Facial neuritis
Introduction
Introduction to facial neuritis Facial neuritis refers to peripheral facial paralysis caused by non-specific inflammation of the facial nerve inside the stem. Young adults often develop, some patients have ipsilateral mandibular angles in the first few days before onset, pain in the ear and mastoid area. The medical history should pay attention to the precautions before and after the onset of cold, etc. Most patients are suddenly found in the morning when they wash. The cheeks are not working or skewed, the expression is not comfortable, the forehead lines disappear, the eyes are cracked open, the nasolabial folds are flat, and the mouth is drooping. Early to improve local blood circulation, eliminate facial nerve inflammation and edema, and later to promote the recovery of nerve function as its main treatment principle. basic knowledge The proportion of illness: 0.06% Susceptible people: young adults Mode of infection: non-infectious Complications: hemifacial spasm
Cause
Facial neuritis
Cause:
Facial neuritis is more common in cranial nerve diseases, which is related to the anatomy of a narrow and long bone tube. When the rock bone is abnormal, the facial nerve tube may be more narrow, which may be an intrinsic factor in the pathogenesis of facial neuritis. The external causes of facial neuritis have not been clarified. Some people have early facial pathological changes mainly for facial nerve edema, myelin and axial space have different degrees of degeneration. It is speculated that the facial may be affected by cold wind, the facial nerves are microvascular vasospasm, causing local tissue. Ischemia, hypoxia, and some believe that it is related to viral infection, but the virus has not been isolated. In recent years, it has been thought that it may be an immune response. Ramsay-Hunt Syndrome is banded. Herpes virus infection causes inflammation of the geniculate ganglia and facial nerve.
Prevention
Facial neuritis prevention
The acute phase should be properly rested, paying attention to the continued warmth of the face. Wear a mask when going out, and stay close to the window when you are sleeping, so as not to suffer from the cold. Be careful not to wash your face with cold water, avoid blowing cold air, pay attention to weather changes, and add clothes in time to prevent colds.
Complication
Facial neuritis complications Complications, facial muscle spasm, twitching
Some may have facial muscle spasm or facial muscle twitching, the former manifests as the deepening of the nasolabial groove on the disease side, the mouth angle is pulled to the disease side, the eye crack becomes small, and the healthy side is easily mistaken for the disease side, and the latter side muscle is not Autonomous twitching, the symptoms are more obvious when nervous, and can affect normal work in severe cases. A few sinus side may also have "crocodile tears", that is, the side of the eye when eating, tearing, may be the nerve function of nerve regeneration during facial nerve repair, stray into adjacent function In the different nerve sheath pathways, electromyography and facial nerve conduction function measurement have considerable value in judging the degree of facial nerve damage and the extent of possible recovery. It can be examined two weeks after onset.
Symptom
Symptoms of Facial Neurone Symptoms Common facial symptoms of facial muscles disappeared from the mouth muscles twitching facial muscles soreness drumsticks and whistling leaks nasolabial folds shallow mouth drooping hypersensitivity eating tears
Young adults often develop, some patients have ipsilateral mandibular angles in the first few days before onset, pain in the ear and mastoid area. The medical history should pay attention to the precautions before and after the onset of cold, etc. Most patients are suddenly found in the morning when they wash. The cheeks are not working or skewed, the expression is not comfortable, the forehead lines disappear, the eyes are cracked open, the nasolabial folds are flat, and the mouth is drooping.
1. The facial nerve branch below the stem of the stem is affected by peripheral facial paralysis. The frontal line of the disease disappears. The eye fold cannot be folded, the eye crack becomes large, and it cannot be closed or closed. Bell sign (the eyeball turns upwards when the eye is closed, revealing White sclera), the nasolabial fold becomes shallow, the mouth angle droops, the mouth angle is biased to the healthy side, the drumsticks and the whistle leak, and common food stays in the cheeks of the disease side.
2, the damage affects the facial nerve branch above the tympanic cord in addition to the peripheral facial paralysis, there are also 2/3 taste disturbance in the ipsilateral tongue.
3. Hearing hypersensitivity occurs when the facial nerve branch above the iliac crest muscle is involved, and 2/3 taste disturbance and peripheral facial paralysis in front of the tongue.
4, skeletal ganglion involvement, in addition to hypersensitivity, ipsilateral tongue 2 / 3 taste disorder and peripheral facial paralysis, as well as ipsilateral mastoid pain, auricle and external auditory canal sensation, external ear canal or tympanic membrane herpes, called Hunt Syndrome.
Examine
Facial neuritis examination
Auxiliary examination of facial neuritis
No special inspection is required. However, the following tests are helpful for the diagnosis and differential diagnosis of atypical patients and for the diagnosis of nerve damage and recovery.
1, cerebrospinal fluid examination: check the phenomenon of no protein and fine brain separation can exclude Green-Barre syndrome.
2, electrical diagnostic electrical diagnostic examination: including EMG, nerve conduction time measurement, nerve excitability and facial nerve network. Can understand the extent of facial nerve block and degeneration. It is helpful to judge the prognosis. The difference between the healthy side and the ipsilateral nerve excitability is more than 3.5MA, indicating a poor prognosis.
3, blood, blood routine, brain sputum and other tests: can help identify and determine the cause.
Diagnosis
Diagnosis and differentiation of facial neuritis
diagnosis
Diagnosis can be made based on clinical performance and related examinations.
Differential diagnosis
First, the central facial paralysis: due to damage to the contralateral cortical brain stem, only the lesions of the contralateral side of the facial muscle spasm.
Second, the identification of peripheral facial paralysis caused by other causes:
(A) acute infectious polyneuritis: may have peripheral facial paralysis, but often bilateral, most with other cranial nerves and limb symmetry and cerebrospinal fluid protein cell separation phenomenon.
(2) Bridge brain damage: the cerebral nucleus and its fibrous damage may have peripheral facial paralysis, but often accompanied by adjacent structures inside the pons, such as abductor nerve, trigeminal nerve, pyramidal tract, spinal cord and other damage, The ipsilateral extraocular rectus tendon, facial dysfunction and contralateral limb spasm (cross sputum) appear in the tumor, inflammation, vascular disease and so on.
(C) cerebellopontine angle damage: more damage to the trigeminal nerve, the auditory nerve, ipsilateral cerebellum and medulla, so in addition to peripheral facial paralysis, there may be pain in the same side of the pain, tinnitus, deafness, dizziness, nystagmus, limbs Ataxia and contralateral limb spasm and other symptoms, called "Cerebellar cerebral horn syndrome", more common in this part of the tumor, inflammation and so on.
(4) Structural lesions adjacent to the facial nerve canal: seen in otitis media, mastoiditis, middle ear mastoid surgery and skull base fracture, etc., may have corresponding medical history and clinical symptoms.
(5) Diseases other than stems and pores: seen in mumps, parotid gland tumors, jaw neck and parotid area surgery, in addition to peripheral facial paralysis, there is a history and clinical manifestations of the corresponding diseases.
