facial paralysis
Introduction
Introduction Facial paralysis is a common disease characterized by motor dysfunction of facial expression muscles. The general symptom is oblique eye and mouth. It is a common disease, frequently-occurring disease, and it is not limited by age. The patient's face often fails to complete the basic eyebrow lifting, eye closing, and drumming. The human facial nerve is one from left to right. It is emitted from the brain stem and is divided into five large branches after the face. It is distributed on the entire face on both sides, which governs the movement of the facial muscles. In normal state, the facial nerve is dominated by the human brain, so the facial Exercise is arbitrary and controllable, so there are no symptoms. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: hemifacial spasm
Cause
Facial paralysis
Cervical skeletal dislocation (30%):
The root cause of facial paralysis is the cervical spine bone dislocation. The oblique nerve compression causes nerve spasm to form facial nerve paralysis, which leads to complete facial muscle spasm, forehead wrinkles disappear, eye cracks expand, nasolabial folds are flat, mouth angle droops, mouth-to-mouth angle to the healthy side Hemiplegia embolism.
Psychological factors (20%):
Psychological factors are easy to cause facial paralysis: investigations show that psychological factors are one of the important factors that cause facial paralysis. Before the occurrence of facial nerve palsy, a considerable number of patients have physical fatigue, lack of sleep, mental stress and physical discomfort.
Prevention
Facial prophylaxis
Prevent facial paralysis from starting from a small place, avoid air conditioning, electric fans blowing directly into the body, feel a little cold, it is necessary to adjust the wind direction or turn off the electrical appliances. In the face of strong winds and cold weather, you should tap and tap some important points on the face, behind the ear and neck to increase your ability to keep out the cold. Face work and life with an optimistic and peaceful state, reduce psychological stress and avoid overwork. If you have numbness and other discomfort on your face, you should seek medical attention as soon as possible. Patients with facial nerve paralysis should not eat spicy and greasy food. Spicy food such as pepper, pepper, green onion, garlic, etc., such foods are hot and hot, easy to stagnate, and some patients with facial paralysis are caused by diseases such as otitis media or meningitis. Spicy food or smoking will aggravate otitis media. Onset, thereby aggravating the secondary "face nerve paralysis" condition.
Complication
Facial complications Complications, facial muscle spasm, twitching
The general prognosis is good, usually begins to recover after 1 to 2 weeks of onset, and healed within 2 to 3 months. About 85% of cases can be completely recovered without leaving sequelae. However, those who have not recovered for more than 6 months have a poor prognosis, and some may have hemifacial spasm or facial muscle convulsions. The former manifests as the deepening of the nasolabial fold on the disease side, the angle of the mouth is pulled to the side of the disease, the ocular fissure becomes small, and the contralateral side is easily mistaken for the disease side; the latter side of the disease is involuntarily twitched, and the symptoms are more obvious when the tension is severe, and may be affected when severe. normal work. A small number of diseased side may also have a "crocodile tear sign", that is, the disease side eye tears when eating, may be caused by the nerve sheath regeneration in the process of facial nerve repair, and mistakenly enter the nerve sheath pathway with different adjacent functions. Electromyography and facial nerve conduction function measurement are of great 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 paralysis Common symptoms Can not continue blinking, ptling, drooping, taste, abnormal, single side atrophy
Most patients often wash their faces in the morning. When they sip, they suddenly find that one side of the cheeks is not working properly, the mouth is skewed, the facial muscles are completely paralyzed, the forehead wrinkles disappear, the eye cracks are enlarged, the nasolabial folds are flat, the mouth angle is drooping, and the teeth are exposed. The cervix is hemiplegic to the healthy side, and the disease side can not be used for wrinkles, eyebrows, eyes closed, suffocating, and squeaking. When drumsticks and whistling, the affected side lips can not be closed and leaking; when eating, food residue Often staying in the buccal space of the disease side, and often the saliva from the side of the squat, because the puncture is inversion with the chin, so that the tears can not overflow as normal drainage.
Examine
Face check
Static check
Stem mastoid: Check for pain in the mastoid or pain in the palate or on the face.
Forehead: Check whether the skin wrinkles in the forehead are the same, light or disappear, and whether the outside of the eyebrows is symmetrical and sagging.
Eye: Check the size of the eye crack, whether the sides are symmetrical, smaller or larger, whether the upper eyelid is drooping, whether the lower eyelid is everted, whether the eyelid is twitching, swelling, whether the conjunctiva is congested or not, whether there is tearing, dryness, acid, The symptoms of swelling.
Ear: Check for tinnitus, ear nausea, and hearing loss.
Cheeks: Check if the nasolabial folds become shallow, disappear or deepen. Whether the cheeks are symmetrical, flat, thickened or twitched. Whether the face feels tight, stiff, numb or atrophy.
Mouth: Check whether the mouth angle is symmetrical, drooping, lifting or twitching; whether the lips are swollen and whether the person is skewed.
Tongue: Check if the taste is involved.
Exercise check
Eyebrow lift exercise: check the motor function of the frontal occipital muscle. Severe patient's forehead is flat, wrinkles generally disappear or become significantly shallower, and the outer side of the eyebrows is obviously drooping.
Frown: Check if the frowning muscles can move, and the amplitude of the eyebrows on both sides is consistent.
Closed eyes: When closing the eyes, you should pay attention to whether the mouth of the affected side has a lifting angle, whether the affected side can be closed, and the degree of closure.
Shrugging: Observe whether there is wrinkles in the nasal pressure muscles, and whether the upper lip movements on both sides are the same.
Show teeth: pay attention to observe the amplitude of the movement of the mouth on both sides, whether the mouth is deformed, the number and height of the upper and lower teeth.
Nuptula: Pay attention to whether the distance between the sides of the mouth and the person is the same, and whether the shape of the mouth is symmetrical.
Drumstick: Mainly check the movement function of the diaphragm muscle.
Diagnosis
Diagnostic diagnosis
According to the onset form and clinical features, the diagnosis is not difficult. The disease should be differentiated from facial paralysis, facial nerve palsy caused by acute infectious polyradiculitis, posterior fossa inflammation, and facial nerve paralysis caused by tumor.
Identification of peripheral and central facial paralysis:
The identification of peripheral and central facial paralysis is obvious at a glance. The identification of extremely light people is difficult. It can be identified by the following aspects: one is by expression movement, the surrounding sex is more obvious, and the central one does not show sorrow when laughing and laughing. The second is by the palmar reflex, the peripheral facial paralysis is absent or weakened, and the central facial paralysis has or is hyperthyroidism, but this method is not reliable, and the third is to determine the other signs to be the most reliable.
Facial nerve function
The normal facial nerve is like a 1 mm thick cable. There are tens of thousands of nerve fibers in the cable. Each nerve fiber has a sheath (like a layer of insulating tape wrapped around the wire). The nerve fiber's action current (a kind of biological current) is transmitted and transmitted to all walks of life, normal operation, fulfilling its own functions, and governing the movement of facial muscles. There are often several small blood vessels (usually small) around the roots of the facial nerve. The arteries walk through and are generally not in contact with the nerves. However, if one or more of these blood vessels are abnormal, they "crawl" onto the nerve roots. Because of the certain pressure of the arteries, this will cause long-term compression of the nerves. Due to the long-term friction of the arterial pulsation, the sheath wrapped around the surface of the nerve fiber is worn away. Thus, the afferent and efferent bioelectric currents of the nerve will cause a "string short circuit" at the broken place, causing disorder of facial nerve function and not appearing. Autonomous facial muscle twitching, the initial compression injury is slight, the patient's symptoms are also light, with the passage of time, the course of the disease is extended, the compression injury continues to increase, the symptoms will More and more heavy.
