home Folk remedies Facial nerve paresis: types and methods of treating the disease. Paresis of the facial nerve - symptoms and treatment Damage to the facial nerve of central and peripheral origin

Facial nerve paresis: types and methods of treating the disease. Paresis of the facial nerve - symptoms and treatment Damage to the facial nerve of central and peripheral origin

Facial nerve lesions- a pathology common in otolaryngology, maxillofacial surgery, sometimes evidence of infections.

Pathological conduction damage, according to medical statistics, is:

unilateral nature - 94% in patients with a problem of the facial nerve;

bilateral nature - 6% in patients with similar causes.

Predominantly unilateral damage to the facial nerve is a feature of the peculiar (characteristic of the VII-pair) innervation of the nucleus of the facial nerve. The most vulnerable segment of the facial nerve is located in the narrow facial canal of the temporal bone. The facial nerve fills 70% of the diameter of the space of this canal. Disease in this area can occur as a result of even slight swelling that compresses the nerve.

Signs of facial nerve diseases always appear:

motor disorders, in the form of changes in the motor activity of the muscles of the maxillofacial area (paresis and paralysis of facial muscles);

sensory disturbances, in the form of changes (increased, decreased) sensitivity of the skin and muscles of the maxillofacial area in the form of a decrease or increase in the pain threshold;

secretory disorders of the lacrimal and salivary glands;

internal pain (neuralgia - nerve pain), not to be confused with sensitivity to external pain

The main indication of a disorder of the facial nerve is, and in severe cases, paralysis of the facial muscles, their symptoms and the resulting disorders of the body systems are detected in all diseases of this nerve.

Facial nerve paresis

A partial decrease in motor activity (voluntary movements) of facial muscles is called paresis, in some cases the term prosoparesis is used to designate it.

Mild paresis is manifested by minor changes in facial expressions when speaking, severe paresis is manifested by a mask-like face, severe difficulty in performing simple actions (puffing out the cheeks, closing the eyes, etc.).

Paresis of any depth always implies only a partial impairment of muscle function. This is the most important difference from paralysis. Several options have been proposed for determining the depth of involvement of facial muscles in the pathogenesis and, accordingly, the depth of prosoparesis.

Most often, in the available literature, the option of determining the degree of functional ability of facial muscles in cases of disorders of the VII pair of cranial nerves, proposed by American otolaryngologists House W.F., Brackmann D.E., is mentioned. (1985). In 2009, they improved the scale for determining facial nerve paresis.

Six-point system for determining facial nerve paresis according to House-Brackmann (1985)

Normal (1st degree)

Facial symmetry corresponds to the morphophysiological characteristics of the individual. There are no deviations in the functions of facial muscles at rest or during voluntary movements, pathological involuntary movements are excluded.

Mild paresis (2nd degree)

At rest the face is symmetrical. Voluntary movements:

the skin of the forehead gathers into a fold;

moderate effort when closing the eyes;

asymmetry of the mouth during conversation.

Moderate paresis (grade 3)

At rest there is slight asymmetry of the face. Voluntary movements:

forehead skin, moderate;

eyes close completely with difficulty;

mouth, slight weakness with effort.

Moderate paresis (4th degree)

At rest, facial asymmetry is obvious and muscle tone is reduced. Voluntary movements:

the skin of the forehead is motionless;

eyes cannot be closed completely;

mouth, asymmetry, movement with difficulty.

Severe paresis (grade 5)

At rest there is a deep degree of facial asymmetry. Voluntary movements:

forehead skin, motionless;

the eyes do not close completely; when closing, the pupil rises up;

the mouth is asymmetrical and motionless.

Total paralysis (6th degree)

At rest, the patient has a motionless, mask-like face (usually one half). There are no voluntary movements of the skin of the forehead, mouth, or eyes.

In some cases, paresis is accompanied by pathological synkinesias - friendly voluntary and involuntary movements of different muscle groups, for example:

drooping of the eyelid is accompanied by raising the corner of the mouth (livid-labial synkinesis);

drooping of the eyelids is accompanied by wrinkling of the forehead (eyelid-frontal synkinesis);

squinting of the eyes is accompanied by tension in the neck muscles (veloplatysmal synkinesis);

winking is accompanied by tension in the wing of the nose on the same side (Huillet synkinesis);

Partial impairment of the motor function of the facial nerve in the corticonuclear fibers of the cerebral cortex is central paresis.

Central paresis VII – pairs of cranial nerves

They arise from lesions of corticonuclear fibers. The consequence of damage to the cerebral cortex is supranuclear paresis, which has characteristic signs, disturbance (of varying degrees) of motor activity of the muscles of the maxillofacial area, which manifest themselves as symptoms:

paresis (weak mobility) of the tongue, develops on the opposite side of the damage to the cerebral cortex simultaneously with muscle hemiparesis (paresis of half the body);

paresis of facial muscles of the lower part of the face, muscles of the upper part of the face;

all muscles of the face and body on the right or left side.

With minor damage, facial asymmetry disappears during emotions. Facial muscles involuntarily contract rhythmically (tic).

Lesions of the nerve fibers of the facial nerve in the peripheral part with partial loss of motor activity are peripheral paresis.

Peripheral paresis of VII–pairs of cranial nerves

There are several types of damage along the facial nerve bundles (after the nerve nucleus, in the canal of the temporal bone pyramid, in the tissues of the maxillofacial zone).

Peripheral lesions of the facial nerve are manifested by symptoms:

asymmetry of the facial muscles with a sharp increase during emotions, absence of the nasolabial and frontal folds, a mask-like face on the affected side;

decreased tone of the muscles of half the face;

decreased corneal reflex - closure of the cornea, conjunctival reflex - closure of the conjunctiva, brow reflex (Bechterev's) - closure of the eyes in response to their irritation;

Bell's symptom or the "hare's eye" symptom; when you try to close the eye, the apple of the eye moves upward, the palpebral fissure does not close;

inability to wrinkle the forehead, close the eyes on the affected side, and other simple facial actions;

half of the face on the affected side is inactive;

when opening the mouth, the affected half remains inactive;

liquid food, saliva flows from the corner of the lips of the affected side;

possible pain in the ear and face (evidence of involvement in the pathogenesis of the V pair, passing next to the facial nerve in the fallopian canal.

Central and peripheral lesions do not always present with symptoms on the same side of the body or face. Sometimes the opposite happens: true nerve damage is on the left side, and symptoms indicating damage are on the opposite side.

Topical symptoms describe the involvement in the pathogenesis of specific areas of the facial nerve located at different segments of the nerve pathway (from the brain to the final neurons - axons or dendrites).

Alternating (alternating) Millard-Gübler syndrome

This syndrome is evidence of lesions of the nucleus of the facial nerve at the level of the trunk and fibers of the pyramidal tract, which manifests itself:

on the affected side - paresis of the facial nerve;

on the opposite side - hemiparesis (paresis of half the body), hemiplegia (paralysis of half the body).

Alternating Foville syndrome

Alternating Foville syndrome is evidence of the involvement of the pyramidal tract of the facial nerve and the abducens nerve (VI pair) in the pathogenesis, which manifests itself:

on the affected side, paresis (paralysis) of the abducens nerve (that is, the patient’s pupils are directed towards the lesion);

facial paralysis (facial asymmetry).

Involvement of the facial nerve root in the pathogenesis manifests itself:

paralysis of facial muscles;

symptom of damage to the V pair

symptom of damage to the VI pair

symptom of damage to the VIII pair

The pathogenesis of the facial nerve above the branch of the greater petrosal nerve manifests itself:

hypofunction of the lacrimal gland;

dry eyes.

The pathogenesis of the facial nerve below the origin of the greater petrosal nerve manifests itself:

hyperfunction of the lacrimal gland (lacrimation);

hyperacusis (increased sensitivity to sounds);

hypofunction of the salivary glands (submandibular and sublingual);

paralysis of facial muscles on the same (ipsilateral) side of the lesion of the facial nerve.

The pathogenesis of the facial nerve at a level above the origin of the chorda tympani appears in the form of:

paralysis of facial muscles;

lacrimation;

taste disturbances.

The pathogenesis of the facial nerve below the origin of the chorda tympani manifests itself in the form of:

movement disorders;

paralysis of facial muscles;

lacrimation.

Causes of facial nerve paresis

Multiple etiologies of the causes of paresis have been proven against the background of a single development of pathogenesis.

The most common causes of facial nerve paresis:

mechanical damage or rupture of fibers;

compression of the nerve, as a result:

infectious, cold or post-traumatic inflammation;

neuromas (benign tumor of the vestibulocochlear nerve of the VIII pair of cranial nerves), located next to the facial nerve in the temporal canal;

give the face asymmetry, disrupt facial expressions, the person is embarrassed by this state, experiences can lead to self-isolation of the patient and take extreme forms;

manifested by the patient’s difficulty or inability to perform simple actions (movements of the eyes, eyebrows, nose, skin of the cheeks and forehead, and others) on the right and/or left sides of the face, also causing anxiety in a previously healthy person;

Pain (neuralgia) and sensitivity disorders due to damage to the VII pair of cranial nerves stimulate neuroses, dull attention, and change the patient’s behavior.

Violation of the secretory functions of the glands provokes diseases of the organs (eyes, digestion), for which their secretions play an important role.

Damage to the facial nerve is accompanied by loss of taste; taste (sweet, salty, bitter) is not felt.

Numerous symptoms and signs of neuropathies of the facial nerve, or rather its different parts, are described by the patient’s subjective sensations and simple physical examination methods. For differential diagnosis, the following methods are used: computed tomography (CT), magnetic resonance imaging (MRI), electromyography, serological methods when excluding infectious diseases, and other methods. The doctor is required to know the topography of the nerve pathways, the patterns of neural responses to stimulation of different parts of the facial nerve. From the patient - a clear description of the sensations.

Symptoms of facial nerve neuropathy

Common characteristics of all diseases of the facial nerve include paresis (paralysis), various changes in sensitivity, pain and other symptoms characteristic of lesions of the facial nerve.

Bell's palsy or facial neuritis

The disease manifests itself as facial paralysis. The reasons are unknown. It is considered an idiopathic neuritis.

Symptoms of Bell's palsy:

weakness that develops within two days to a maximum;

pain behind the ear;

lack of taste perception of food;

increased sensitivity to sounds - hyperacusis;

there are abnormally many lymphocytes in the spinal punctate - pleocytosis;

Paresis that develops during the first week, but does not progress to paralysis, is a sign of a favorable outcome.

Inflammation of the knee joint

The knee is a bend with thickening of the facial (fallopian canal). The facial nerve runs along the canal for approximately 40 mm, occupying up to 70% of its diameter. Causes of inflammation of the facial nerve ganglion:

inflammation.

Symptoms of inflammation of the knee node (synonyms - ganglionitis (neuralgia) of the knee nodes) appear as:

pain in the ear area, radiating to the back of the head, face, neck;

herpetic rashes (Hunt's syndrome) in the area of the eardrum, auricle, other localization of the tonsil, face, head;

hyperesthesia (increased sensitivity to sounds);

hearing loss, ringing in the ears;

nystagmus (involuntary rhythmic eye movements in a horizontal or vertical direction);

taste disorders;

lacrimation.

The disease lasts several weeks, the prognosis is favorable, and relapses are rare. Possible relapses are due to the lifelong localization of the herpes virus in the nervous tissue and their periodic activation.

The causes of the disease are not fully understood, hypotheses for the causes:

injuries (cracks) of the red border of the lips;

drug intoxication;

functional disorders of peripheral and central fibers of cranial nerves

Symptoms of Rossolimo-Melkersson syndrome:

recurrent paresis of the facial nerve and facial muscles, smoothness of the nasolabial fold;

neuritis of the facial nerve;

Central paralysis of the facial nerve is caused by damage to the nerve at the level of the nuclei and brain stem, peripheral paralysis occurs when the nerve is damaged in the area from the internal auditory canal to the stylomastoid foramen.

With central paralysis of the facial nerve, a dysfunction of the facial muscles of the lower part of the face is characteristic; with peripheral paralysis, all facial muscles suffer.

Peripheral facial paralysis is accompanied by a number of features. Damage to the facial nerve in the internal auditory canal can cause dizziness and hearing loss. When the nerve is damaged at the level of the geniculate ganglion and the petrosal nerve, dry eye (xerophthalmia) appears in the clinical picture. When affected at the level of the stapedius muscle, hyperacusis (painful perception of loud sounds) is characteristic. When the facial nerve is injured at the level of the chorda tympani, taste sensitivity in the anterior 2/3 of the tongue is lost and salivation decreases. To quickly assess the level of damage to the facial nerve, you can use the scheme of N. Curtin (1986).

A comprehensive diagnosis of the area of damage to the facial nerve can be carried out using electrophysiological ones. acoustic and audiological research methods. The first work on acoustic reflexometry (study of thresholds, latency and amplitude characteristics of the stapedial reflex) was carried out by A. I. Lopotko (1976) at the ENT Department of the First Leningrad Medical Institute.

Damage to the VII nerve causes peripheral paralysis of the facial muscles (prosopoplegia). Even with a simple examination, the sharp asymmetry of the face is striking (Fig. 29). The affected side is mask-like, the folds of the forehead and the nasolabial fold are smoothed out, the main fissure is wider, the corner of the mouth is lowered. When the forehead wrinkles, no folds form on the side of paralysis (the m. frontalis is affected); When you close your eyes, the palpebral fissure does not close (lagophtalmus) due to weakness of m. orbicularis oculi. In this case, the eyeball moves upward (Bell's phenomenon), moreover on the affected side than on the healthy side. With lagophthalmos, increased lacrimation is usually observed (for exceptions, see below). When showing teeth, the corner of the mouth on the affected side is not pulled back (m. risorius), and the m. platysma myoides on the neck. Whistling is impossible, speech is somewhat difficult (m. orbicularis oris). As with any peripheral paralysis, a degeneration reaction is observed, the superciliary reflex (and corneal) is lost or weakened.

The height of the lesion of the facial nerve should be determined depending on the symptoms accompanying the described picture.

When the nucleus or fibers inside the brain stem are damaged (see Fig. 28), damage to the facial nerve is accompanied by central paralysis or paresis of the limbs of the opposite side (Millard-Gubler alternating syndrome), sometimes with the addition of lesion n. abducentis (Fauville syndrome).

Damage to root n. facialis at the site of its exit from the brain stem is usually combined with lesions of n. acustici (deafness) and other symptoms of damage to the cerebellopontine angle (see Fig. 22). Paralysis of the facial nerve in these cases is not accompanied by lacrimation (dry eye), there is a disturbance of taste in the anterior two-thirds of the tongue, and dry mouth may be felt. Hyperakusis is not observed due to concomitant damage to the VIII nerve.

During processes in the area of the bone canal up to genu n. facialis, i.e. above the origin of n. petrosi superficialis majoris, along with paralysis, dry eyes, taste disturbances and salivation are also noted (see Fig. 28); on the hearing side, hyperakusis is observed here (damage to the fibers of the n. stapedii). With a lesion in the bone canal below the origin of n. petrosi, the same disorders of taste, salivation and hyperakusis are observed along with paralysis, but instead of dry eye, increased lacrimation occurs. In case of damage to the facial nerve in the bone canal below the origin of n. stapedii and above chordae tympani (see Fig. 28) paralysis, lacrimation, taste disorders and salivation are observed. Finally, when the nerve is damaged in the bone below the origin of the chordae tympani or after it exits the skull through the foramen stylomastoideum, only paralysis with lacrimation is observed without those accompanying symptoms discussed with higher lesions.

The most common are the latter cases with peripheral localization of the process, and paralysis is usually unilateral. Cases of diplegiae facialis are quite rare. It should be noted that with peripheral paralysis of the facial nerve, especially at the onset of the disease, pain in the face, in the ear and in its circumference (especially often in the mastoid region) is very often observed.

This is explained by the presence on the face of rather intimate connections (anastomoses) with branches of the trigeminal nerve, the possible passage of sensory fibers of the V nerve into the canalis facialis (chorda tympani - canalis Fallopii - n. petrosis superficialis major), the simultaneous involvement of the facial nerve and the root of the trigeminal nerve or its node during processes at the base of the brain (see Fig. 22).

Central paralysis (paresis) of the facial muscles is observed, as a rule, in combination with hemiplegia. Isolated lesions of the facial muscles of the central type are rare and are sometimes observed with damage to the frontal lobe or only the lower part of the anterior central gyrus. It is clear that central paresis of the facial muscles is the result of a supranuclear lesion of the tractus cortico-bulbaris in any part of it (cerebral cortex, corona radiata, capsula interna, cerebral peduncles, pons). With central paralysis, the upper facial muscles (m. frontalis, m. orbicularis oculi) are almost not affected, and only the lower (oral) muscles are affected. This is explained by the fact that the upper cell group of the nucleus of the VII nerve has bilateral cortical innervation, in contrast to the lower one, the cells of which are approached by fibers of the central nerves (tractus cortico-bulbaris) mainly only from the opposite hemisphere.

With central paralysis of the facial muscles, unlike peripheral paralysis, a degeneration reaction will not be observed; the brow reflex is preserved and even strengthened.

Phenomena of irritation in the area of the facial muscles include various types of tics (a manifestation of neurosis or organic disease), contractures that may be a consequence of peripheral paralysis of the VII nerve, localized spasm, and other clonic and tonic convulsions (cortical or subcortical hyperkinesis).

The facial nerve passes through a narrow canal, which causes its possible damage due to infections, injuries, and hormonal imbalances. When this happens, facial nerve paresis (paralysis) occurs, with possible pain. This disease usually involves weakening of the facial muscles; its symptoms are noticeable: one half of the face “sags”, the folds on it are smoothed out, and the mouth warps to one side. When it is severe, it becomes difficult to cover the eye with the eyelid.

The disease has an acute course, develops in a few hours and lasts two weeks (as can be judged from the patients’ medical histories), after which the symptoms, under therapeutic influence or independently, weaken and go away. Treatment should be prescribed from the first days of the onset of paresis to avoid the development of complications.

When doctors talk about paresis, they mean weakened function. Paralysis means its complete loss and absence of voluntary movements.

When does paresis develop?

The main possible reasons for the development of the disease:

traumatic brain injury;
infectious diseases (borreliosis, herpes, chickenpox, influenza, measles, etc.);
hypothermia (mainly, infection develops against its background);
circulatory disorders, stroke;
otitis;
neurosurgical treatment;
inflammation of the brain and its membranes;
tumors and cysts that can compress the nerve;
hormonal imbalance;
autoimmune diseases.

If facial nerve paresis is diagnosed in a newborn child, the main cause is birth trauma. Much less often, nerve damage occurs in utero as a result of infection or developmental abnormalities. In an older child, the disease may develop against the background of otitis (since the facial nerve canal originates in the internal auditory canal) or during chickenpox (the facial nerve is exposed to the varicella-zoster virus).

If symptoms of paresis (paralysis) of the facial nerve are recorded, the doctor is faced with the task of finding the causes of this pathology, since it may be concomitant with a serious disease (tick-borne borreliosis, stroke, tumor). But in most cases, the exact reasons remain unknown.

Types of disease

Facial nerve palsy is divided into two types:

The first is the most common; it was its symptoms that were described at the beginning of the article. Other signs that accompany the disease:

swelling of the cheeks when pronouncing vowels (sail syndrome);
rolling the eye upward when trying to close it (lagophthalmos);
pain symptoms in some areas of the face, behind the ear and in the ear, back of the head, eyeball;
impaired diction;
saliva leaking from the corner of the lips;
drying of the oral mucosa;
increased sensitivity to sounds, ringing in the ears;
hearing loss;
decreased taste sensitivity;
symptoms of eye damage on the affected side: lacrimation or, conversely, drying out of the mucous membrane.

In the mild stage, peripheral paresis of the facial nerve is sometimes difficult to establish. To do this, they perform a series of tests: they close their eyes and evaluate how difficult it was to do it (one eye can be closed with effort), they stretch out their lips with a tube, frown their forehead, and puff out their cheeks.

Central paresis affects the lower part of the face - one (it is opposite to the lesion) or both.

Its main symptoms:

weakening of the muscles of the lower facial part;
hemiparesis (partial paralysis of half the body);
preservation of the eye and muscles of the upper facial part;
unchanged taste sensitivity.

Central paresis mainly occurs due to or as a result of a stroke.

Diagnostic procedures

Treatment of the disease should begin as soon as it is detected. Sometimes paresis of the facial nerve can go away on its own, but in which cases this will happen is difficult to predict.

The symptoms of the disease are quite clear, but before treatment, you must try to determine the reasons that caused the paresis (paralysis). In some cases, elimination of the underlying disease leads to restoration of the function of the facial nerve (this can happen, for example, with a brain tumor). For this purpose, tomography (computer or magnetic resonance imaging) is performed.

In addition, an examination of reflexes on an electroneuromyograph should be prescribed. The procedure allows you to evaluate the speed of impulses passing through the fibers, their number, as well as the location of the lesion. One way to determine the degree of paresis (paralysis) is to conduct electrogustometry.

This procedure is performed using an electroodontometer. An anode is applied to the front of the tongue, the electrodes are located 1.5 cm from the midline. The current strength is gradually increased until the patient registers a sensation of sour or metallic taste.

Paresis therapy

Treatment in the acute period is aimed at relieving swelling and inflammation and improving microcirculation. For these purposes the following is used:

corticosteroids;
diuretics;
antiviral drugs (if the disease occurs against the background of herpes or chickenpox);
antibiotics (with the development of paresis during infection, otitis media).

Gymnastics and massage can be prescribed no earlier than the third day from the onset of the disease and only under the supervision of a doctor, since independent treatment and improper use of techniques threatens the appearance of contractures and synkinesis.

The phenomenon of contracture consists of increased muscle tone with pain on the affected side and twitching of the facial muscles. There is a feeling of tightening of the face.
Synkinesis - movements that appear simultaneously with the main ones. This may include wrinkling the forehead or raising the corner of the mouth when closing the eyes. Either raising the ears or flaring the wings of the nose when closing the eyes with effort, etc.

These complications appear, as can be learned from medical histories, in 30% of all cases of facial nerve paresis. If this happens, massage and physiotherapy are temporarily canceled and the muscles are given rest.

Principles of gymnastics and massage

Therapeutic gymnastics consists of certain techniques. It could be:

puffing out the cheeks (alternating, simultaneous);
snorting, pronunciation of the letter “p” with a delay at the initial stage of movement;
manual assistance when performing movements (closing eyes, wrinkling the forehead, etc.), which is performed by a specialist.

One of the recovery methods is post-isometric muscle relaxation, which is alternate short-term isometric work of the muscles and their passive stretching afterwards. This type of gymnastics is performed only under the supervision of a doctor, since it has many nuances in its implementation, failure to do which can lead to complications.

The main massage is carried out from the inside of the mouth, which allows you to define the muscles and increase blood circulation in them. In addition, acupressure is performed, since classic massage can lead to muscle strain.

During the recovery period, group B drugs and alpha-lipoic acid, UHF, and phonophoresis are also prescribed.

If the lesion is severe, treatment should be aimed at preserving the eye on the affected side of the face. Drops are used to eliminate and prevent dry mucous membranes, but if the eyelid does not droop at all, this threatens the development of keratopathy and blindness. Doctors can sew the eyelids together and insert implants into the upper eyelid to force it to droop. Currently, the injection of botulinum toxin is popular, which lasts 2-3 weeks. Injections are also effective in combating contractures and can be used for aesthetic facial correction in the future.

During the acute period of the disease, it is not recommended to treat the affected side of the face mechanically, using treatment methods such as massage and gymnastics. At home, you need to use a patch that will fix the weakened muscles on the sore side of the face. Your doctor will show you how best to do this.

Features of the course of the disease and treatment in childhood

A disease in children that is secondary in nature (that is, another disease is the cause of its occurrence) is usually accompanied by pain in the parotid region. In some cases, pain and discomfort may be experienced in various parts of the face and back of the head, depending on the location of the nerve damage.

In a child, paresis of the facial nerve usually goes away faster than in an adult. In this case, complications may be completely absent or their degree may be minimal. Symptoms of the disease in childhood are more likely to regress on their own than in adults. However, it is necessary to treat paresis, since there is no guarantee that it will go away without therapy.

In a newborn who has suffered nerve damage during childbirth, in addition to visual signs, damage to some reflexes is noted: palatine, search, sucking, proboscis. A complication that occurs with this pathology in an infant is difficulty or complete inability to suck on the mother’s breast. In this case, feeding is carried out from a bottle with a lightweight nipple.

Therapy

Treatment for paresis begins in the maternity hospital according to the standard regimen. In some cases, doctors do not use corticosteroids, since their use in infancy can lead to complications.

A child with damage to the facial nerve often suffers from hyperacusis - it is necessary to protect him from loud sounds and not use rattles.

After the maternity hospital, treatment for paresis continues on an outpatient basis: during the recovery period, massage and physiotherapy can be prescribed. At home, parents have access to therapeutic exercises, with the help of which reflexes are induced in the child.

The palmo-oral reflex is caused by pressing the parent's fingers on the middle of the child's palm: the baby's mouth opens slightly.
To trigger the proboscis reflex, you need to lightly touch the baby’s lips with your finger: his lips should stretch into a tube.
The search reflex is caused by stroking the baby's cheek near the corner of the lips, after which the baby moves his mouth towards.
The sucking reflex is formed thanks to the pacifier.

Also, at home, parents continue treatment with medications prescribed by the doctor. Massage, heating and any other influences should not be carried out independently - only in a clinic with a specialist. This will avoid the appearance of contractures and synkinesis.

If the pathology at birth is diagnosed as congenital, surgical treatment is indicated.

So, paresis of the facial nerve is a pathological condition that occurs acutely and is characterized by weakening of the muscles of one side of the face (peripheral paresis) or the lower facial part (with the central type). The causes of this phenomenon often remain unclear, but they may include tumors, infections, neurosurgical interventions, and in newborns, birth trauma. Treatment of the disease begins with medication from the first day to avoid complications. During the recovery period, massage and therapeutic exercises can be added.

Causes and treatment of facial nerve paresis

The facial nerve functions as a kind of motor for all facial muscles. It is also responsible for skin sensitivity. Paresis of the facial nerve characterizes the rapid development of a violation of facial symmetry. One half of the patient's face is motionless and affected by paralysis.

What is paresis?

Damage to the facial nerve develops very rapidly. In just a few days, the motor function of the affected side of the face is completely impaired.

Facial paralysis always has the same symptoms, but different causes of development.

The disease is not rare. Both men and women are equally susceptible to it, and the disease often occurs in children.

The main cause of damage to the facial nerve is infectious diseases affecting the upper respiratory tract.

The defeat results in disruption of the passage of nerve impulses along the facial nerve. As a result, the motor activity of the facial muscles is disrupted, and the skin loses sensitivity. As a rule, prosoparesis affects only half of the face, which is responsible for the pronounced asymmetry, which is the main symptom of the disease.

Causes of paresis

The most common cause of damage to the facial nerve is infectious and colds of the upper respiratory tract. Prosoparesis can also develop against the background of purulent inflammation of the middle ear (otitis media) or sinusitis.

There are often cases when paresis develops due to the presence of a tumor. Also, muscles can be paralyzed after surgery and removal of a tumor.

Dental treatment and manipulation of the patient’s jaw can also trigger the development of paralysis.

The pathology often occurs in children of preschool and primary school age. In this case, the disease is caused by the following reasons:

In childhood, complete restoration of the motor function of the facial muscles is possible, but only if treatment is started in a timely manner.

Primary paralysis is idiopathic and occurs due to hypothermia. As a rule, hypothermia causes the development of ARVI, which is often accompanied by paresis of the facial nerve. Most often, this form of the disease appears as a result of exposure to a draft and ranks first among all cases of disease of the facial nerve.

The second place in the frequency of cases is occupied by prosoparesis, caused by purulent inflammation of the middle ear or surgical intervention in the jaw, maxillary sinuses or ear canal of the patient.

Very rarely, paresis of the facial nerve develops as a result of tuberculosis, the action of the herpes virus or syphilis. Such cases are quite rare, but they do occur.

An indirect cause of the development of paresis can be a stroke and progressive sclerosis against the background of diabetes mellitus.

Symptoms of pathology

Damage to the facial nerve causes disruption of the passage of nerve impulses. This results in a violation of the main function of the facial nerve - ensuring the motor activity of facial muscles. Since facial paralysis often affects only one side of the face, the characteristic symptoms are difficulty moving the muscles in the affected area.

Paralysis is characterized by the following symptoms:

drooping of the corners of the mouth and smoothing of the nasolabial fold on the affected part of the face;
the patient cannot completely close the eye;
disturbances in the natural hydration of the eye develop - the tear fluid is either insufficient or too much;
difficulty chewing food develops due to weakening of the muscles around the mouth;
loud sounds cause discomfort;
the patient cannot frown.

Depending on the severity of facial asymmetry, mild, moderate and severe degrees of paralysis are distinguished. In mild forms of the disease, there is slight distortion of the corners of the mouth, and the motor activity of the facial muscles is difficult, but not completely paralyzed.

Moderate disease is characterized by worsening symptoms. The lower part of the face is motionless, but motor activity in the eyebrow area is still present.

The severe form is characterized by a visible violation of the symmetry of the face, and there is a significant distortion of the diseased side in relation to the healthy one. Motor activity of the muscles is completely absent, the patient cannot control facial expressions.

Paresis in infants

Paresis of the facial nerve in a newborn may be a congenital pathology in the infant. In this case, the disease is caused either by birth trauma or infectious diseases suffered by the mother during the period of bearing the child.

Often, paralysis of the facial muscles is observed during complicated childbirth, when forceps were applied to the child’s head, or vacuum extraction was performed.

A characteristic external manifestation of paresis in newborns is weakening of one side of the mouth. The baby's lips are lowered and feeding is difficult.

As a rule, the situation in infants can be corrected with the help of massage. With timely treatment, paralysis is completely cured, the motor functions of the facial muscles are restored, and the risk of developing any complications is minimal.

Congenital paresis of the facial nerve in newborns, not caused by birth trauma, is treated depending on the degree of nerve damage. For mild to moderate illness, recovery is achieved through massage and drug therapy, but for severe paresis, surgical intervention may be necessary.

Types of nerve damage

There are two types of pathology - central paresis and peripheral.

Central paresis is characterized by damage to the lower facial muscles. External asymmetry may be absent. The patient does not experience difficulty moving his eyes, he can frown or relax his forehead, but the muscles around the jaw and cheeks are tense, and there is no facial expression in this area.

Central paresis is rare and is caused by damage to the neural network of the brain.

In 85% of cases, doctors diagnose peripheral paresis. The onset of the disease is characterized by pain behind the ear. When palpated, it feels lethargic and lacks muscle tone. As a rule, the disease affects only one side of the face, which causes visible asymmetry.

The cause of peripheral paresis is an infectious disease and inflammatory process. As a result, swelling of the nerve fibers is formed and their further compression, which causes paralysis of the facial muscles.

Bell's palsy

Bell's palsy is a disorder of facial expression due to damage to the facial nerve. Paresis (prosoparesis) and Bell's palsy have similar symptoms: the disease affects one side and is characterized by visible asymmetry of facial features.

The disease is accompanied by the formation of nerve edema. The causes of Bell's palsy are hypothermia, impaired immunity and infectious lesions of the body.

This form of paresis is characteristic of older people and is often a secondary disease that develops against the background of progressive atherosclerosis, but children are also susceptible to paralysis.

Therapy includes taking antiviral drugs. Unlike facial paresis, Bell's palsy can be successfully treated in nine out of ten cases.

Many people are interested in whether facial nerve paresis can go away without treatment? It should be remembered that this serious disease is fraught with loss of facial function and hearing impairment, so it must be treated in a timely manner.

Facial nerve paresis, its symptoms and treatment require attention from the patient. The disease cannot be started.

Conservative treatment methods

The best treatment for facial paresis depends on the severity of the disease. Conservative treatment is based on drug therapy. Treatment includes therapy with the following groups of drugs:

non-steroidal anti-inflammatory drugs for pain relief;
drugs to quickly get rid of swelling;
taking antispasmodics to relieve spasm of nerve fibers;
in severe cases of the disease, injections of corticosteroids are indicated to relieve swelling and relieve pain;
to improve local nutrition, vasodilating drugs are used;
moisturizing drops to normalize tear production.

Paresis is often accompanied by feelings of anxiety and sleep disturbances. In this case, taking mild sedatives before bed is indicated. As a rule, such therapy helps to quickly relieve spasms by normalizing sleep and the activity of the nervous system.

A course of vitamins to strengthen the nervous system (group B drugs) is mandatory.

Prognosis with conservative treatment

The success of a patient’s cure depends on timely consultation with a doctor.

Typically, paresis is characterized by acute and subacute forms. The acute form of the disease develops quickly, and from the appearance of the first symptoms (ear pain) to impaired facial expressions, it takes from one to two weeks. The subacute form develops within a month.

If treatment is not started at this stage, the subacute form may become chronic. In this case, surgical intervention will be required to correct the facial expression disorder.

Treatment of paresis is a long process. From the start of therapy to the restoration of facial expressions, at least six months of intensive treatment take place.

However, timely treatment guarantees the patient’s full recovery without the development of possible complications.

The chronic form of the disease is dangerous with the risk of hearing loss and decreased visual acuity due to lack of blood circulation in the affected area.

Physiotherapeutic methods

Along with drug treatment, physiotherapeutic methods are used. As a rule, electrophoresis or phototherapy is indicated for paresis. Low-frequency magnetic therapy methods are also used.

Physiotherapeutic methods are aimed at restoring normal blood flow. They help improve metabolic processes in the affected area and relieve spasm of nerve fibers.

In addition to physiotherapy, some massage techniques and acupuncture are used. All this allows you to improve local blood circulation and gradually helps restore the ability to control your own facial expressions.

Patients are shown facial gymnastics, which helps restore motor activity. It includes the following exercises:

“frowning eyebrows” - the patient needs to frown and relax the brow ridges several times a day;
“full cheeks” - you should puff out your cheeks as much as possible and then relax them;
“whistle” - you need to stretch your lips folded forward as much as possible, imitating a whistle.

Exercises for developing the facial muscles responsible for the movement of the eyelid also help: the eyes should be opened as wide as possible, making a surprised face, and then relax. Gymnastics is performed up to 10 times a day, in any free minute.

However, gymnastics or massage alone cannot cure paresis, so it is necessary to combine these methods with conservative drug treatment.

The need for surgical intervention

The operation is indicated in the following cases:

nerve rupture;
paresis caused by trauma;
congenital facial paralysis;
ineffectiveness of conservative treatment for chronic disease.

In case of rupture, surgery involves suturing the damaged area of the facial nerve. This intervention is quick and rehabilitation does not require a long time.

For congenital paralysis or other anomalies, nerve transplantation from other parts of the patient’s body is used.

The operation leaves no visible scars, except for a small strip behind the ear. As a result of surgical intervention, the asymmetry is successfully corrected, and difficulties with facial expressions do not arise in the future.

Treatment of newborns and children

Prosoparesis of the facial nerve in newborns is treated in the maternity hospital immediately after birth. The baby is exposed to thermal physiotherapy, which helps relieve swelling and spasm of nerve fibers.

Treatment of infants continues after discharge, at home. It involves applying heat to a soft cloth that is applied to the affected area on the child. Loud and sudden noises should be avoided at home as they may cause discomfort to the sick child.

In order for the baby to recover faster, a massage is needed that will help quickly restore facial activity. Massage should only be performed by a specialist!

Treatment of children of primary school age is also based on physiotherapeutic methods, gymnastics and massage. Along with these methods, drug therapy is carried out, including taking antispasmodics. Young patients are required to take a course of vitamins.

Traditional treatment

Traditional methods of treatment should complement, but not replace, drug therapy prescribed by a doctor, otherwise anything can happen.

Heat exposure helps relieve swelling and spasm of nerve fibers. To do this, dry heat is used at home - heated salt is poured into a bag made of thick natural fabric and applied to the affected area.

To improve local blood circulation and relieve symptoms, you can rub slightly heated fir oil into the affected areas. It promotes vasodilation and has a slight warming effect.

For paresis, sedatives work well to relieve muscle tension and calm the nervous system. In folk medicine, peony tincture is used, which is taken before bed. A good effect is also achieved by taking a mixture of alcoholic tinctures of hawthorn and motherwort.

It should be remembered that only timely and qualified treatment will allow the restoration of facial function over time. If you follow the recommendations of your doctor, the result will not be long in coming and muscle sensitivity will be completely restored after a few months.

Treatment of facial nerve paresis. We will quickly restore your health

We continue to get acquainted with neurological diseases. And today talk about facial nerve paresis. The disease develops in a matter of days. The resulting asymmetry on one side of the face does not change a person’s appearance for the better. Timely treatment measures will help to quickly cope with the disease. Let's sort it out in order.

What is facial nerve paresis?

The main symptom indicating the progression of facial nerve paresis is facial asymmetry or the complete absence of motor activity of muscle structures on the side of the lesion.

Most often, the cause of paresis is colds of the upper respiratory tract, but there are several other factors that provoke the disease, which we will discuss further.

The average age of a neurologist's patients with this disease is about 40 years, both men and women suffer from the disease equally often, and the disease develops in childhood.

The facial nerve refers to the nerves responsible for the motor and sensory function of the muscles of the face. As a result of its defeat, nerve impulses do not pass through in the required volume, the muscles become weakened and can no longer perform their main function to the required extent.

The facial nerve is also responsible for the innervation of the lacrimal and salivary glands, taste buds on the tongue, and sensory fibers of the upper layer of the face. With neuritis, as a rule, one of its branches is involved in the pathological process, so the symptoms of the disease are noticeable only on one side.

What symptoms can you use to recognize facial nerve paresis?

Symptoms of facial nerve paresis are divided into basic and additional.

The main symptoms include: tilting of the face to one side, partial immobility of some part of the face, a condition in which a person cannot close one eye. Also, complete immobility of the eyebrows, cheeks, or the corners of the mouth drooping downwards is often observed; often a person suffering from facial nerve paresis can be recognized by difficulty speaking.

Additional signs of the presence of facial nerve paresis include constant dry eyes or, conversely, excessive lacrimation. Almost complete loss of taste, as well as increased salivation. A person may become irritable, loud noises will get on his nerves, and the corners of his mouth will involuntarily droop.

Where are the roots of all diseases?

Our world is diverse and complex for some, but simple and great for others. The ability to behave, to subordinate thoughts to one’s will, to manage one’s condition in different situations, to launch the correct biochemical processes, allows a person to have strong energy and strong immunity, and therefore resistance to any diseases.

The integrity of the body begins to collapse with psycho-emotional factors that affect us every day. If a person knows how to cope with them, processing any emotional surges towards a positive shift forward for himself, he will be able to react easily to any uncomfortable situation, remain in good health and, moreover, develop his energy potential.

Otherwise, under the influence of a crazy pace of life, stressful situations at work, at home or on the road, a negative energy charge begins to accumulate, gradually destroying a person’s energy shell.

First, this affects a person’s psychological health; later, the destruction moves to the physical level, where internal organs begin to suffer and various sores appear.

What is the cause of facial paresis and what factors contribute to its development?

Paresis of the facial nerve can act in two qualities - an independent nosological unit, and a symptom of a pathology already progressing in the human body. The reasons for the progression of the disease are different, therefore, based on them, it is classified into idiopathic damage and secondary damage that progresses due to trauma or inflammation.

polio
pathogenic activity of the herpes virus
mumps
respiratory pathologies of the upper airways
head injuries of varying severity
nerve fiber damage due to otitis media
damage to the nerve fiber during surgery in the facial area
syphilis
tuberculosis

Another reason that can provoke paresis is a violation of blood circulation in the facial area. This violation is often observed with such ailments as:

multiple sclerosis
ischemic stroke
hypertensive crisis
diabetes.

The following types of paresis are distinguished:

Peripheral paresis

As a rule, this type of paresis begins with severe pain behind the ear or in the parotid area. One side is affected; upon palpation, the muscles are flaccid, and their hypotonicity is noted.

The disease develops under the influence of inflammation, which leads to swelling of the nerve fibers and their compression in the narrow channel through which they pass. Peripheral paresis developing according to this etiology is called Bell's palsy.

Central paresis

With this form of the disease, the muscles located in the lower part of the face are affected, the forehead and eyes remain in their normal physiological position, that is, the patient easily wrinkles the frontal folds, the eye functions fully, closes without a gap, and no change in taste is noted.

On palpation, the muscles at the bottom of the face are tense, and in some patients there is bilateral damage. The cause of central paresis of the facial nerve is ongoing damage to the neurons of the brain.

Congenital paresis

This lesion of the facial nerve accounts for approximately 10% of cases of the total identified number of patients with this pathology. For mild and moderate forms, the prognosis is favorable; for severe cases, one type of surgery may be prescribed.

A congenital anomaly of the facial nerve must be distinguished from Mobius syndrome; with this pathology, lesions of other nerve branches of the body are also recorded.

How to recover from facial nerve paresis with Tibetan medicine?

Rapid restoration of the body using Tibetan methods occurs thanks to methods of external and internal influence. Everything that can contribute to rapid recovery is taken into account. Lifestyle and nutrition also play an important role here.

We already know that the “Wind” constitution is responsible for the nervous system. And since the occurrence of this disease is closely related to disruption of the passage of nerve impulses, it means that in order to calm the disease it is necessary to restore the harmony of the wind in the body. This is achieved precisely with the help of external and internal influence.

Methods of external influence used for paresis are aimed at resuming the passage of nerve impulses to muscle structures, normalizing the psycho-emotional state, eliminating congestion and stimulating the body’s own immune forces to resist the disease. The procedures are prescribed by the doctor, taking into account the medical history and characteristics of the patient’s mental state.

The main external influences include the following procedures:

In combination with herbal medicine, these procedures provide a tremendous healing effect and allow you to quickly relieve pain and alleviate the condition.

Properly selected herbal remedies have an immunomodulatory, antibacterial and anti-inflammatory effect, harmonizing the state of the body’s internal systems.

An integrated approach is the basis of Tibetan medicine. External influence by the above procedures leads to the following:

Relieves inflammation and swelling
Pain syndrome is quickly eliminated
Reduces compression of the damaged nerve bundle
Blood supply is normalized
Stagnation is eliminated
Nerve tissue is restored
Normal muscle activity returns
Facial expressions are restored
Increases immunity

Tibetan medicine has helped many patients regain lost health. Even in those cases when ordinary doctors refused the patient, saying that he could no longer be helped, Tibetan medicine helped.

Not because she has some kind of magic pill, but because she has enormous knowledge about human nature and its interaction with this world. This experience has been accumulated over thousands of years and is now quickly gaining popularity due to its amazing results.

Without chemicals, antibiotics, painful procedures and surgeries, we manage to get people back on their feet, significantly improving their condition.

People also come to us to prevent diseases. Relax, unload your emotional state, raise your vitality and restore your energy.

After complex procedures, a person gains harmony with himself and the outside world for a long time. He simply glows with love, energy and life.

Therefore, if you have any health problems, come, we will help you.

Health to you and your loved ones!

Questions

Question: How to treat facial nerve paresis?

During ear surgery, my wife's facial nerve was injured, resulting in paralysis of the left side of her face. She underwent a series of physiotherapy procedures, acupuncture and sewing in threads with medications, took a bunch of antibiotic tablets and vitamins, the result was very weak. The eye closes weakly, the cheek droops, the mouth pulls to the right when speaking.

First, you need to determine the condition of the nerve using electromyography. Based on the results, treatment tactics can be determined: a conservative or surgical approach. The best results are shown by complex therapy using (in addition to drug treatment) medicinal injections into the facial nerve canal, electrical myostimulation of facial muscles and a course of facial rehabilitation.

Thanks for your response! I may have missed important information. My wife is 55 years old.

Electromyography was performed, and here are the results:

WHEN STUDYING WITH SKINAL ELECTRODES: There is no spontaneous activity from the orbicularis oris and ocular muscles. With voluntary contraction, recording of reduced amplitude, rarefaction and synchronization of recording to 2 B-V type on the left.

DURING STIMULATION STUDY: The conduction velocity along the n.facialis is normal. The amplitude of the M-response from the orbicularis oculi muscle on the left is reduced to 0.75 mv, on the right 2.55 mv, from the orbicularis oris muscle on the left 1.5 mv, on the right 1.9___mv/normal from 1___mv /

M-responses on the left are deformed, expanded, TL is increased.

Conclusion: Rough axonal neuropathy n.facialis on the left.

Consult a neurosurgeon. Paresis requires long-term physiotherapeutic treatment, the use of drugs that stimulate the regeneration of nervous tissue (B vitamins, drugs containing substances necessary for restoring the myelin sheath of the nerve, improving its impulse conductivity).

3 years ago, my facial nerve was injured during surgery to remove an acoustic neuroma. Since then, the left side of my face has been paralyzed; in my opinion, there has been no improvement and no worsening either. Most doctors say that too much time has passed to wait for improvements, and inpatient treatment in neurology 2 times a year only improves the general condition. I am a woman, I am 30 years old and I still hope that my face will become healthy. Maybe you can tell me how to proceed next?!

You should contact a neurosurgeon for a face-to-face consultation, who will give an opinion on the prospects for surgical intervention.

6.5 years ago I experienced paralysis of the facial nerve, I was treated with massage, laser therapy, hirudotherapy, and B vitamins, and in the end the disease almost went away, but residual effects remained: the eye twitches (it narrowed a little) when moving the mouth or wing of the nose. Maybe I can be helped with medication?

Unfortunately, this problem cannot be solved with medication.

I really want to get rid of these twitchings, if it can’t be helped with medication, then with what? Is this problem in the muscle? Is there something wrong with her or is it a damaged nerve?

Twitching of facial muscles in such cases can be caused by an error in the functioning of the subcortical nuclei of the brain, overexcitation of the centers of the facial nerve in the brain stem, or irritation of the facial nerve itself after it leaves the brain. In some cases, the administration of Botulinum toxin helps to eliminate hyperkinesis of the blinking muscle. Consult an experienced neurologist.

I have left-sided paresis, almost since birth. Now it is almost not noticeable. All the muscles on my face work, only the left half of the lips and the corner of the lips rise strongly upward when talking.

How to make your face more symmetrical? Maybe some exercises for facial expressions? Or medication?

In this case, a personal consultation with a neurologist is necessary. Only after identifying the cause of paresis will a specialist doctor be able to prescribe adequate treatment.

paresis due to left-sided cerebral palsy. But it is in a mild form. I went to a neurologist, they said that there was no way to get rid of it. I was very upset. I would be advised to do a set of exercises, I myself can feel all the muscles on my face, on the left side they are poorly developed. eyes I close it, puff out my cheeks, raise my eyebrows and forehead. Only my lips don’t work well, on the left side they are almost motionless, because of this the asymmetry of the face is noticeable. It can’t be that there’s no way to fix it. Help!

Which doctor should I contact? And which facial exercises should I choose?

Where do kinetherapists see doctors in St. Petersburg?

thank you very much for the answers!

Unfortunately, we do not have our own information base that would allow us to accurately answer your question.

Hello, please tell me, I had an injury to my eyebrows and the left corner of my eye on the right side of my face, all the muscles work normally, but I can’t feel the corner of my nose on this side and I can’t feel part of my upper lip, what is it. This muteness can be somehow treated, and often this place itches and seems to tighten! What could it be?! And in general, sensitivity will return or not?! Thank you.

In this case, there is a high probability that the altered sensitivity of this localization is caused by traumatic damage to the branches of the trigeminal nerve, which is responsible for the innervation of this area. The fact is that in case of mechanical damage to peripheral nerves, the recovery of the latter occurs quite slowly (in some cases, sensitivity may not be restored at all). To prescribe adequate treatment (including medication, physiotherapy), you need to seek a personal consultation with a neurologist. A personal consultation with a specialist doctor is necessary to assess the extent of damage and exclude possible contraindications for the required treatment. Read more about the work of the trigeminal nerve and the symptoms of its damage in articles devoted to this topic by following the link Trigeminal nerve. Perceived itching and discomfort may indicate the continued growth of peripheral nerve trunks towards the skin they innervate.

I am 23 years old. 5 years ago I was diagnosed with facial nerve paresis. I was treated for six months with medications, acupuncture, and massage, even with some kind of massage device that operates on the basis of current impulses. As a result, when I smile, a slightly residual effect of this disease is visible, even in photographs it is sometimes clear that there is a slight asymmetry. Is there anything else I can do now so that my face takes on a normal appearance and I can smile as before?

In this case, it is recommended to undergo a repeated course of therapeutic rehabilitation; after such an illness, the rehabilitation process is long, several courses of physiotherapy and drug treatment will be required to completely restore nerve function. Read more about this disease in a series of articles by clicking on the link: Facial nerve paresis.

I have had paresis since childhood, possibly since birth. Asymmetry in the smile, I don’t blink, there’s a heaviness in my cheek, and my cheek has begun to droop a little. I didn’t pay attention before, but now I understand that it greatly spoils my appearance. Is it possible to treat paresis at this stage? I am 28 years old.

There are many modern techniques to treat paresis, including electrical stimulation, acupuncture, and physiotherapy. You definitely need treatment. You need to personally consult with a neurologist so that after examination and examination, the doctor can prescribe you adequate treatment. You can learn more about this from the section: Neurologist

Hello. I am 32 years old. A year ago I had the root of a tooth removed (upper left side). The doctor fussed for a long time and finally cut my gum (the cut went almost from the wing of the nose to the 6.7th tooth) and removed the root. He put several stitches. All this took a long time to heal and hurt. There was a feeling that all the nerves were outside and constantly hurt. The doctor He said that with time everything will pass. After 2 months, I installed a dental bridge. And a month later, pain appeared on the entire left side of my face. A swelling appeared in the area of the nasal sinus. They took an x-ray, it turned out that a lot of fluid had accumulated there, which began to put pressure even on the eye. They pierced the nasal sinus through the gum. (And it so happened that the puncture site was exactly in the area where the gum was cut dentist) Since then I have been suffering from constant pain, both headaches and dental pain. This year I forced the dentist to remove the bridge. I thought that was where the problem lay. It turned out there was no inflammation and the bridge sat perfectly. But the pain continued. The left upper lip periodically goes numb. All the doctors shrugged and “kicked” me from one to the other. Then they advised me to undergo a course of physical therapy, perhaps the trigeminal nerve was damaged due to all the medical manipulations. With difficulty I got a referral from the dentist (this is the only way we can do this) And now I’m already doing the second course, 10 minutes with a device and a minute of acupressure. The headaches seem to have gone away, but at times there is severe pain in the area of the dental bridge (a burning sensation and nagging pain of these sharpened ones teeth, the upper lip periodically goes numb). Tell me, am I being treated in the right direction, was the trigeminal nerve really damaged? Perhaps I need to see a neuropathologist. By the way, I live in Germany and these are the “miracle doctors” we have.

In this case, based on the symptoms described, damage to the trigeminal nerve cannot be ruled out. However, only a neurologist can make an accurate diagnosis and prescribe adequate treatment for you after a personal examination. Read more on this issue in the section: Trigeminal nerve

The facial nerve is responsible for the functioning of the lacrimal and sebaceous glands, facial expressions, facial sensitivity (superficial), perception of tastes and sounds. It consists of two branches, but the lesion most often affects only one of them. Therefore, signs of paresis are usually observed only on one side of the face.

Facial nerve paresis: causes

Most often, paresis develops as a result of hypothermia or previous colds. Sometimes paresis can be otogenic, occurring due to nerve damage due to inflammation of the ear (mastoiditis, otitis media) or during surgery. In rare cases, paresis of the facial nerve becomes a consequence of tuberculosis, mumps, syphilis or polio. Damage can also occur as a result of trauma to the skull.

Facial nerve paresis: symptoms at different degrees of severity

The pathological process can have different degrees of severity. In mild cases, the patient can perform actions on the affected side of the face such as wrinkling the forehead, closing the eyes, and raising the eyebrows. Of course, these manipulations are difficult, but they are still possible. The mouth barely tilts to the healthy side. If the severity of paresis is moderate, the patient cannot close his eyes completely. When you try to wrinkle your forehead or move your eyebrow, you can see some movements, but they are very minor. When paresis of the facial nerve is severe, the patient cannot perform any movements on the affected side of the face. The pathological process can be acute (lasting no more than two weeks), subacute (lasting up to four weeks), chronic (lasting more than four weeks).

Facial nerve paresis: characteristic signs

With unilateral paresis of the facial muscles, the affected side becomes like a mask: wrinkles on the forehead (if any) and nasolabial folds are smoothed out, the corner of the mouth droops. When a person tries to close his eyes, complete closure does not occur, that is, a gap remains. But such signs do not appear immediately. At first, the patient will only feel numbness in the ear area, and only then, after a day or two, paresis develops. Also, the pathological process is accompanied by loss of taste on the tongue on the affected side, dry mouth or, conversely, drooling, decreased hearing or, conversely, its aggravation, dry eyes or lacrimation.

Facial nerve paresis: diagnosis

To make a correct diagnosis, you will need to be examined by a therapist, neurologist and otolaryngologist. The main doctor in this case is a neurologist, and he will prescribe the necessary treatment. An examination by an otolaryngologist is necessary to exclude the possibility that the existing condition is a complication of pathology of the throat, nose or ear. The therapist gives an opinion on the general health of the patient. To determine the degree of paresis, electroneuromyography is performed. In addition, the nature of the pathological process is revealed.

Facial nerve paresis: treatment

It should be said that therapy must be started as quickly as possible, otherwise there is a risk of permanent paralysis. Also, treatment may be ineffective if the nature of the paresis is traumatic or otogenic. For treatment, vasodilators, anti-inflammatory and decongestant drugs, and antispasmodics are used. If there is pain, analgesics are additionally prescribed. Subsequent therapy is aimed at regenerating the affected nerve fibers and preventing muscle atrophy. For this purpose, physiotherapy and drugs that improve metabolism are prescribed. If conservative therapy is powerless, they resort to surgical intervention, during which the nerve is sutured, its plastic surgery is performed, and in case of tightening, the facial muscles are corrected.

Facial nerve paresis: symptoms and treatment

Facial nerve paresis - main symptoms:

Facial nerve paresis is a disease of the nervous system characterized by impaired functioning of the facial muscles. As a rule, a unilateral lesion is observed, but total paresis is not excluded. The pathogenesis of the disease is based on a disruption in the transmission of nerve impulses due to trauma to the trigeminal nerve. The main symptom indicating the progression of facial nerve paresis is facial asymmetry or the complete absence of motor activity of muscle structures on the side of the lesion.

The most common cause of paresis is an infectious disease that affects the upper airways. But in fact, there are much more reasons that can provoke nerve paresis. This pathology can be eliminated if you contact a medical facility in a timely manner and undergo a full course of treatment, including drug therapy, massage, and physiotherapy.

Facial nerve paresis is a disease that is not uncommon. Medical statistics are such that it is diagnosed in approximately 20 people out of 100 thousand people. More often it progresses in people over 40 years of age. Pathology has no restrictions regarding gender. It affects both men and women with equal frequency. Trigeminal nerve palsy is often detected in newborns.

The main task of the trigeminal nerve is to innervate the muscle structures of the face. If it is injured, nerve impulses cannot fully travel along the nerve fiber. As a result, muscle structures weaken and cannot fully perform their functions. The trigeminal nerve also innervates the lacrimal and salivary glands, sensory fibers of the epidermis on the face and taste buds located on the surface of the tongue. If the nerve fiber is damaged, all of these elements cease to function normally.

Etiology

idiopathic lesion;
secondary damage (progressing due to trauma or inflammation).

The most common cause of nerve fiber paresis in the facial area is severe hypothermia of the head and parotid area. But the following reasons can also provoke the disease:

polio;
pathogenic activity of the herpes virus;
mumps;
respiratory pathologies of the upper airways;
head injuries of varying severity;
damage to the nerve fiber due to otitis media;
damage to the nerve fiber during surgery in the facial area;
syphilis;
tuberculosis.

Another reason that can provoke paresis is a violation of blood circulation in the facial area. This is often observed with the following ailments:

The trigeminal nerve is often damaged during various dental procedures. For example, tooth extraction, root apex resection, opening of abscesses, root canal treatment.

Varieties

Clinicians distinguish three types of trigeminal nerve paresis:

peripheral. This is the type that is diagnosed most often. It can manifest itself in both an adult and a child. The first symptom of peripheral paresis is severe pain behind the ears. As a rule, it appears on one side of the head. If you palpate the muscle structures at this time, you can identify their weakness. The peripheral form of the disease is usually a consequence of the progression of inflammatory processes that provoke swelling of the nerve fiber. As a result, nerve impulses sent by the brain cannot fully pass through the face. In the medical literature, peripheral paralysis is also called Bell's palsy;
central. This form of the disease is diagnosed somewhat less frequently than the peripheral one. It is very severe and difficult to treat. It can develop in both adults and children. With central paresis, atrophy of the muscle structures on the face is observed, as a result of which everything that is localized below the nose sags. The pathological process does not affect the forehead and visual apparatus. It is noteworthy that as a result of this the patient does not lose his ability to distinguish taste. During palpation, it can be noted that the muscles are under strong tension. Central paresis does not always manifest itself unilaterally. Bilateral damage is also possible. The main reason for the progression of the disease is damage to neurons located in the brain;
congenital. Trigeminal nerve palsy in newborns is rarely diagnosed. If the pathology is mild or moderate in severity, then doctors prescribe massage and gymnastics for the child. Massage of the facial area will help normalize the functioning of the affected nerve fiber, and also normalize blood circulation in this area. In severe cases, massage is not an effective treatment method, so doctors resort to surgical intervention. Only this method of treatment will restore innervation to the facial area.

Degrees

Doctors divide the severity of trigeminal nerve paresis into three degrees:

light. In this case, the symptoms are mild. A slight distortion of the mouth may occur on the side where the lesion is localized. A sick person must make an effort to frown or close his eyes;
average. A characteristic symptom is lagophthalmos. A person can practically not move the muscles in the upper part of the face. If you ask him to move his lips or puff out his cheeks, he will not be able to do this;
heavy. The asymmetry of the face is very pronounced. Characteristic symptoms are that the mouth is severely distorted, the eye on the affected side practically cannot close.

Symptoms

The severity of symptoms directly depends on the type of lesion, as well as on the severity of the pathological process:

smoothing the nasolabial fold;
drooping corner of the mouth;
the eye on the affected side may be unnaturally wide open. Lagophthalmos is also observed;
water and food flows out of the slightly open half of the mouth;
a sick person cannot wrinkle his forehead much;
a characteristic symptom is deterioration or complete loss of taste;
auditory function may become somewhat worse in the first few days of pathology progression. This causes great discomfort to the patient;
lacrimation. This symptom manifests itself especially clearly during meals;
the patient cannot pull the lip into a “tube”;
pain syndrome localized behind the ear.

Diagnostics

A doctor’s pathology clinic usually leaves no doubt that the patient’s trigeminal nerve paresis is progressing. In order to exclude pathologies of the ENT organs, the patient may additionally be referred for a consultation with an otolaryngologist. If the cause of such symptoms cannot be clarified, then the following diagnostic techniques may be additionally prescribed:

Therapeutic measures

This disease must be treated as soon as the diagnosis has been made. Timely and complete treatment is the key to restoring the functioning of the nerve fibers of the facial area. If the disease is neglected, the consequences can be disastrous.

Treatment of paresis should only be comprehensive and include:

eliminating the factor that provoked the disease;
drug treatment;
physiotherapeutic procedures;
massage;
surgical intervention (in severe cases).

Drug treatment of paresis involves the use of the following pharmaceuticals:

analgesics;
decongestants;
vitamin and mineral complexes;
corticosteroids. Prescribe with caution if the pathology progresses in the child;
vasodilators;
artificial tears;
sedatives.

Massage for paresis is prescribed to everyone - from newborns to adults. This method of treatment produces the most positive results in cases of mild to moderate damage. Massage helps restore the functioning of muscle structures. Sessions are carried out a week after the onset of paresis progression. It is worth considering that massage has specific features, so it should be entrusted only to a highly qualified specialist.

warming up the neck muscles - you should bend your head;
massage begins with the neck and back of the head;
You should massage not only the sore side, but also the healthy one;
an important condition for a quality massage is that all movements should be carried out along the lines of lymph outflow;
if the muscle structures are very painful, then the massage should be superficial and light;
It is not recommended to massage the localization of lymph nodes.

Pathology should be treated only in a hospital setting. Only in this way will doctors have the opportunity to monitor the patient’s condition and observe if there are positive dynamics from the chosen treatment tactics. If necessary, the treatment plan can be adjusted.

Some people prefer traditional medicine, but it is not recommended to treat paresis in this way alone. They can be used as an adjunct to primary therapy, but not as individual therapy. Otherwise, the consequences of such treatment can be disastrous.

Complications

In case of untimely or incomplete therapy, the consequences may be as follows:

irreversible damage to the nerve fiber;
improper nerve restoration;
complete or partial blindness.

If you think that you have Facial Nerve Paresis and the symptoms characteristic of this disease, then doctors can help you: a neurologist, an otorhinolaryngologist.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Facial paralysis leads to impairment of the facial muscles. Depending on the extent of the damage, there is a slight movement deficit or general muscle relaxation of the affected side of the face. Paralysis can occur at any age, regardless of gender, very often without a clear cause. However, it also happens that this is a complication of pathological processes (for example, infectious diseases, cancer, complications after surgery). The prognosis in the vast majority of cases is good, and treatment results in complete recovery.

The facial nerve is the VII cranial nerve and can be classified as a mixed nerve, meaning that it contains three types of muscle fibers:

sensory
movement
parasympathetic

The muscle fibers that supply the muscles of the face and neck, as well as the inner muscles of the ear, predominate. On the other hand, sensory fibers supply 2/3 of the anterior part of the tongue, and parasympathetic fibers are responsible for the proper functioning of the glands:

lacrimal gland
sublingual and submandibular gland
glands of the nasal cavity, soft palate and oral cavity

Facial paralysis can occur at different levels and so you can differentiate between:

central facial palsy – damage involves brain structure
Peripheral facial paralysis – damage occurs to the nerve. This occurs much more often than central palsy.

Bell's palsy accounts for almost 60-70% of all unilateral cases. Paralysis occurs regardless of gender and age. It also does not indicate that either side of the face is more likely to be paralyzed.

Other causes of facial paralysis include: The most common form of facial paralysis is a spontaneous lesion called Bell's palsy.

ear injuries
bacterial infections
intracranial tumors
cooling the ear area
viral infections – HIV, chicken pox, shingles, mumps, herpes
meningitis
multiple sclerosis
parotid tumors
diabetes
mechanical nerve damage, such as during head and neck surgery
otitis media
Guillain-Barré syndrome is an autoimmune disease that attacks the peripheral nervous system.

Factors predisposing to facial nerve disorder include general body weakness, fatigue and chronic stress.

Diagnosis of the disease

To provide effective treatment, it is important to distinguish between spontaneous paralysis and disease and whether the paralysis affects the peripheral or central system.

Differentiation of spontaneous paralysis and paralysis due to illness also uses observation of the increase in symptoms. The sudden and rapid onset of symptoms is characteristic of spontaneous paralysis, while in the case of ongoing illnesses the symptoms gradually increase (from several weeks to several months).

the most commonly used images are magnetic resonance imaging (MRI) and computed tomography (CT). Diagnosis is based on an interview with the patient and a clinical examination, which assesses the severity of symptoms. For more accurate testing, additional tests are used:

electromyography – allows you to evaluate the electrical activity of the motor system of muscles based on electrical potentials
electroneurography – assesses nerve function after stimulation with an electrical stimulus

The type and severity of the disease depend on the location of the nerve damage and the extent of the process in the nerve.

The vast majority of cases are unilateral nerve palsies, and bilateral palsies are rare.

Symptoms that identify facial palsy include areas such as sensory, motor and glandular functions:

complete cancellation (paralysis) or impairment (paresis) of facial expressions by half:
wrinkled forehead
raise eyebrows
squeezing of eyelids
drop in the corner of the mouth
grin
ear pain and its immediate surroundings – the pain is usually located behind the ear
numbness and tingling on the affected side of the face
hypersensitivity of the tongue and taste disorder (mainly within 2/3 of the anterior parts)
impaired tear secretion
hypersensitivity to auditory stimuli
decreased salivation
removal of the corneal reflector, which is the protective mechanism of the eye and involves closing the eyelid when it touches the eye.
impaired deep feeling from the facial area

Physiotherapeutic treatment of facial paralysis

The goal of treatment in the acute phase is to speed up recovery and also prevent possible complications. In contrast, in the chronic phase, activities focus on accelerating the regeneration of nerve fibers and preventing muscle atrophy and striving for facial symmetry.

For effective medical rehabilitation, an integrated approach includes pharmacotherapy, physical therapy, kinesitherapy and massage.

The first stage of treatment should be prevention, understood as educating patients in the field of daily care and counteracting adverse complications. Caution if eyelid closure does not work. Then it is necessary to moisten the eye and protect it from contamination of the cornea by gluing. Other preventive measures:

supporting the falling corner of the mouth with tape or rail
avoiding sudden cooling and drafts
avoiding excessive pressure and stretching of the muscles of the affected side

Kinesitherapy plays a significant role in the healing process, including facial exercises, massage and neuromuscular stimulation. The sooner exercises and therapy are performed, the faster lost functions return.

Facial muscle exercises should be performed in front of a mirror and under the supervision of a physiotherapist. It is recommended to perform the following movements:

wrinkled forehead – both horizontal and vertical
alternating eye closing
closing the eyes with maximum pressure
bend of the nose
lowering of the eyebrows
smiling with clenched teeth
smiling with open teeth
grin
pulling the corners of the lips to the sides
lowering the corners - a gesture of disgust
pushing out the tongue of the left and right cheek
forward and removal of the lower jaw
moving the jaw sideways
wide lip opening
turning the tongue into a pipe
whistling
blowing, blowing straw into a glass of water
pursing the lips while stretching the lips
pronouncing “R” with resistance from the fingers located at the corners of the mouth
pronunciation of vowels: I, O, U, Y, E, A

Exercises to learn the correct pattern should be performed with support, avoiding stretching of weakened muscles.

Kinesiology, touch for facial paralysis – reduces pain and regulates muscle tone. This is reflected in improved speech and facial symmetry.

Massage in case of facial paralysis can be performed on one side or both sides. It includes classical massage methods - stroking, friction, stroking, vibration, which are aimed at achieving proper muscle tone, improving the flexibility of muscle fibers and improving blood circulation.

Places for development: * area of the upper and lower lips, * beard, * bridge of the nose, * eyebrows, * cheeks, * round muscle of the mouth, * ocular muscle of the eye, * on the forehead.

The last but very important element of physical therapy is neuromuscular stimulation. Stimulation methods are aimed at activating proprioceptive sensation. The therapy often uses stronger muscles, which stimulate the infected areas through radiation (radiation of muscle tone). Each therapy is characterized by different working methods aimed at improving coordination and conscious tightening and loosening of muscles. Examples of therapeutic elements:

pressure, interrupted vibration
stretching - contraction
rhythmic stimulation of movement - passively, assistance and resistance of the therapist
combination of isotonic contractions – uses all types of contractions (concentric, eccentric, static)

Physical treatments

Laser biostimulation	Laser biostimulation accelerates the regeneration of nerve fibers, which directly affects the return of muscle function. Individual facial nerves are stimulated. Treatment parameters: beam length: 800-950 nm, treatment dose 2-9 J/cm²
Solar lamp lighting	Sollux lamp exposure (red filter) is mainly used for acute illness. The heat generated allows for a congestive effect and also supports nerve regeneration.
Electrical stimulation	Electrical stimulation uses pulsed current with a triangular shape. The active electrode is the cathode, which stimulates the motor points of the affected muscles. Electrical stimulation should be performed in repeating rows of about 10-20 pulses.
Magnetotherapy	Both a slowly varying magnetic field and a high-frequency electromagnetic pulsed field (short-wave diathermy) are used. Slow magnetic field parameters – induction 5-20Hz, pulse frequency 10-20Hz, sinusoidal pulses. Gradual increase in frequency as therapy progresses to 20 and 50 Hz. Electromagnetic field processing parameters: frequency 80 and 160 Hz, rectangular pulse shape, pulse time 60 μs. Gradual increase in frequency as therapy progresses to 160 and 300 Hz. Treatment using magnetic and electromagnetic fields is characterized by analgesic, anti-inflammatory, vasodilating and angiogenic effects, and also enhances regeneration processes.
Ultrasonic	They are characterized by analgesic and anti-inflammatory effects, and thanks to “micro-massage” a stagnant effect is achieved. Treatment of individual branches of the facial nerve. To obtain a better anti-inflammatory effect, drugs from the group of non-steroidal anti-inflammatory drugs are used. Treatment parameters: dose 0.1-0.3 W/cm².
Zinc plating / iontophoresis	In addition to electrical stimulation, electroplating (cathodic current) using a Bergoni electrode is also used. Due to the high sensitivity of facial tissue, low doses are used. Galvanization can be enriched with vitamin B1 (administered from the negative electrode) or 1-2% calcium chloride (including the positive electrode).

Treatment statistics

Treatment should be carried out as soon as possible, as it affects the consequences of the procedure. In most cases, treatment is effective and the patient returns to normal functioning. However, the key element of treatment is the timing of initiation and patient participation; lack of cooperation may cause failure.

The average duration of therapy is about 6 months, during which time:

70% of patients – complete restoration of function was registered
15% of patients – a slight deficiency is noticeable
15% of patients – permanent nerve damage found

The absence of conservative therapeutic effects is an indicator for surgical treatment.

Video: Acute neuritis of the facial nerve treatment. Symptoms, causes, 8 ways to relieve pain

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Description:

The facial nerve is characterized by a relatively acute development of dysfunction of the facial muscles. At the same time, on the affected side there are no folds in the forehead, the nasolabial fold is smoothed, and the corner of the mouth is lowered. The patient cannot wrinkle his forehead, frown his eyebrows, close his eye (“hare eye”), puff out his cheek, whistle, or blow out a burning candle. When teeth are bared, a lack of movement on the affected side is revealed, and slower and less frequent blinking occurs here. On the side of the muscle paralysis, salivation is increased, saliva flows from the corner of the mouth. When the peripheral parts of the nerve are damaged, facial pain is often observed, which may precede the development of paralysis of the facial muscles. Depending on the level of nerve damage, motor disturbances may be combined with taste disorders on the anterior half of the tongue and increased hearing. A hare's eye is often combined with impaired lacrimation (dry conjunctiva), which can lead to the development.
The onset of the disease is acute, then during the first 2 weeks the condition begins to improve. The lack of restoration of movements of facial muscles within a month is alarming regarding the possibility of the development of irreversible changes in the nerve. In this case, an unfavorable symptom is the development of keratitis (due to drying of the conjunctiva of the eye on the side of paralysis) and paralyzed muscles (the nasolabial fold is emphasized, as a result of contraction of the orbicularis oculi muscle, the palpebral fissure narrows, tic-like twitching of the facial muscles is observed).

Symptoms:

Damage to the motor portion of the facial nerve leads to peripheral paralysis of the innervated muscles - the so-called. peripheral paralysis n.facialis. In this case, facial asymmetry develops, noticeable at rest and sharply increasing with facial movements. Half of the face on the affected side is motionless. When trying to wrinkle the skin of the forehead into folds on this side, the skin of the forehead does not gather, and the patient is unable to close his eyes. When you try to close your eyes, the eyeball on the affected side turns upward (Bell's sign) and a strip of sclera becomes visible through the gaping palpebral fissure (hare's eye). In the case of moderate paresis of the orbicularis oculi muscle, the patient is usually able to close both eyes, but cannot close the eye on the affected side, while leaving the eye on the healthy side open (eyelid dyskinesia, or Revillot's sign). It should be noted that during sleep the eye closes better (relaxation of the muscle that lifts the upper eyelid). When the cheeks are puffed out, the air comes out through the paralyzed corner of the mouth, the cheek on the same side “sails” (sail symptom). The nasolabial fold on the side of the muscle paralysis is smoothed, the corner of the mouth is lowered. Passive lifting of the corners of the patient's mouth with fingers leads to the fact that the corner of the mouth on the side of the lesion of the facial nerve rises higher due to decreased muscle tone (Russetsky's symptom). When you try to bare your teeth on the side of the paralyzed orbicularis oris muscle, they remain covered with your lips. In this regard, the asymmetry of the oral fissure is roughly expressed; the oral fissure is somewhat reminiscent of a tennis racket, with the handle turned towards the affected side (racket symptom). A patient with paralysis of the facial muscles caused by damage to the facial nerve experiences difficulty while eating; food constantly falls behind the cheek and has to be removed from there with the tongue. Sometimes there is biting of the mucous membrane of the cheek on the side of paralysis. Liquid food and saliva may leak from the corner of the mouth on the affected side. The patient also experiences a certain awkwardness when talking. It is difficult for him to whistle or blow out a candle.

Due to paresis of the orbicularis oculi muscle (paretic lower eyelid), the tear does not completely enter the lacrimal canal and flows out - the impression of increased lacrimation is created.

With neuropathy of the facial nerve in the late period, contracture may appear with the face pulled to the healthy side.

After peripheral paralysis of the n.facialis, partial or incorrect regeneration of damaged fibers, especially vegetative ones, is possible. The surviving fibers can send new axons to the damaged parts of the nerve. Such pathological reinnervation can explain the occurrence of contractures or synkinesis in the facial muscles. Imperfect reinnervation is associated with crocodile tears syndrome (paradoxical taste-tear reflex). It is believed that the secretory fibers for the salivary glands grow into the Schwann membranes of degenerated damaged fibers that originally supplied the lacrimal gland.

Causes:

Peripheral paralysis of the facial nerve develops under the influence of cooling, infection and some other factors; spasm of the vessels of the facial nerve occurs, which leads to its swelling and a discrepancy between the diameters of the facial nerve and its canal.

Treatment:

For treatment the following is prescribed:

It is advisable to carry out treatment in a hospital setting. Treatment tactics depend on the cause, period of the disease, and the level of nerve damage. If the cause of the disease is infectious, semi-bed rest is recommended for 2-3 days, and anti-inflammatory therapy is used. In the early stages of the disease, treatment with hormones - corticosteroids (prednisolone and its analogues) is effective. Due to swelling of the nerve and pinching of it in the bone canal, diuretics (furosemide, diacarb, triampur) are used. Regardless of the cause of neuropathy, medications are prescribed that improve blood circulation in the nerve (nicotinic acid, complamine). To prevent dryness of the conjunctiva and the development of trophic disorders, it is necessary to instill albucid and vitamin drops into the eye 2-3 times a day. From 5-7 days vitamin therapy is added, on days 7-10 drugs are added that improve nerve conduction and neuromuscular transmission (prozerin). The course of treatment necessarily includes physical therapy: infrared rays, UHF electric field, laser therapy, sinusoidal modulated currents, ultrasound, massage of the collar area. From the first days of the disease, therapeutic exercises are prescribed. Acupuncture is used for all forms of the disease.