Flaccid paralysis of a facial nerve

Description:

For paralysis of a facial nerve typically rather acute development of dysfunctions of mimic muscles. At the same time on the party of defeat there are no folds in a forehead, the nasolabial fold is maleficiated, the mouth corner is lowered. The patient cannot frown, frown an eyebrow, close an eye ("a hare eye"), to inflate a cheek, to whistle, blow out the burning candle. At a grin of teeth lack of movements on the struck party comes to light, there is slower and rare blinking. On the party of paralysis of muscles salivation is strengthened, saliva follows from a corner of a mouth. At defeat of peripheral departments of a nerve face pains which can precede development of paralysis of mimic muscles are often noted. Depending on the level of damage of a nerve motive disturbances can be combined with disorders of taste on a front half of language and a sharpening of hearing. A "hare" eye is quite often combined with disturbance of a slezootdeleniye (dryness of a conjunctiva) that can lead to development of a keratitis.
The beginning of a disease acute, then within the first 2 weeks a state begins to improve. Lack of recovery of movements of mimic muscles within a month guards concerning a possibility of development of irreversible changes in a nerve. At the same time an adverse symptom is development of a keratitis (in connection with drying of a conjunctiva of an eye on the party of paralysis) and contractures of the paralyzed muscles (the nasolabial fold is emphasized, as a result of reduction of a circular muscle of an eye the palpebral fissure is narrowed, tikoobrazny twitchings of mimic muscles are observed).

Symptoms of the Flaccid paralysis of a facial nerve:

Defeat of a motive portion of a facial nerve leads to a flaccid paralysis of the innervated muscles - a so-called flaccid paralysis of n.facialis. At the same time the asymmetry of the person noticeable at rest and sharply amplifying at the mimic movements develops. The half of the face on the party of defeat is not mobile. Forehead skin in attempt to its namorshchivaniye in folds does not gather on this party, the patient does not manage to cover an eye. In attempt to close eyes an eyeglobe on the party of defeat it is wrapped up (a symptom Bella) and through the gaping palpebral fissure the sclera strip (a hare eye, a lagophthalmia) becomes visible. In case of moderate paresis of a circular muscle of an eye, the patient usually has an opportunity to cover both eyes, but cannot cover eyes on the party of defeat, having left at the same time an eye on the healthy party opened (dyskinesia a century, or Reviyo's symptom). It is necessary to specify that during sleep an eye is closed better (relaxation of the muscle raising an upper eyelid). At inflation of cheeks air comes out through the paralyzed mouth corner, the cheek on the same party "parusit" (a sail symptom). The nasolabial fold on the party of paralysis of muscles is maleficiated, the corner of a mouth is lowered. The passive raising fingers of corners of a mouth of the patient conducts to the fact that the mouth corner on the party of defeat of a facial nerve because of the lowered tone of muscles rises above (Russetsky's symptom). In attempt to grin on side of the paralyzed circular muscle of a mouth they remain the covered lips. In this regard asymmetry of an oral crack is roughly expressed, the oral crack resembles the tennis racket turned by the handle towards defeat (a racket symptom). The patient at the paralysis of mimic muscles caused by defeat of a facial nerve experiences difficulties during food, food is constantly filled up for a cheek and it should be taken language from there. The biting of a mucous membrane of a cheek on the party of paralysis is sometimes observed. Liquid food and saliva can follow from a mouth corner on the struck party. Tests a certain awkwardness of the patient also at a conversation. It is difficult for it to whistle, blow out the candle.

Owing to paresis of a circular muscle of an eye (a paretic lower eyelid) the tear does not get completely to the lacrimal canal and follows outside – an impression of the raised slyozootdeleniye is made.

At a neuropathy of a facial nerve during the late period emergence of a contracture with pulling of the person in the healthy party is possible.

After a flaccid paralysis of n.facialis partial or wrong regeneration of the damaged fibers, especially vegetative is possible. The remained fibers can send new axons to the damaged parts of a nerve. Such pathological reinnervation is capable to explain emergence of contractures or synkineses in mimic muscles of the person. The syndrome of crocodile tears (an inverted vkuso-lacrimal reflex) is connected with imperfect reinnervation. Assume that secretory fibers for slyunootdelitelny glands burgeon in schwannian covers of the degenerated damaged fibers which were originally supplying the lacrimal gland.

Reasons of the Flaccid paralysis of a facial nerve:

The flaccid paralysis of a facial nerve develops under the influence of cooling, an infection and some other factors there is a vasospasm of a facial nerve that leads to its hypostasis and discrepancy of diameters of a facial nerve and its channel.

Treatment of the Flaccid paralysis of a facial nerve:

It is desirable to carry out treatment in the conditions of a hospital. Tactics of treatment depends on the reason, the period of a disease, level of damage of a nerve. At an infectious cause of illness the semi-bed rest within 2-3 days is recommended, antiinflammatory therapy is applied. At early stages of a disease treatment by hormones — corticosteroids (Prednisolonum and its analogs) is effective. Due to hypostasis of a nerve and infringement it in the bone channel use diuretic drugs (furosemide, Diacarbum, Triampur compositum). Regardless of the reason of a neuropathy the means improving blood circulation in a nerve are appointed (niacin, компламин). For prevention of dryness of a conjunctiva and development of trophic disturbances 2-3 times a day in an eye it is necessary to dig in albucid, vitamin drops. From 5-7 in the afternoon vitamin therapy joins, for 7-10 day add the drugs improving carrying out on a nerve and neuromuscular transmission (прозерин). The course of treatment surely joins physical therapy: infrared beams, electric field of UVCh, laser therapy, the sinusoidal modulated currents, ultrasound, massage of a collar zone. From the first days of a disease the remedial gymnastics is appointed. At all forms of a disease the acupuncture is applied.