Help the development of the site, sharing the article with friends!

Palsy of the facial nerve is one of the most common palsy of the cranial nerves. The causes of the facial nerve (seventh cranial nerve) palsy are different, as are the symptoms - some patients experience only a drop of the corner of the mouth, while others have all facial muscles paralyzed. Check how to recognize facial nerve palsy, how to treat and rehabilitate this condition.

Facial nerve palsyis one of the most common palsy of the cranial nerves. The facial nerve is the seventh of the twelve pairs of cranial nerves. This structure includes sensory fibers, motor fibers and parasympathetic fibers belonging to the autonomic system. For this reason, the facial nerve corresponds to, inter alia, for the sensation of taste from the front 2/3 of the tongue, controls the activity of the facial muscles, and is also involved in controlling the secretion of tears and saliva.

Palsy of the facial nerve: causes

Palsy of the facial nerve can be both congenital and acquired. Possible causes of a facial nerve paralysis are:

  • Moebius syndrome (also associated with palsy of the abductor nerve)
  • childbirth with forceps
  • sarcoidosis
  • stroke (especially sinus stroke)
  • Lyme disease
  • active herpes infection
  • shingles
  • myotonic dystrophy
  • head injuries (especially those involving damage to the temporal bone)
  • Millard-Gubler syndrome
  • otitis
  • Guillain-Barre team
  • Ramsay-Hunt syndrome
  • diabetes
  • multiple sclerosis
  • mononucleosis
  • tumors of the parotid gland
  • hyperthyroidism
  • pregnancy
  • vitamin A deficiency
  • poisoning (e.g. with carbon monoxide or ethylene glycol)
  • tumors of the central nervous system (especially those that develop in the vicinity of the nuclei or fibers of the facial nerve)
  • alcohol abuse
  • Melkersson-Rosenthal syndrome
  • myasthenia gravis
  • complications of postoperative procedures performed within the head (then the palsy of the facial nerve is defined as iatrogenic, such a complication may occur, for example, after removal of the tonsils orfollowing tumor resection)

Despite the exceptionally large number of potential causes, the underlying cause of the facial nerve palsy cannot be identified most often - then idiopathic palsy of the facial nerve (Bell's palsy) is diagnosed.

Facial nerve palsy: types and symptoms

There are two types of facial nerve palsy:

Palsy of the facial nerve can be bilateral, but it is a rare situation - the most common is unilateral palsy of this nerve.

  • peripheral: occurs when the defect is located within the fibers of the facial nerve themselves, the symptoms apply to the entire side of the face on the side of the nerve damage
  • central: it is associated with damage to the nucleus of the facial nerve in the brain, in its course the symptoms concern the opposite side of the face, and the paralysis affects only the muscles of the lower part of the face

In the course of facial nerve palsy, the facial muscles are dysfunctional. Patients may not be able to:

  • frown
  • grin your teeth
  • raise eyebrows
  • whistle
  • close the eye (due to paralysis of the muscles surrounding the eyeball, there may be problems with closing the eye)

There may also be disturbances in the secretion of tears and saliva, and there may also appear disturbances in the facial sensation, as well as disturbances in the perception of taste from the front surface of the tongue.

Facial nerve palsy: diagnosis

The course of the diagnostic process in the case of suspected facial nerve palsy varies depending on the suspected cause of the disease. As mentioned earlier, the most common is Bell's palsy, where its cause cannot be determined, but this diagnosis is made out of exclusion - it can only be diagnosed when all other potential causes of facial nerve palsy have been dismissed.

Neurological examinations are of fundamental importance in the diagnosis of the disease. On its basis, one can draw a suspicion whether the paralysis is central or peripheral. In addition, this test assesses whether the patient has paralyzed other cranial nerves and whether there are any other neurological defects. Further diagnosis depends on the possible cause of the disease. Imaging tests may be performed in patients with a head injury or in those who may have a proliferative disease. Research can also be helpfullaboratory tests (e.g. blood to determine inflammatory markers in case of suspected infection) or immunodiagnostics (e.g. in case of suspected Lyme disease). Occasionally, electrophysiological tests are also performed to assess the degree of facial nerve damage.

Worth knowing

When a patient is diagnosed with palsy of the facial nerve, the severity of the condition can be determined using the House and Brackmann scale. There are six degrees on this scale:

  • Grade I: the facial muscles are fully functional
  • grades II-V: related to paresis of mimic muscles, from slight (II), through moderate (III) to significant (IV) and severe (V)
  • grade VI: means complete paralysis with the inability to move the facial muscles

Facial nerve palsy: treatment

In the case of the most common facial nerve palsy, Bell's palsy, pharmacological treatment is applied - patients are given glucocorticosteroids. In other situations, the therapy depends on the specific cause of the paralysis.

In a situation where the facial nerve has been permanently damaged (e.g. due to trauma or due to complications of surgical treatment of other conditions), surgical treatment may be applied. Nerve transposition procedures are used (e.g. it is possible to connect the damaged nerve with another, not pathologically affected facial nerve, or with another cranial nerve, e.g. sublingual), as well as muscle transplantation (thanks to this, the patient may be able to perform certain facial movements with the help of these other muscles).

Due to the limited ability to close the eye, patients with facial nerve palsy are recommended to take special care of the eye. Excessive drying of the cornea may lead, for example, to an increased risk of its infection. To protect the eye, patients can be advised to use the so-called artificial tears, in addition, before going to sleep for the night, they can cover the eye with special plasters.

Facial nerve palsy: prognosis

The prognosis of patients with facial nerve palsy depends on the cause of the disease. In most cases, the symptoms of paralysis disappear with time, but it happens at different times - in some patients the disease disappears after a few days, and in others only after a few months. Regardless of the cause of paralysis, patients are recommendedrehabilitation . While exercising the facial muscles does not usually speed up the healing process, it prevents the appearance of permanent contractures.

A bit worseis the prognosis of patients with complete facial nerve damage - in such situations, the recovery (at least partially) of paralyzed muscle function is usually impossible without surgical treatment.

Help the development of the site, sharing the article with friends!

Category:

Neurology