity.	Such a situation is observed with inflammation of the fiber of the intermediate nerve, so the brain does not receive signals transmitted by the receptors of the tongue.
The hearing becomes acute.	A person hears better with one ear than with the other.	The nerve is inflamed in the temporal bone.

Depending on the symptoms of neuritis, we can conclude which part of the facial nerve was inflamed:

• Damage to the nerve in the cerebral cortex is indicated by violations of facial expressions of the lower part of the face, its muscles make involuntary movements, and a nervous tic may be observed.
• Nystagmus, facial numbness, twitching of the palate and pharynx indicate the defeat of the facial nerve nuclei, the patient cannot wrinkle the forehead.
• When a nerve is damaged in the pyramid of the temporal bone and in the cranial cavity, the mimic muscles are completely immobilized, little saliva is produced, the sensitivity of the tongue worsens, hearing is aggravated, the eyeball dries up.

A person needs to go to see a doctor as soon as possible if he notices the following symptoms:

• There is no way to frown.
• Can't hang or blow.
• I cannot get water into my mouth.
• I can't blink or close my eyes completely.

Diagnostics of the neuritis of the facial nerve

If signs of neuritis appear, you need to consult a neurologist. As a rule, an external examination of the patient is enough for the doctor to make the correct diagnosis. Instrumental examination methods are required to identify the cause of neuritis.

The patient may be assigned such diagnostic procedures as:

• MRI.
• CT scan of the brain.
• Electroneurography.
• Electromyography.

If a viral or bacterial nature of neuritis is suspected, blood is taken for a general analysis.

Treatment of facial nerve neuritis

Group of drugs	Drug name	How does the drug work?	How to take the drug?
Diuretics	Furon or Furosemide	The drugs promote the removal of excess fluid from the body, due to which the edema subsides, the vessels are not overfilled with blood, and the nerve will not be pinched.	1 tablet 1 time per day, in the morning.
NSAIDs	Nise or Nurofen	The drugs relieve inflammation, relieve pain.	1 tablet 2 times a day. The course of treatment is 1-2 weeks.
GKS	Dexamethasone or Prednisolone	The drugs reduce pain, relieve swelling and inflammation, and improve the conduction of impulses along nerve fibers.	In the first days, 2-3 mg of the drug, after improving health, the dose is reduced by 3 times. The course of treatment is 10 days.
Antiviral drugs	Zovirax or Acyclovir.	The drugs destroy the herpes viruses.	1 tablet 5 times a day with meals. The course of treatment is 5 days.
Antispasmodics	No-shpa or Spazmalgon	Relieve spasm from blood vessels, dilate arteries, improve blood supply to the affected area, reduce pain.	2 tablets 3 times a day. The course of treatment is 14 days.
Neurotropic drugs	Phenytoin, Levomepromazine, Carbamazepine.	Nerve cells begin to function better, metabolic processes stabilize, pain goes away, nervous tic decreases, muscles stop involuntarily contracting, the work of the nervous system improves.	1/2 or 1 tablet 2 times a day. The duration of treatment is 10 days.
B vitamins	Thiamine, Pyridoxine, Riboflavin (B1, B6, B12)	These vitamins are essential for the nervous system to function properly.	1-2 tablets 1 time per day. Duration of treatment is 30-60 days.
Anticholinesterase drugs	Proserin, Galantamine	The drugs improve the transmission of impulses along nerve fibers, increase muscle tone, normalize the work of the salivary and lacrimal glands	1 tablet 1-2 times a day from the second week of illness. The course of treatment is 1-1.5 months.

Physiotherapy

Procedure name	When is it prescribed?	What's the effect?	Frequency rate
UHF	Inflammation of the facial nerve, impaired blood supply, insufficient lymph drainage.	Improvement of metabolic processes, heating of tissues, removal of edema and inflammation.	The duration of the procedure is 10-15 minutes. The course consists of 5-15 sessions, which are carried out every other day.
UV	Acute or subacute neuritis of the facial nerve, starting from the 7th day of illness.	Increasing immunity, reducing the intensity of inflammation, relieving pain.	The course of treatment is 5-20 procedures, 1-2 biodoses per session.
UHF decimeter therapy	Acute and subacute neuritis of the facial nerve	Warming up tissues, activating metabolic processes, dilating blood vessels, improving nerve nutrition and its restoration.	One procedure takes 5-15 minutes. The course consists of 3-15 procedures.
Electrophoresis with dibazol, proserin, nivalin, potassium, vitamin B1.	Inflammation of the facial nerve, metabolic disorders, muscle atrophy.	Removal of inflammation and edema, pain relief.	The course of treatment consists of 10-20 procedures, each of which lasts 10-30 minutes.
Diadynamic therapy	Muscle paralysis, contractures, pain in the affected area, damage to the facial nerve.	Reducing swelling and inflammation, improving metabolic processes, rapid tissue regeneration.	The course consists of 10-30 sessions, 10-20 minutes each.
Applications with paraffin or ozonokerite	Subacute facial nerve inflammation, facial muscle paralysis	Fast regeneration of nerve fibers.	The course consists of 10-20 procedures, 40 minutes each.

Massage

Massage can be started no earlier than 5-7 days after the onset of the disease. Features of its holding:

• Before starting the procedure, you need to stretch the neck muscles by turning your head back and forth, making head rotations in different directions.
• First, the back of the head and neck are massaged.
• Then massage the diseased and healthy part of the head is performed.
• The face, mastoid process, neck, collar area are carefully worked out.
• Massage movements are superficial. In the future, you can make light vibrations.
• All movements should be directed along the lymph flow.
• The face is massaged with fingers from the center of the chin, nose and forehead to the ears.
• You cannot massage those areas in the area of which the lymph nodes are located, as this can cause their inflammation.
• Then the exercise is done. They put the thumb behind the cheek and stretch the muscles with it. In this case, the index and thumb of the other hand work out the muscles of the cheek from the outside.
• Finish the massage with exercises aimed at working out the muscles of the neck.

The massage should last at least 10-15 minutes. It is performed until the symptoms of inflammation completely disappear. It is best to trust your face to a professional.

Complications of facial nerve neuritis

Possible complications of the disease:

• Facial muscle atrophy.
• Contractures of the muscles responsible for facial expressions.
• Blepharospasm, facial hemispasm.
• Synkinesia of the face.
• Keratitis and conjunctivitis.

Nerve fibers regenerate slowly. To speed up this process and avoid complications, you need to follow all the doctor's instructions and seek medical help in a timely manner.

Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".