home Auditorium 7 Symptoms and treatment of facial nerve diseases. Facial nerve Branches of the facial nerve in the temporal bone canal

Symptoms and treatment of facial nerve diseases. Facial nerve Branches of the facial nerve in the temporal bone canal

Rice. 984. Facial nerve, n. facialis, left (photo. Preparation by E. Strakhovoy)..

Facial nerve [intermediate nerve], n. facialis [n. intermediofacialis](VII pair) (Fig. , , , , ; see Fig. , , , ), – mixed nerve. Nucleus of the facial nerve, nucleus n. facialis, lies in the central part of the bridge, in the reticular formation, somewhat posterior and outward from the nucleus of the abducens nerve. From the side of the rhomboid fossa, the nucleus of the facial nerve is projected lateral to the facial tubercle (see Fig.,).

The processes of the cells forming the nucleus of the facial nerve first follow in the dorsal direction, bending around the nucleus of the abducens nerve, then forming genu of the facial nerve, genu n. facialis, are directed ventrally and exit onto the lower surface of the brain at the posterior edge of the pons, above and lateral to the olive of the medulla oblongata.

The facial nerve itself is motor, but after joining intermediate nerve, n. intermedius, represented by sensory and vegetative fibers (gustatory and secretory), acquires a mixed character and becomes intermediate-facial nerve.

Intermediate nerve nucleus superior salivatory nucleus, - the autonomic nucleus, lies somewhat posterior and medial to the nucleus of the facial nerve.

The axons of the cells of this nucleus make up the bulk of the intermediate nerve.

At the base of the brain, the intermediate nerve appears along with the facial nerve. Subsequently, both nerves, together with the vestibulocochlear nerve (VIII pair), enter through the internal auditory opening of the petrous part (pyramid) of the temporal bone into the internal auditory canal. Here the facial and intermediate nerves connect and through field of the facial nerve, area n. facialis, enter the facial nerve canal. At the point where this canal bends, the facial nerve forms knee, geniculum n. facialis, and thickens due to ganglion geniculi. This node belongs to the sensitive part of the intermediate nerve.

The facial nerve follows all the bends of the facial canal and, leaving the pyramid through the stylomastoid foramen, lies in the thickness of the parotid gland, where it divides into its main branches.

Inside the pyramid, a number of branches depart from the interfacial nerve:

Greater petrosal nerve, n. petrosus major, begins near the genu ganglion and consists of parasympathetic fibers of the intermediate nerve. It leaves the pyramid of the temporal bone through the cleft of the canal of the greater petrosal nerve, lies in the groove of the same name and exits the cranial cavity through the lacerated foramen. Subsequently, this nerve, passing through the pterygoid canal of the sphenoid bone, in which, together with the sympathetic nerve, forms nerve of the pterygoid canal, n. canalis pterigoidei, enters the pterygopalatine fossa, reaching the pterygopalatine node. Preganglionic parasympathetic fibers of the greater petrosal nerve switch on the cells of this ganglion [see. "Autonomic (autonomic) nervous system"].
Connecting branch with the tympanic plexus, r. communicans (cum plexu tympanico), departs from the genu ganglion or from the greater petrosal nerve and approaches the lesser petrosal nerve.
Stapedial nerve, n. stapedius, is a very thin branch that starts from the descending part of the facial nerve, approaches the stapedius muscle and innervates it.
Connecting branch with the vagus nerve, r. communicans (cum nerve vago), is a thin nerve that approaches the lower node of the vagus nerve.
Drum string, chorda tympani, is the terminal branch of the intermediate nerve. It departs from the trunk of the facial nerve slightly above the stylomastoid foramen, enters the tympanic cavity from the posterior wall, forming a small arch, concavely facing downwards, and lies between the handle of the malleus and the long leg of the incus. Approaching the petrotympanic fissure, the chorda tympani leaves the skull through it. Subsequently, it is directed downwards and, passing between the medial and lateral pterygoid muscles, enters the lingual nerve at an acute angle. In its course, the chorda tympanum does not give off branches; only at the very beginning, after leaving the skull, it is connected by several branches to the ear node.

The chorda tympani consists of two types of fibers: prenodular parasympathetic, which are processes of the cells of the superior salivary nucleus, and gustatory fibers, which are peripheral processes of the cells of the genu ganglion. The central processes of these cells end in the nucleus of the tractus solitarius.

Some of the fibers of the chorda tympani, which are part of the lingual nerve, are directed to the submandibular and sublingual nodes as part of the nodal branches of the lingual nerve (centrifugal fibers), and the other part reaches the mucous membrane of the back of the tongue (centripetal fibers are processes of the cells of the genu ganglion).

Having emerged through the stylomastoid foramen from the pyramid of the temporal bone, the facial nerve, even before entering the thickness of the parotid gland, gives off a number of branches:

Posterior auricular nerve, n. auricularis posterior, begins directly below the stylomastoid foramen, turns posteriorly and upward, goes behind the external ear and divides into two branches: anterior auricular branch, r. auricularis, and back – occipital branch, r. occipitalis. The auricular branch innervates the posterior and superior auricular muscles, the transverse and oblique muscles of the auricle, and the antitragus muscle. The occipital branch innervates the occipital belly of the supracranial muscle and connects with the greater auricular and lesser occipital nerves of the cervical plexus and with the auricular branch of the vagus nerve.
Stylohyoid branch, r. stylohyoideus, may arise from the posterior auricular nerve. This is a thin nerve that goes downwards, enters the thickness of the muscle of the same name, having previously connected with the sympathetic plexus located around the external carotid artery.
Digastric branch, r. digastricus, can arise from both the posterior auricular nerve and the trunk of the facial nerve. It is located slightly below the stylohyoid branch, descends along the posterior belly of the digastric muscle and gives branches to it. It has a connecting branch with the glossopharyngeal nerve.
Lingual branch, r. lingualis, non-permanent, is a thin nerve that bends around the styloid process and passes under the palatine tonsil. It gives off a connecting branch to the glossopharyngeal nerve and sometimes a branch to the styloglossus muscle.

Having entered the thickness of the parotid gland, the facial nerve is divided into two main branches: the more powerful upper and smaller lower. These branches are further divided into second-order branches, which diverge radially: up, forward and down to the facial muscles. Between these branches in the thickness of the gland, connections are formed that make up parotid plexus, plexus parotideus.

Zygomatic branches, rr. zygomatici, two, sometimes three, are directed forward and upward and approach the zygomatic muscles and the orbicularis oculi muscle.

Buccal branches, rr. buccales, are three or four fairly powerful nerves. They arise from the upper main branch of the facial nerve and send their branches to the following muscles: the zygomaticus major, the laughter muscle, the buccal muscle, the levator and depressor of the upper and lower lips, the levator and depressor of the angle of the mouth, the orbicularis oris muscle and the nasal muscle. Occasionally, there are connecting branches between the symmetrical nerve branches of the orbicularis oculi muscle and the orbicularis oris muscle.

Marginal branch of the lower jaw, r. marginalis mandibulae, heading anteriorly, passes along the edge of the lower jaw and innervates the muscles that lower the angle of the mouth and the lower lip, the mental muscle.

Cervical branch, r. colli, in the form of 2-3 nerves, goes behind the angle of the lower jaw, approaches the subcutaneous muscle, innervates it and gives off a number of branches connecting to the upper (sensitive) branch of the cervical plexus.

The facial nerve or nervus facialis is the seventh paired cranial nerve CN VII. In terms of anatomy, it performs motor, sensory and parasympathetic functions. According to evolutionary anatomy, the branches of the facial nerve, like itself, originate from the second branchial arch, which is present in the embryo.

The facial nerve innervates the muscles responsible for facial expression, the stylohyoid muscle, the posterior belly of the digastric muscle, and the stapedius muscle. It also recognizes the sense of taste in the tongue and transmits a signal to the corresponding part of the brain.

Nervus facialis performs a parasympathetic function. It lies in the fact that this nerve (nervus) can innervate many glands of the neck and head, including:

lacrimal;
salivary;
producing mucus in the nasal cavity, palate and pharynx.

The topography of the facial nerve is quite complex. It has many branches, which consist of various combinations of sensory, motor and parasympathetic fibers.

From an anatomical point of view, the nervus facialis is divided into two parts. The first is intracranial, that is, it passes through the skull and its cavity. The second part is extracranial: it goes outside the skull, through the face and neck.

Intracranial part

The nuclei of the facial nerve are located in the brainstem, which is called the pons. This is where the facial nerve begins. Its origin consists of two roots, large motor and small sensory. The part of the nervus facialis that originates from the small sensory root is called the intermediate nervus, in other words, the Wriesberg nerve.

Two roots pass through the internal auditory canal of the skull, then pass through a 1 cm long hole in the petrous (petrous) part of the temporal bone. At this point, the facial nerve runs very close to the inside of the ear. Further, bypassing the temporal bone, the roots of the nervus facialis leave the internal auditory canal and enter the facial canal of the skull (facial nerve canal). This channel has a zigzag shape.

Inside the facial canal, changes occur in the structure of the nervus facialis. Both roots merge into one facial nerve, after which it bends around the inner ear, forming the geniculate ganglion, which is a ganglion, that is, a collection of nerves. Then the nervus facialis gives off several branches. One of them is the nerve of the stapes muscle, which is the motor fibers of the stapes muscle.

Another branch is the greater petrosal nerve, which controls the lacrimal gland. It begins distal to the geniculate ganglion in the facial canal of the cranial bones. Then, passing in the anterior-internal direction, it exits through the temporal bone into the recess of the base of the skull. From here it goes near the lacerated foramen, which is located at the junction of the temporal, sphenoid and occipital bones.

Next, it intertwines with the deep petrosal nerve and creates the common nervus of the pterygoid canal, which passes through the Vidian canal and enters the pterygopalatine fossa. Here it connects with the pterygopalatine ganglion. The branches of this ganglion extend to the glands of the oral mucosa, nasopharynx, and lacrimal glands.

The third branch is the chorda tympani, which is responsible for the innervation of the anterior part of the tongue. It begins in the facial canal and passes through the bones of the middle ear. After this, it exits through the petrotympanic fissure and ends up in a fossa in the lower part of the temporal bone, where it intertwines with the lingual nerve. The parasympathetic fibers of the chorda tympani remain with the lingual nervus, but the main trunk branches off to innervate the anterior two-thirds of the tongue.

The chorda tympani also conducts parasympathetic fibers. They intertwine with the lingual nerve (a branch of the trigeminal nerve) in the recess of the base of the skull under the temporal bone and form the submandibular ganglion. The branches of this ganglion go to the submandibular and sublingual salivary glands.

Damage to the intracranial part

Damage to the intracranial portion of the nervus facialis results in paralysis or severe muscle weakening. The manifestation of symptoms largely depends on the location of the damage and which branches of the facial nerve are damaged.

For example, injury to the chorda tympani causes decreased salivation and loss of taste on the affected side of the tongue. Damage to the stapedial nerve leads to increased sensitivity to sounds in the ear on the injured side. If the greater petrosal nerve is damaged, there is a reduction in tear production in the injured eye.

The most common cause of damage to the intracranial part of the facial nerve is pathological processes in the middle ear, such as a tumor or infection. If none of these causes are identified, the condition is called Bell's palsy.

Extracranial part

After leaving the skull, the course of the facial nerve turns upward and goes to the front of the external ear. The first extracranial branch is the anterior auricular nerve. It provides motor innervation to some of the muscles near the ear. Near it, motor branches go to the posterior belly of the digastric muscle and the stylohyoid muscle.

The main trunk of the nervus facialis, which is called the motor root of the facial nerve, branches back and forth, passing near the parotid salivary glands, which are innervated by the glossopharyngeal nerve. Near the parotid salivary glands, the nervus facialis branches into five terminal branches:

Temporal branch - innervates the muscles of the forehead, orbicularis and those responsible for wrinkling the eyebrows.
The zygomatic branch controls the orbicularis orbitalis muscle.
Buccal branch – controls the orbicularis oris, zygomatic and buccal muscles.
The branch of the edge of the lower jaw is responsible for the muscle of the chin.
Cervical branch - controls the platysma, the subcutaneous muscle of the neck.

These motor terminal branches of the facial nerve innervate the muscles that give the face a certain expression. When the extracranial part of the facial nerve is injured, paralysis or severe weakness of the muscles of facial expression occurs, which leads to various pathologies.

Motor functions

The branches of the nervus facialis are individual facial nerves, the pattern of which indicates the innervation of many muscles of the head and neck. All these muscles originate from the second visceral arch. The first motor branch begins in the facial canal of the skull. It innervates the stapedius muscle, for which it passes through the pyramidal process to the inner ear.

Between the carotid canal and the parotid salivary gland there are three more motor branches:

Posterior auricular nerve - rises in the anterior part of the mastoid process and controls the internal and external muscles of the outer ear. In addition, it is responsible for the occipital part of the supracranial muscle;
Nerve of the posterior belly of the digastric muscle (raises the hyoid bone).

Within the parotid gland, the facial nerve branches into five branches that are responsible for facial expression. The muscles they control are located in the subcutaneous tissue, making them the only muscle group in the human body that is embedded in the skin. By contracting, they tighten the skin and produce the action inherent in each muscle. These muscles, like the nervus facialis, originate from the second branchial (visceral) arch. All these muscles are innervated by the facial nerve and are divided into three groups - ocular, nasal and oral.

Eye muscles

The ocular muscle group is two muscles associated with the eye socket. They control the movements of the eyelids necessary to protect the cornea from damage.

The orbicularis orbitalis muscle surrounds the eyeball and enters the tissues of the eyelid. According to its functions, it can be divided into two parts, the external, orbital and internal, age-old. The eyelid part of the muscle gently closes the eye, and the orbital part closes the eyelid more strongly.

There is also a muscle that corrugates the eyebrow. It is located posterior to the orbicularis orbitalis muscle, originates at the brow arch and runs in the upper lateral direction, entering the skin of the eyebrow. This muscle brings the eyebrows together, creating vertical wrinkles on the bridge of the nose. When the facial nerve is injured, the orbicularis orbital muscle ceases to function. Since only she can close her eyelids, the consequences can be very serious.

If the eyes are unable to close, this causes the cornea to dry out, causing keratitis. In this case, the lower eyelid droops, which causes tear fluid to accumulate in the lower eyelid and is unable to wet the eyes. This leads to the fact that the eyes do not clean themselves, dirt accumulates in the eyes, and ulcers appear on the surface of the cornea.

Nasal muscle group

The muscles of the nose are responsible for its movement, as well as the skin around it. There are three muscles in this group innervated by the facial nerve. The nasalis muscle is the largest of all the muscles of the nose. It is divided into two parts, external and internal. Both parts start from the upper jaw. The external one is attached to the aponeurosis passing through the dorsum of the nose. The inner part is attached to the cartilage of the nasal wing. These two parts of the nasal muscle have opposite actions. The outer part compresses the nostrils, and the inner part opens them.

The pride muscle is the uppermost muscle of the nose. It is located above the other muscles of facial expression and is attached to the nasal part of the frontal bone. Contraction of the pride muscle moves the eyebrows down, which leads to the appearance of wrinkles on the bridge of the nose. The depressor nasal septum muscle helps the wings of the nose open the nostrils. It runs from the upper jaw above the middle incisor to the nasal septum. This muscle moves the nose down and opens the nostrils.

Oral muscle group

The oral muscles are the most important group of maxillofacial muscles in facial expression: they control the movements of the mouth and lips. These movements are important when speaking, singing and whistling; with their help, speech acquires different intonations. This group of maxillofacial muscles includes the orbicularis oris muscle, the buccal muscle and other small muscles.

Fibers of the orbicularis muscle surround the opening leading to the oral cavity. It starts from the upper jaw and other cheek muscles and enters the skin and mucous membrane of the lips. This muscle puffs out the lips.

The maxillofacial muscle, known as the buccal muscle, is located between the upper and lower jaws much deeper than the rest of the facial muscles. Its fibers start from the lower and upper jaw and are located in the lower-middle direction, mixing with the fibers of the orbicularis oris muscle and the skin of the lips. The buccal muscle pulls the cheeks inward towards the teeth, pushing out accumulated food.

There are other maxillofacial muscles of the mouth. Anatomically they can be divided into the following groups:

Lower - includes the muscles that lower the corners of the mouth, lips and mental muscle.

The superior muscle is the laughter muscle, the zygomaticus minor and major, the superior levator of the lip and ala nasi, as well as the levator of the angle of the mouth.

With dysfunction of the nervus facialis, the muscles of the mouth can be paralyzed. This manifests itself in the fact that the patient cannot eat; food constantly clogs the oral cavity, accumulating behind the cheeks. When laughing and smiling, the muscles work in the opposite direction, giving the face an ominous expression. Such damage is difficult to treat.

Intracranial - from the brain stem to the internal auditory canal;

Canal – internal auditory canal;

Labyrinthine - from the opening of the internal auditory canal to the ganglion geniculi - the first knee - gives off n.petrosus major - parasympathetic branch to the lacrimal glands;

Drum - from the first knee to the pyramidal protrusion (second knee);

Mastoid - from the pyramidal protrusion to the stylomastoid foramen - extends n.stapedius, to the stapedius muscle, and chorda tympani, secretory innervation of the submandibular and sublingual salivary glands, taste innervation for the anterior 2/3 of the tongue;

Extratemporal - from the stylomastoid foramen to the facial muscles.

2. Anatomical and physiological features of the facial nerve

Facial nerve ( n. facialis) (VII pair of cranial nerves) develops in connection with the formation of the second branchial arch and innervates all facial muscles and partially the muscles of the floor of the mouth. The nerve is mixed, includes motor fibers from the efferent medullary nucleus, as well as sensory and autonomic (taste and secretory) fibers belonging to the intermediate nerve, which is closely connected with the facial nerve ( n. intermedius), which runs partially together with the facial one, being, as it were, its dorsal root (Fig. 1). Rice. 1. Anatomical and topographic diagram of the structure of the facial nerve: 1 - bottom of the IV ventricle, 2 - nucleus of the facial nerve, 3 - stylomastoid foramen, 4 - posterior auricular muscle, 5 - occipital vein, 6 - posterior belly of the digastric muscle, 7 - stylohyoid muscle, 8 - branches of the facial nerve to the facial muscles and subcutaneous muscle of the neck, 9 - depressor anguli oris muscle, 10 - mental muscle, 11 - depressor lower lip muscle, 12 - buccal muscle, 13 - orbicularis oris muscle, 14, 15 - levator muscle upper lip, 16 - zygomatic muscle, 17 - orbicularis oculi muscle, 18 - corrugator muscle, 19 - frontal muscle, 20 - chorda tympani, 21 - lingual nerve, 22 - pterygopalatine ganglion, 23 - trigeminal ganglion, 24 - internal carotid artery, 25 - intermediate nerve, 26 - facial nerve, 27 - vestibulocochlear nerve [V.A. Karlov, 1991]

The motor nucleus of the facial nerve, consisting of large motor cells, is located at the bottom of the fourth ventricle, in the reticular formation of the posterior part of the brain. Nerve fibers from this nucleus form the intracerebral part of the facial nerve root, which has a complex topography in the thickness of the bridge (Fig. 2).

Rice. 2. The location of the nuclei of the facial nerve and the course of its root in the brain stem (according to Braus): 1 - red nucleus, 2 - aqueduct of Sylvius (midbrain cavity), 3 - quadrigeminal plate, 4 - epiphysis, 5 - midbrain tract of the trigeminal nerve, 6 - trochlear nerve nerve, 7 - frenulum of the anterior medullary velum, 8 - motor nucleus of the trigeminal nerve, 9 - genu of the facial nerve (loop n. facialis, covering the nucleus of the abducens nerve), 10 - roof of the IV ventricle or tent, 11 - plexus of the meninges of the IV ventricle, 12 - solitary tract, 13 - nucleus of the gray wing (nucleus of the vagus nerve), 14 - nucleus of the hypoglossal nerve, 15 - central canal, 16 - spinal tract of the trigeminal nerve, 17 - accessory nerve, 18 - nucleus of the accessory nerve, 19 - hypoglossal nerve, 20 - accessory nerve, 21 - vagus nerve, 22 - double nucleus, 23 - hypoglossal nerve, 24 - glossopharyngeal nerve, 25 - inferior olive nucleus, 26 - salivary nucleus, 27 - acoustic nerve, 28 - facial nerve, 29 - abducens nerve, 30 - facial nerve nucleus, 31 - trigeminal nerve, 32 - pons, 33 - cerebellar peduncle, 34 - oculomotor nerve [ A.K. Popov, 1968]

From the reticular formation, the root goes along the bottom of the IV ventricle, bends around the nucleus of the abducens nerve and forms a genu ( genu n. facialis). After which it leaves the brain in the cerebellopontine angle in front of the roots of the intermediate and vestibulocochlear nerves, between the posterior edge of the pons and the olive of the medulla oblongata. This place is called the cerebellopontine angle and is often the target of damage. The entire path of the facial nerve should be divided into the following segments (V.O. Kalina, M.A. Shuster, 1970): supranuclear, subnuclear, inside the temporal bone and outside the temporal bone.

Rice. 3. Supranuclear tracts of the facial nerve (according to Mc Gwern and Fitz-Hugh): 1 - precentral gyri, 2 - thalamonuclear tract (anatomically not established), 3 - nucleus of the facial nerve [V.O. Kalina, M.A. Shuster, 1970]

Supranuclear segment . It is known that the motor fibers of the facial nerve, as part of the general motor pathway, begin in the lower part of the precentral gyrus (Fig. 3), go further as part of the corona radiata to the posterior leg of the internal capsule and, passing near the knee, together with the pyramidal tract enter the basal part of the vorolii bridge. Here, most of the fibers cross and go to the facial nerve nucleus on the opposite side, and some of the fibers enter the facial nerve nucleus on the same side. Thus, both on the right and on the left the core n. facialis(only in its upper part) receives innervation from the cortex of both hemispheres of the brain. Subnuclear segment. The nucleus of the facial nerve is located in the ventral part of the roof of the pons, in the rhomboid fossa, ventrolateral to the nucleus of the abducens nerve (in colliculus facialis), where it is divided into upper and lower parts. The superior part of the nucleus, which receives bilateral cortical innervation, supplies the axons of its ganglion cells m. frontalis (occipito-frontalis), m. orbicularisoculi And m. corrugator supercilii, the lower part of the nucleus receives innervation only from the opposite side of the cerebral cortex. From its ganglion cells, axons go to all other facial muscles (with the exception of the levator palpebrae superioris muscle, innervated by the oculomotor nerve), to the stylohyoid muscle, the posterior belly of the digastric muscle and the platysma. These anatomical features make it possible to distinguish central (cerebral) palsy of the facial nerve, in which the upper branch is preserved (due to bilateral cortical innervation) from peripheral (when both the upper and lower branches are paralyzed).

Next, the facial and intermediate nerves enter the internal auditory opening and enter the facial canal (Fig. 4). Rice. 4. Scheme of the location of nerves in the canals of the temporal bone: 1 - stapedial nerve, 2 - chorda tympani, 3 - tympanic plexus, 4 - connecting branch of the facial nerve with the tympanic plexus, 5 - genu ganglion, 6 - facial nerve, 7 - intermediate nerve, 8 - vestibulocochlear nerve, 9 - connecting branch from the genu ganglion to the plexus of the middle meningeal artery, 10 - greater petrosal nerve, 11 - carotid-tympanic nerve, 12 - lesser petrosal nerve, 13 - nerve plexus of the internal carotid artery, 14 - deep petrosal nerve , 15 - nerve of the pterygoid canal, 16 - pterygopalatine nerves, 17 - maxillary nerve, 18 - pterygopalatine ganglion, 19 - nerve plexus of the middle meningeal artery, 20 - middle meningeal artery, 21 - auricular nerve, 22 - branches of the auricular node to the auriculo-periodic nerve, 23 - connecting branch between the ear node and the chorda tympani, 24 - masticatory nerve, 25 - mandibular nerve, 26 - lingual nerve, 27 - inferior alveolar nerve, 28 - auriculotemporal nerve, 29 - tympanic nerve, 30 - glossopharyngeal nerve , 31 - superior node of the vagus nerve, 32 - auricular branch of the vagus nerve, 33 - connecting branch of the facial nerve with the auricular branch of the vagus nerve, 34 - branches of the facial nerve to the stylohyoid muscle, 35 - branches of the facial nerve to the posterior belly of the digastric muscle, 36 - posterior auricular nerve, 37 - mastoid process [V.A. Karlov, 1991]

The right and left nuclei of the facial nerve are connected to the cerebral cortex (lower quarter of the precentral gyrus) through corticonuclear fibers ( fibrae corticonucleares), which is schematically presented in Figure 5. In this case, the part of the nucleus responsible for the innervation of the muscles of the lower half of the face is connected only with the cortex of the opposite hemisphere. The other part of the nucleus, innervating the facial muscles of the upper half of the face, has bilateral corticonuclear fibers and receives signals from the cortex of both hemispheres. In this regard, with unilateral damage to the corticonuclear fibers, central paralysis of the facial muscles is observed only in the lower half of the face on the side opposite to the lesion. There is a direct projection of fibers from the retina to the motor nucleus of the facial nerve, which contains mononeurons to the orbicularis oculi muscle. Thanks to this connection, reflexive closure of the eyelids occurs during certain visual stimuli.

Rice. 5. Diagram of the connection between the nucleus of the facial nerve and the cerebral cortex: 1 - fibers of the facial nerve to the facial muscles of the upper part of the face, 2 - fibers of the facial nerve to the facial muscles of the lower part of the face, 3 - fibers of the facial nerve to the orbicularis oris muscle (originating in the nucleus of the hypoglossal nerve ) [A.K. Popov, 1968]

Intermediate nerve ( n. intermedius) mixed. Contains parasympathetic secretory fibers to the lacrimal gland, sublingual and submandibular salivary glands, as well as sensitive taste fibers from the taste buds of the fungiform and foliate papillae of the tongue and fibers of the superficial sensitivity of the external auditory canal and auricle. Secretory fibers begin in the brain stem from the nerve cells of the superior salivary ( nucl. salivatorius superior) and lacrimal nuclei. Sensitive nerve fibers arise from the pseudounipolar cells of the genu ganglion ( gangl. geniculi) in the facial nerve canal. The central processes of the genu node go to the solitary tract node ( nucl. solitarius), which is located in the brain stem, then dorsally in the roof of the caudal part of the pons, in the medulla oblongata, and are directed to the spinal nucleus of the trigeminal nerve. In the facial canal, both nerves form a common trunk, which makes two turns in accordance with the bend of the canal. Initially, this trunk lies horizontally and is directed forward and laterally over the tympanic cavity. Then, along the facial canal, the trunk turns at a right angle posteriorly, forming a knee ( geniculum n. facialis) and elbow assembly ( gangl. geniculi), belonging to the intermediate nerve. Having passed above the tympanic cavity, the indicated trunk makes a second downward turn and is located behind the middle ear cavity. The branches of the intermediate nerve branch off in this area. The facial nerve canal has a very pronounced tortuous course. Variations in channel sizes can be observed in any part of it. Defects may occur due to complete closure of the walls of the facial canal during its development. In such patients, the nerve protrudes into the defect (into the oval window or facial recess). In exceptional cases, the nerve is hypoplastic or even absent. The facial nerve exits the canal through the stylomastoid foramen ( for. stylomastoideum) and enters the parotid salivary gland. At a depth of 2 cm from the outer surface, the facial nerve divides into 2–5 primary branches, which divide into secondary branches and form the parotid plexus. It is customary to distinguish between two forms of the external structure of the parotid plexus - reticular and trunk. In the reticular form, the nerve trunk in the thickness of the gland is divided into many branches that have multiple connections among themselves, as a result of which a narrowly plexus is formed. There are multiple connections with the branches of the trigeminal nerve. In the main form, the nerve trunk is divided into two branches (superior and inferior), which give rise to several secondary branches. There are few connections between the secondary branches, the plexus is broadly looped. On its way, the facial nerve gives off branches along the canal, as well as when leaving it. The root of the facial nerve is supplied with blood from the inferior anterior cerebellar artery, the trunk of the facial nerve in the facial canal - from the stylomastoid, the branching area and branches of the facial nerve on the face - from the branches of the external carotid artery.

Facial neuritis or Bell's palsy– this is inflammation of the 7th pair of cranial nerves, or rather one of them. The disease deprives a person of the ability to control his face and show emotions: frown, smile, raise his eyebrows in surprise, and even chew food normally. The face looks asymmetrical and skewed.

The facial nerve is most often affected. This is due to the fact that on its way it passes through the narrow canals of the facial bones. Therefore, even minor inflammation leads to constriction and oxygen starvation, which causes symptoms of the disease. For most people, the facial muscles on one side of the face fail. But in 2% of people, inflammation occurs on both sides.

Facial neuritis is a fairly common disease. Every year, 25 people per 100 thousand of the population suffer from this disease. Both men and women are equally susceptible to it. A surge in the disease is observed during the cold season. There are especially many patients in the northern regions.

Neuritis of the facial nerve is characterized by a protracted course. You will have to spend an average of 20-30 days in the hospital. Full recovery will take 3-6 months. But, unfortunately, in 5% of people the function of the facial muscles is not restored. This happens if facial neuritis is caused by a brain tumor or traumatic brain injury. And in 10% of cases, after recovery, a relapse occurs.

The severity of the disease and recovery time depend on which part of the nerve is damaged, to what depth and how quickly treatment was started.

Anatomy of the facial nerve

The facial nerve is primarily motor and regulates the facial muscles. But it contains fibers of the intermediate nerve. They are responsible for the production of tears and saliva by the glands, as well as the sensitivity of the skin and tongue.

The nerve trunk itself is the long processes of nerve cells called neurons. These processes are covered on top with a membrane (perineurium), consisting of special cells called neuroglia. If the nerve sheath is inflamed, then the symptoms of the disease are mild and they are not as numerous as when neurons are damaged.
What does the facial nerve consist of:

the area of the cerebral cortex that is responsible for facial expressions;
The nuclei of the facial nerve are located on the border of the medullary pons and the medulla oblongata.
- nucleus of the facial nerve – responsible for facial expressions;
- nucleus of the solitary tract - responsible for the taste buds of the tongue;
- superior salivary nucleus - responsible for the lacrimal and salivary glands.
The motor processes (fibers) of nerve cells are the nerve trunk.
a network of blood and lymphatic vessels - capillaries penetrate the nerve sheath and are located between the processes of nerve cells, providing them with nutrition.

The facial nerve stretches from the nuclei to the muscles, bending and forming 2 extended knees along its path. Through the auditory opening, together with the fibers of the intermediate nerve, it enters the temporal bone. There, its path passes through the petrous part, the internal auditory canal and the facial nerve canal. The nerve exits the temporal bone through the stylomastoid foramen and enters the parotid gland, where it divides into large and small branches that intertwine. The branches control the muscles of the forehead, nostrils, cheeks, orbicularis oculi and orbicularis oris.

As you can see, the facial nerve makes a tortuous path and passes through narrow channels and openings. If it becomes inflamed and swollen, the nerve fibers increase in volume. In narrow areas, this can lead to compression and destruction of nerve cells.

Causes of neuritis of the facial nerve

Scientists have not been able to definitively establish the cause of the disease. A number of factors have been associated with inflammation of the facial nerve.

The mechanism of development of neuritis of the facial nerve.

These factors lead to spasm (narrowing) of the arteries. In this case, the blood stagnates in the capillaries, and they expand. The liquid component of the blood penetrates the capillary wall and accumulates in the intercellular spaces. Swelling of the tissue occurs, as a result of which the veins and lymphatic vessels are compressed - the outflow of lymph is disrupted.

This leads to disruption of the blood circulation of the nerve and its nutrition. Nerve cells are very sensitive to lack of oxygen. The nerve trunk swells and hemorrhages appear in it. This leads to the fact that nerve impulses are poorly transmitted from the brain to the muscles. The command given by the brain does not travel through the fibers, the muscles do not hear it and are inactive. All signs of the disease are associated with this.

Symptoms and signs of facial neuritis

Neuritis of the facial nerve always has an acute onset. If symptoms appear slowly, this indicates another pathology of the nervous system.

Symptom	Its manifestations	Cause	Photo
1-2 days before the disturbance in facial expressions, pain appears behind the ear.	The pain can radiate to the back of the head and face. After a few days, the eyeball begins to hurt.	The discomfort is caused by swelling of the nerve. It is compressed at the exit from the auditory opening of the temporal bone.
The face is asymmetrical and resembles a mask on the affected side.	The eye is wide open, the corner of the mouth is lowered, the nasolabial fold and folds on the forehead are smoothed. The asymmetry becomes more noticeable when talking, laughing, or crying.	The brain loses the ability to control the facial muscles of one side of the face.
The eye on the affected side does not close.	When you try to close your eyes, the eye on the affected side does not close, and the eyeball turns upward. A gap remains through which the white membrane of the hare's eye is visible.	The orbicularis oculi muscle is poorly innervated. The muscles of the eyelid on the affected side do not obey.
The corner of the mouth droops. The mouth becomes like a tennis racket with the handle turned towards the affected side.	When eating, liquid food pours out from one side of the mouth. But at the same time, the person retains the ability to move the jaw and chew.	The buccal branches of the facial nerve cease to control the orbicularis oris muscle.
The cheek muscles do not obey.	While eating, a person bites his cheek and food constantly falls behind it.	The facial nerve does not transmit brain signals to the cheek muscles.
Dry mouth.	Constant thirst, feeling of dry mouth, while eating food is not sufficiently moistened with saliva. But in some cases, excessive salivation occurs. Saliva runs in a stream from the lowered corner of the mouth.	The salivary gland receives distorted commands from the brain.
Speech becomes slurred.	Half of the mouth is not involved in the articulation of sounds. Noticeable problems arise when pronouncing consonant sounds (b, v, f).	The facial nerve supplies the lips and cheeks, which are responsible for the pronunciation of sounds.
Dryness of the eyeball.	Not enough tears are produced, and the eye is wide open and rarely blinks. This causes it to dry out.	The functioning of the lacrimal gland is disrupted; it produces an insufficient amount of tear fluid.
Tearing.	For some people the situation is the opposite. Tears are produced in excess. And they, instead of going into the tear duct, flow down the cheek.	Active work of the lacrimal gland, disruption of the outflow of tears.
The perception of taste on one half of the tongue is impaired.	The anterior 2/3 of the tongue on the affected side of the face cannot taste food.	This is caused by inflammation of the nerve fibers that carry signals from the taste buds on the tongue to the brain.
Increased hearing sensitivity.	Sounds on one side seem louder than they really are. This is especially true for low tones.	The facial nerve is inflamed in the temporal bone near the auditory receptors, which affects their function. The nucleus of the facial nerve is located next to the nucleus of the auditory nerve. Therefore, inflammation affects the functioning of the auditory analyzer.

Based on the symptoms of the disease, an experienced doctor can determine exactly where the lesion has occurred on the facial nerve.

Damage to the cerebral cortex which is responsible for the facial nerve - paralysis of the facial muscles of the lower half of the face, nervous tics, involuntary movements of the facial muscles. When laughing and crying, the asymmetry is not noticeable.
Damage to the facial nerve nuclei – involuntary rapid movements of the eyeballs (nystagmus), a person cannot wrinkle his forehead, decreased sensitivity of the skin on half of the face (numbness), frequent twitching of the palate and pharynx occurs. Impaired coordination of movements in the entire half of the body may occur.
Damage to the facial nerve in the cranial cavity and in the pyramid of the temporal bone – paralysis of facial muscles, salivary glands do not produce enough saliva, dry mouth, the front part of the tongue does not feel taste, heightened hearing or nervous deafness, dry eyes.

You can independently determine whether you have facial neuritis. Contact your doctor immediately if you cannot:

frown;
wrinkle your forehead;
wrinkle your nose;
whistle;
blow out the candle;
puff out your cheeks;
take water into your mouth;
blink both eyes in turn;
close your eyes (there is a gap on the affected side through which the white of the eye is visible).

If you start treatment in the first hours after these signs appear, you will be able to cope with the disease much faster. The doctor prescribes decongestants (Furosemide), which relieve swelling of the nerve.

Diagnosis of the causes of neuritis of the facial nerve

If you experience signs of facial neuritis, consult a neurologist on the same day. An experienced doctor can make a diagnosis without additional research. But in some cases, instrumental examinations are carried out. This is necessary to identify the cause of nerve inflammation. Neuritis can be caused by tumors, inflammation of the membranes of the brain, and similar symptoms occur with a stroke.

Blood analysis

For a general analysis, blood is taken from a finger. Signs of bacterial inflammation that could cause neuritis are:

significant increase in erythrocyte sedimentation rate;
increase in the number of leukocytes;
decrease in the percentage of lymphocytes.

Such results, together with other symptoms (headache, ear discharge, foci of purulent inflammation), may indicate prolonged otitis media, meningitis or other diseases that led to neuritis.

Magnetic resonance imaging (MRI)

The research is based on the interaction of a magnetic field and hydrogen atoms. After irradiation, the atoms release energy, which is recorded by sensitive sensors and allows one to obtain a layer-by-layer image.

The procedure lasts about 40 minutes, its cost reaches 4-5 thousand rubles. This method is considered the most accurate, since the bones of the skull are not an obstacle to the magnetic field. In addition, in this case there is no risk of exposure to x-rays. Therefore, this procedure can be performed even on pregnant women.

MRI can reveal the following signs of the disease:

brain tumors;
signs of cerebral infarction;
abnormal vascular development;
inflammation of the membranes of the brain.

MRI results allow the doctor to judge what exactly caused the development of the disease. This is necessary for effective treatment of neuritis.

Computed tomography of the brain CT

The study is based on the properties of tissues that partially absorb X-rays. To obtain accurate information, irradiation is carried out from several points.

During the procedure, you lie down on a couch that moves along a scanner placed in the walls of the tube.
The duration of the procedure is about 10 minutes. This study costs from 3 thousand rubles and is widely distributed.
As a result of the procedure, pathologies that caused neuritis can be detected:

tumors;
signs of a stroke;
areas of poor circulation near the nuclei of the facial nerve;
consequences of head injuries - brain hematomas.

Depending on the CT results, the doctor chooses a treatment strategy: removal of the tumor or restoration of blood circulation.

Electroneurography

Study of the speed of propagation of an electrical signal along a nerve. The nerve is stimulated with a weak electrical impulse in one place, and then activity is measured at two other points on its branches. The received data is automatically entered into the computer.

During the procedure, 2 electrodes are placed along the facial nerve. The first one receives weak electrical discharges; you may feel a tingling sensation in this area. The other electrode only picks up the signals. The procedure lasts 15-40 minutes. Cost from 1500 rub.

Signs of the disease:

a decrease in the speed of impulses - indicates inflammation of the nerve;
the electrical signal is not transmitted to one of the nerve branches - a rupture of the nerve fiber has occurred
a decrease in the number of muscle fibers excited by electricity - there is a danger of developing muscle atrophy;
facial muscles respond weakly to electrical discharges - the conduction of nerve impulses along the trunk is impaired.

Electromyography

This method studies electrical impulses that spontaneously occur in muscles (without stimulation by electrical current). Often the study is carried out together with electroneurography.

During the procedure, thin disposable needles are inserted into different areas of the muscle. At this point you experience short-term pain. Such needle electrodes make it possible to determine the propagation of an impulse in individual muscle fibers. To do this, the technician will first examine your relaxed muscles, and then ask you to frown, puff out your cheeks, and wrinkle your nose. At this moment, electrical impulses arise in the muscles, which are captured by the electrodes. The procedure lasts 40-60 minutes. Cost from 2000 rub.

With neuritis, the following deviations are detected:

the impulse takes longer to travel through the muscle;
the number of fibers that respond to the signal decreases.

These examination results indicate that there is nerve damage. This method cannot detect inflammation, but only its consequences: muscle atrophy and contractures. A repeat study carried out after 2-3 weeks allows us to judge the effectiveness of treatment.

Treatment of neuritis of the facial nerve

Treatment with medications

Group of drugs	Representatives	Mechanism of therapeutic action	How to use
Diuretics	Furosemide Furon	Accelerate the excretion of urine from the body. Thanks to this, the tissues are freed from edematous fluid. This helps to avoid pressure on blood vessels and swelling of the nerve.	Take 1 tablet 1 time per day. It is advisable to do this in the morning, since urination will be frequent for 6 hours.
Nonsteroidal anti-inflammatory drugs	Nise Nurofen	They relieve inflammation along the nerve fiber and help relieve pain in the face and ear.	Take 1 tablet 2 times a day. If necessary, the doctor may increase the dose. Course 10-14 days.
Steroid anti-inflammatory drugs - glucocorticoids	Dexamethasone Prednisolone	Relieves inflammation in nerve fibers, swelling and pain. They activate the release of a special substance (neurotransmitter) that improves the conduction of impulses along nerve fibers. People who take glucocorticoids do not experience muscle tightness (contractures).	Take Dexamethasone during or after meals. The first days are prescribed 2-3 mg, after the inflammation subsides, the dose is reduced by 3 times. The course of treatment is up to 10 days.
Antiviral agents	Zovirax Acyclovir	They stop the division of the herpes virus, which often causes inflammation of the facial nerve.	Take 1 tablet 5 times a day at regular intervals. It is better to do this during meals with a glass of water. The course of treatment is 5 days.
Antispasmodics	No-shpa Spasmol	Relieves spasm of smooth muscles in blood vessels, dilates arteries, improves blood circulation in the inflamed area, and reduces pain.	Take 2 tablets 3 times a day. The course of treatment is up to 2 weeks.
Neurotropic agents	Carbamazepine Levomepromazine Phenytoin	They improve the functioning of nerve cells, normalizing their mineral metabolism. They have an analgesic (pain-relieving) effect. Reduce nervous tics and involuntary muscle contractions. Improves the functioning of the nervous system as a whole.	Take half or a whole tablet 2 times a day with a small amount of water. The course of treatment is from 10 days. During this period, refrain from drinking alcohol, otherwise serious adverse reactions may occur.
B vitamins	B1, B6, B12 Thiamine, Pyridoxine, Riboflavin	B vitamins are part of nerve cells and their processes. They play an important role in the functioning of the nervous system and protect it from poisoning by toxins.	Take 1-2 tablets after meals, 1 time per day. The course of treatment is 1-2 months.
Anticholinesterase agents	Prozerin Galantamine	They improve the transmission of signals along the nerves to the muscles, increasing their tone. Normalize the functioning of the lacrimal and salivary glands.	Starting from the second week of the disease, 1 tablet is prescribed 1-2 times a day, half an hour before meals. Duration of treatment is 4-6 weeks. If muscle contractures appear, then these drugs are discontinued.

Remember that treatment of neuritis of the facial nerve should be carried out only in a hospital or, with the permission of a doctor, in a day hospital. Self-administration of medications can cause serious side effects. In addition, self-medication of neuritis leads to the fact that the facial muscles may never recover.

Physiotherapy for neuritis

Physiotherapeutic treatment can be used only from 7-10 days from the onset of the disease!

Type of physiotherapy	Indications	Mechanism of therapeutic action	How to use
Ultrahigh frequency therapy (UHF) of low thermal intensity	Inflammatory process in the facial nerve; Impaired blood circulation and lymph drainage in the inflamed area.	The ultrahigh frequency electric field is partially absorbed by tissues. Charged particles penetrate into cells, and this leads to changes in metabolic processes. The tissues heat up, their nutrition improves, and swelling goes away. The number of leukocytes (cells that fight inflammation) increases.	Condenser plates are placed 2 cm above the mastoid process and above the branching point of the facial nerve. Duration 8-15 minutes, course 5-15 sessions daily or every other day.
Ultraviolet (UV) irradiation of half or the entire face (1-2 biodoses)	Acute and subacute (from 5-7 days from the onset of the disease) periods of inflammation of peripheral nerves. Diseases of the nervous system that are accompanied by severe pain.	Ultraviolet rays stimulate the production of hormones, various immune cells and immunoglobulins. In this way, an anti-inflammatory and analgesic effect is achieved.	First, the biodose is determined. This irradiation time is necessary for redness with clear boundaries to appear on the skin (1-5 minutes). In the future, the session time is equal to 1-2 biodoses. The course of treatment is 5-20 procedures.
Decimeter DMV therapy on the affected side of the face	Acute (non-purulent) and subacute inflammatory processes of the nervous system.	Electromagnetic ultra-high-frequency decimeter waves cause an increase in tissue temperature by 3-4 degrees and activate metabolism. As a result, blood vessels dilate, blood supply improves, and impaired nerve functions are restored.	You are seated on a wooden couch. The emitter is installed so that it barely touches the skin. If the nozzle is pressed tightly, a burn may appear after 1-2 days. Session duration is 5-15 minutes. 3-15 procedures are prescribed for a course of treatment.
Electrophoresis of medicinal substances - dibazole (0.02%), proserin (0.1%), nivalin, potassium, vitamin B 1	Inflammatory processes in nerve fibers, Metabolic disorders Weakening (atrophy) of muscles	The action of a constant continuous electric current of low strength and voltage has an anti-inflammatory, decongestant, analgesic, and calming effect. Using current, you can inject the medicine under the skin and achieve a high concentration at the site of inflammation.	Warm flannel pads moistened with a medicinal solution are placed on the areas along the nerve, and electrodes are placed on top. They are fixed with a rubber band or adhesive tape. After this, the current is gradually added until you feel a slight tingling sensation. The course of treatment is 10-20 procedures, the duration of one is 10-30 minutes.
Diadynamic therapy	Muscle paralysis Contractures Pain in the affected half of the face Nerve fiber damage	Pulsed direct currents penetrate the skin into the muscle fibers, causing them to contract. This is very important, given that the muscles do not work for a long time and weaken. They expel fluid, activate enzymes that fight inflammation, and accelerate recovery processes in nerve fibers	Fabric pads with electrodes moistened with warm water are fixed to the skin in the area where the nerves pass. Electrical impulses are applied through them. Depending on the type of current, you will feel pressure, muscle compression, and tingling. The duration of the procedure is 10-20 minutes. It is necessary to undergo 10-30 sessions daily or every other day.
Paraffin or ozokerite applications	Subacute period of nerve inflammation Facial paralysis	Such applications have three mechanisms of action: thermal, mechanical (pressure) and chemical (absorption of natural resins). Thanks to this, it is possible to speed up the process of restoration of damaged nerve fibers and get rid of the consequences of inflammation.	Heated ozokerite or paraffin is applied in an even layer to the damaged and healthy sides of the face with a wide brush. When one layer cools, it is covered with a new one. Several layers are covered with oilcloth and woolen cloth. The duration of the procedure is up to 40 minutes. A course of 10-20 procedures daily or every other day.

During treatment for neuritis of the facial nerve, and especially immediately after physiotherapeutic procedures, beware of hypothermia. This may cause the condition to worsen. After the procedures, it is advisable not to leave the room for 15-20 minutes. And in cold, windy weather outside, wear a hat and cover the affected side of your face with a scarf.

Massage for neuritis of the facial nerve

You can start doing massage for facial neuritis 5-7 days after the first symptoms of the disease appear. It is better to entrust this to an experienced specialist, because massage has some peculiarities.

Before the massage, you need to stretch your neck muscles. To do this, tilt the head back and forth, turn and rotate the head. All exercises are performed 10 times at a very slow pace. Be careful not to get dizzy.
Begin the massage from the back of the head and neck. In this way, the lymphatic vessels are prepared, because they must receive an additional portion of lymph from the facial part of the head.
Massage the sore and healthy side of the head.
Particular attention is paid to the face, mastoid process and neck. The collar area is also kneaded.
Facial massage should be superficial, especially in the first days. Otherwise, painful muscle contractions may occur.
Massage with stroking movements; light vibration gives a good effect.
Movements are performed along the lymph outflow lines.
Run your fingers from the middle of the chin, nose and forehead to the parotid glands. Repeat this movement many times.
Do not massage areas where lymph nodes are located. This can cause them to become inflamed.
Do this exercise yourself. The thumb of one hand is tucked behind the cheek and the muscles are easily stretched. Using the thumb and forefinger of the other hand, massage the muscles of the cheek from the outside.
After the facial massage, the muscles of the back of the head and neck are massaged again to improve the outflow of lymph to the main ducts.
The massage session ends with exercises for the neck muscles.

The duration of the massage session is 10-15 minutes. It is necessary to do a massage until the symptoms disappear completely. Usually a massage therapist conducts 10-20 sessions, and in the future you can do self-massage using the same technique.

Alternative treatment for facial neuritis

Folk remedies for the treatment of facial neuritis successfully complement the therapy prescribed by the doctor and speed up recovery. We offer several of the most effective recipes.

Facial neuritis requires long-term treatment, so you will notice the first results in about 10 days. But do not despair, if you follow all the doctor’s recommendations, the disease will subside in 3-4 weeks.

Consequences of facial neuritis

Nerve cells recover very slowly after neuritis and are extremely sensitive to stress, hypothermia and toxins. This complicates the treatment process. In addition, some people give up after a few days because they do not see any noticeable improvement. This leads to the fact that they do not accurately follow the doctor’s instructions, skip massages, and refuse to take certain medications. This can lead to serious complications.

FAQ

What to do to prevent facial neuritis?

It happens that neuritis of the facial nerve occurs again on the same side of the face, then they talk about a relapse of the disease. In this case, longer treatment is required and the chances of recovery are lower. But if you follow preventive measures, a relapse will be avoided.

Avoid hypothermia. Scientists have proven that this is the main risk factor. Even small drafts are dangerous. Therefore, avoid being under air conditioning, sitting in a vehicle near an open window, do not go outside with a wet head, and in the cold season, wear a hat or a hood.

Treat viral diseases in a timely manner. If you feel that you are getting sick, then immediately take antiviral drugs: Groprinosin, Aflubin, Arbidol. You can instill drops with immunoglobulin Viferon into your nose. This will help prevent the virus from reproducing in nerve cells.

Avoid stress. Severe stress weakens the immune defense and disrupts the functioning of the nervous system. Therefore, it is advisable to learn how to relieve nervous tension with the help of auto-training and meditation. You can take Glycised, motherwort or hawthorn tincture.

Go to the resort. To consolidate the results of treatment, it is advisable to go to a resort. The dry hot climate of the resorts is ideal: Kislovodsk, Essentuki, Pyatigorsk, Zheleznovodsk.

Eat right. Your nutrition should be complete. The main goal is to strengthen the immune system. To do this, you need to consume a sufficient amount of protein products (meat, fish, cottage cheese, eggs), as well as fresh vegetables and fruits.

Take vitamins. It is very important to consume a sufficient amount of vitamins, especially group B. They take part in the transmission of impulses along nerve cells and are part of their membranes.

Toughen up. Gradual hardening strengthens the immune system, and you become insensitive to hypothermia. Start by taking sun-air baths or simply sunbathing. Take a contrast shower: for the first week, the temperature difference between cold and hot water should be only 3 degrees. Make the water a little colder every week.

Self-massage. For a year, massage your face along the massage lines for 10 minutes, 2 times a day. Place one palm on the healthy side and the other on the sore side. Lower the muscles of the healthy side down, and pull the sick side up. This will help get rid of the residual effects of the previous neuritis and avoid relapse.

Is surgery performed for facial neuritis?

If it is not possible to achieve improvement with the help of medications within 8-10 months, then surgery is prescribed. Surgical treatment of facial neuritis is effective only during the first year of the disease. Then irreversible changes in the muscles begin.

Most often, surgery is necessary for ischemic neuritis, when the facial nerve is compressed in the narrow fallopian canal. This happens as a result of prolonged inflammation of the middle ear or a fracture of the skull bones. Surgical treatment is also required for traumatic neuritis of the facial nerve, when the nerve is torn as a result of injury .

Indications for surgery

nerve rupture due to traumatic neuritis;
lack of effect of conservative treatment for 8-12 months;
instrumental studies indicate degeneration of the nerve.

Procedure for performing facial nerve decompression surgery
A semicircular incision is made behind the auricle. Find the place where the nerve exits the stylomastoid foramen. The outer wall of the facial nerve canal is removed with a special surgical instrument. This is done very carefully so as not to damage the nerve trunk. As a result, the nerve no longer passes in a “tunnel”, but in an open groove, and the temporal bone stops squeezing it. After this, stitches are applied. The operation is performed under general anesthesia.

Procedure for suturing a torn facial nerve
An incision is made near the auricle. The surgeon finds the torn ends of the nerve under the skin and muscles and “cleans out” the rupture site so that the nerve heals better. Then the surgeon acts according to the circumstances:

If the distance between the ends of the nerve is no more than 3 mm, then they are sutured. This is the best option, but it is not always possible to implement it;
If up to 12 mm of nerve fiber is missing, then it is necessary to free the nerve from the surrounding tissues and lay out a new, shorter course for it. This operation makes it possible to connect the ends of the nerve with one suture, but its blood supply is disrupted;
Nerve connection using an autograft. A section of the nerve of the required length is taken from the thigh and inserted at the site of the break. In this way, a section several centimeters long can be restored. But in this case, the nerve has to be sutured in 2 places, and this disrupts the transmission of signals.

What gymnastics to perform for neuritis of the facial nerve?

Before gymnastics, do a few exercises to stretch the muscles of your neck and shoulder girdle. Then sit in front of a mirror and relax the muscles on both sides of your face. Perform each exercise 5-6 times.

Raise your eyebrows in surprise.
Frown your eyebrows angrily.
Look down and close your eyes. If that doesn't work, lower your eyelid with your finger.
Squint your eyes.
Make circular movements with your eyes.
Smile without showing your teeth.
Raise your upper lip and show your teeth.
Lower your lower lip and show your teeth.
Smile with your mouth open.
Lower your head and snort.
Flare your nostrils.
Puff out your cheeks.
Move air from one cheek to the other.
Blow out an imaginary candle.
Try whistling.
Pull your cheeks in.
Push your lips out with a straw.
Lower the corners of your mouth downwards, lips closed.
Place your upper lip over your lower lip.
Move your tongue from side to side with your mouth open and closed.

If you are tired, rest and stroke your facial muscles. The duration of the gymnastics is 20-30 minutes. It is necessary to repeat the complex 2-3 times a day - this is a prerequisite for recovery.

After the gymnastics, take a scarf, fold it diagonally and secure your face by tying the ends of the scarf at the crown of your head. After this, tighten the facial muscles on the sore side up, and on the healthy side, lower them down.

What does a patient with facial nerve neuritis look like, photo?

The appearance of a person with facial neuritis is very characteristic. The face resembles a distorted mask.

On the sore side:

the eye is wide open;
the lower eyelid sags;
lacrimation may occur;
the outer edge of the eyebrow droops;
the corner of the mouth is lowered, saliva often oozes from it;
the mouth will be pulled to the healthy side;
the cheek muscles are drooping;
frontal and nasolabial folds are smoothed.

Signs of the disease become even more noticeable when a person speaks or shows emotions. The affected side of the face remains motionless when smiling and raising the eyebrows.

Is acupuncture effective for facial neuritis?

Acupuncture or reflexology is considered one of the most effective treatments for facial neuritis. Impact on acupuncture points helps:

relieve inflammation in the nerve and speed up its recovery;
relieve pain;
get rid of paralysis of facial muscles faster;
eliminate involuntary twitching of the eyes and lips.

Acupuncture helps restore muscle tone on the affected side of the face and relax the healthy side. Thus, the face becomes more symmetrical from the first days.

But remember, the key to successful treatment is an experienced specialist. He must select the necessary techniques and find sensitive points. Disposable needles are used for the procedure, this eliminates the possibility of infection.

Your inner attitude is important for effective treatment. Pay attention to how you feel. You will feel slight pain while the skin is pierced. Then heat or coolness, a feeling of pressure, and tingling will concentrate around the needles. This indicates that the needles are installed in the right places.

From the first days, the disease affects only the healthy side. From 5-7 days you can do acupuncture on the affected side. Many people have become convinced that acupuncture can reduce treatment time by 2 times (up to 2 weeks).

The treatment process for facial neuritis is quite lengthy. You will need to be patient and follow your doctor's recommendations exactly. But remember, there are many effective treatments that can help you overcome the disease.

The largest nerve related to the cranial brain is the trigeminal nerve, which, as the name implies, contains three main branches and many smaller ones. It is responsible for the mobility of the facial muscles, provides the ability to make chewing movements and bite off food, and also gives sensitivity to the organs and skin of the anterior head area.

In this article we will understand what the trigeminal nerve is.

Layout diagram

The branched trigeminal nerve, which has many branches, originates in the cerebellum, comes from a pair of roots - motor and sensory, and envelops all the facial muscles and some parts of the brain with a web of nerve fibers. The close connection with the spinal cord allows you to control various reflexes, even those associated with the respiratory process, such as yawning, sneezing, and blinking.

The anatomy of the trigeminal nerve is as follows: from the main branch, approximately at the level of the temple, thinner ones begin to separate, in turn, branching and thinning further and lower. The point at which separation occurs is called the Gasser, or trigeminal, node. The processes of the trigeminal nerve pass through everything on the face: eyes, temples, mucous membranes of the mouth and nose, tongue, teeth and gums. Thanks to impulses sent by nerve endings to the brain, feedback occurs that provides sensory sensations.

This is where the trigeminal nerve is located.

The finest nerve fibers, literally penetrating all parts of the facial and parietal zones, allow a person to feel touch, experience pleasant or uncomfortable sensations, move the jaws, eyeballs, lips, and express various emotions. Intelligent nature has endowed the nervous network with exactly that amount of sensitivity that is necessary for a calm existence.

Main branches

The anatomy of the trigeminal nerve is unique. The trigeminal nerve has only three branches; from them there is further division into fibers leading to organs and skin. Let's look at them in more detail.

1 branch of the trigeminal nerve is the optic or orbital nerve, which is only sensory, that is, transmitting sensations, but not responsible for the work of motor muscles. With its help, information is exchanged between the central nervous system and nerve cells of the eyes and orbits, sinuses and mucous membrane of the frontal sinus, forehead muscles, lacrimal gland, and meninges.

Three more thinner nerves branch off from the optic nerve:

tearful;

frontal;

nasociliary.

Since the parts that make up the eye must move, and the orbital nerve cannot provide this, a special autonomic node called the ciliary node is located next to it. Thanks to the connecting nerve fibers and the additional nucleus, it provokes contraction and straightening of the pupillary muscles.

Second branch

The trigeminal nerve on the face also has a second branch. The maxillary, zygomatic or infraorbital nerve is the second major branch of the trigeminal and is also intended to transmit only sensory information. Through it, sensations go to the wings of the nose, cheeks, cheekbones, upper lip, gums and dental nerve cells of the upper row.

Accordingly, a large number of medium and thin branches depart from this thick nerve, passing through different parts of the face and mucous tissues and combined for convenience into the following groups:

maxillary main;

zygomatic;

cranial;

nasal;

facial;

infraorbital.

Here, too, there is a parasympathetic vegetative ganglion, called the pterygopalatine ganglion, which promotes salivation and mucus secretion through the nose and maxillary sinuses.

Third branch

The 3rd branch of the trigeminal nerve is called the mandibular nerve, which performs both providing sensitivity to certain organs and areas, and the function of moving the muscles of the oral cavity. It is this nerve that is responsible for the ability to bite off, chew and swallow food, and encourages the movement of the muscles necessary for speaking and located in all the parts that make up the mouth area.

The following branches of the mandibular nerve are distinguished:

buccal;

lingual;

alveolar lower - the largest, giving off a number of thin nerve processes that form the lower dental ganglion;

auriculotemporal;

chewing;

lateral and medial pterygoid nerves;

maxillohyoid.

The mandibular nerve has the most parasympathetic formations that provide motor impulses:

ear;

submandibular;

sublingual.

This branch of the trigeminal nerve transmits sensitivity to the lower row of teeth and the lower gum, lip and jaw as a whole. The cheeks also receive sensations partly with the help of this nerve. The motor function is performed by the masticatory, pterygoid and temporal branches.

These are the main branches and exit points of the trigeminal nerve.

Causes of defeat

Inflammatory processes of various etiologies affecting the tissues of the trigeminal nerve lead to the development of a disease called neuralgia. Based on its location, it is also called “facial neuralgia.” It is characterized by a sudden paroxysm of sharp pain piercing different parts of the face.

This is how the trigeminal nerve is damaged.

The causes of this pathology are not fully understood, but many factors are known that can provoke the development of neuralgia.

The trigeminal nerve or its branches are compressed under the influence of the following diseases:

cerebral aneurysm;
atherosclerosis;
stroke;
osteochondrosis, causing increased intracranial pressure;
congenital defects of blood vessels and skull bones;
neoplasms that arise in the brain or on the face where the branches of the nerve pass;
injury and scarring of the face or jaw joints, temples;
formation of adhesions caused by infection.

Diseases of viral and bacterial nature

Herpes.
HIV infection
Polio.
Chronic otitis media, mumps.
Sinusitis.

Diseases affecting the nervous system

Meningitis of various origins.
Epilepsy.
Encephalopathy, cerebral hypoxia, leading to a lack of supply of substances necessary for full functioning.
Multiple sclerosis.

Surgery

The trigeminal nerve on the face can be damaged as a result of surgery in the area of the face and oral cavity:

damage to jaws and teeth;
consequences of incorrect anesthesia;
incorrectly performed dental procedures.

The anatomy of the trigeminal nerve is truly unique and therefore this area is very vulnerable.

Characteristics of the disease

The pain syndrome can be felt only on one side or affect the entire face (much less often), and can affect only the central or peripheral parts. In this case, the features often become asymmetrical. Attacks of varying strength last a maximum of a few minutes, but can cause extremely unpleasant sensations.

This is how much discomfort the trigeminal nerve can cause. A diagram of possible affected areas is shown below.

The process can cover different parts of the trigeminal nerve - branches individually or some together, the nerve sheath or its entirety. Most often women aged 30-40 years are affected. Paroxysms of pain in severe neuralgia can be repeated many times throughout the day. Patients experiencing this disease describe the attacks as being like electric shocks, and the pain can be so severe that the person temporarily becomes blind and ceases to perceive the world around him.

Facial muscles can become so sensitive that any touch or movement provokes a new attack. Nervous tics, spontaneous contractions of the facial muscles, mild convulsions, and the release of saliva, tears or mucus from the nasal passages appear. Constant attacks significantly complicate the lives of patients; some try to stop talking and even eating, so as not to further affect the nerve endings.

Quite often, facial paresthesia is observed for a certain time before the paroxysm. This feeling is reminiscent of pain in a sedentary leg - goosebumps, tingling and numbness of the skin.

Possible complications

Patients who delay seeing a doctor run the risk of developing many problems in a few years:

weakness or atrophy of the masticatory muscles, most often from trigger zones (areas whose irritation causes painful attacks);

asymmetry of the face and a raised corner of the mouth, reminiscent of a grin;

skin problems - peeling, wrinkles, dystrophy;

loss of teeth, hair, eyelashes, early gray hair.

Diagnostic methods

First of all, the doctor collects a complete medical history, finding out what diseases the patient had to endure. Many of them can provoke the development of trigeminal neuralgia. Then the course of the disease is recorded, the date of the first attack and its duration are noted, and associated factors are carefully checked.

It is necessary to clarify whether paroxysms have a certain periodicity or occur, at first glance, chaotically, and whether there are periods of remission. Next, the patient shows the trigger zones and explains what influences and what force must be applied to provoke an exacerbation. The anatomy of the trigeminal nerve is also taken into account here.

The location of the pain is important - one or both sides of the face are affected by neuralgia, as well as whether painkillers, anti-inflammatory and antispasmodic drugs help during an attack. Additionally, the symptoms that can be described by the patient observing the picture of the disease are clarified.

The examination will need to be carried out both during a quiet period and during the onset of an attack - this way the doctor will be able to more accurately determine the state of the trigeminal nerve, which parts of it are affected, give a preliminary conclusion about the stage of the disease and a prognosis for the success of treatment.

How is the trigeminal nerve diagnosed?

Important Factors

Typically, the following factors are assessed:

The patient's state of mind.

Appearance of the skin.

The presence of cardiovascular, neurological, digestive disorders and pathology of the respiratory system.

The ability to touch trigger areas on the patient’s face.

The mechanism of occurrence and spread of pain syndrome.

The patient's behavior is numbness or active actions, attempts to massage the nerve area and the painful area, inadequate perception of surrounding people, absence or difficulties with verbal contact.

The forehead becomes covered with sweat, the pain area turns red, there is strong discharge from the eyes and nose, and swallowing of saliva.

Facial muscle spasms or tics.

Changes in breathing rhythm, pulse, blood pressure.

This is how the trigeminal nerve is examined.

An attack can be temporarily stopped by pressing on certain nerve points or blocking these points with novocaine injections.

Magnetic resonance and computed tomography, electroneurogathia and electroneuromyography, as well as an electroencephalogram are used as certification methods. Additionally, a consultation with an ENT specialist, neurosurgeon and dentist is usually prescribed to identify and treat diseases that can provoke the appearance of facial neuralgia.

Treatment

Complex therapy is always aimed primarily at eliminating the causes of the disease, as well as relieving symptoms that cause pain. Typically, the following drugs are used:

Anticonvulsants: "Finlepsin", "Difenin", "Lamotrigine", "Gabantine", "Stazepin".
Muscle relaxants: "Baklosan", "Lioresal", "Mydocalm".
Vitamin complexes containing group B and omega-3 fatty acids.
Antihistamines, mainly Diphenhydramine and Pipalfen.
Medicines that have a sedative and antidepressant effect: Glycine, Aminazine, Amitriptyline.

In case of severe lesions of the trigeminal nerve, it is necessary to use surgical interventions aimed at:

to alleviate or eliminate diseases that provoke attacks of neuralgia;

decreased sensitivity of the trigeminal nerve, a decrease in its ability to transmit information to the brain and central nervous system;

The following types of physiotherapy are used as additional methods:

irradiation of the neck and face area with ultraviolet radiation;

exposure to laser irradiation;

treatment using ultra-high frequencies;

electrophoresis with drugs;

Bernard diadynamic current;

manual therapy;

acupuncture.

All treatment methods, medications, course and duration are prescribed exclusively by the doctor and are selected individually for each patient, taking into account his characteristics and the picture of the disease.

We looked at where the trigeminal nerve is located, as well as the causes of its damage and treatment methods.