The cause of disease
There are many reasons for facial neuritis, which can be divided into central facial neuritis and peripheral facial neuritis according to the location of injury. The lesion of central facial neuritis is located in corticobulbar tract between facial nucleus and cerebral cortex, which is usually caused by cerebrovascular disease, intracranial tumor, brain injury and inflammation. Peripheral facial neuritis mainly occurs in facial nucleus and facial nerve.
The common diseases of peripheral facial neuritis are: ① infectious diseases, mostly caused by the activation of sensory ganglion virus lurking in the facial nerve; ② Otogenic diseases, such as otitis media; ③ Autoimmune reaction. ④ tumor; ⑤ Neurogenic; 6 traumatic; All landowners poisoning, such as alcoholism, long-term exposure to toxic substances; 8. Metabolic disorders, such as diabetes and vitamin deficiency; Pet-name ruby vascular insufficiency; Attending congenital hypoplasia of facial nucleus.
clinical picture
The symptoms are mostly facial paralysis, disappearance of forehead wrinkles, enlargement of eye fissure, flattening of nasolabial groove and drooping of corners of the mouth. When smiling or grinning, the drooping corners of the mouth and facial distortion are more obvious. The affected side should not frown, close eyes, inflate or pout. When you drum your cheeks and whistle, the air will leak because the affected lip cannot be closed. When eating, food residues often stay in the gap between the teeth and cheeks of the affected side, and saliva often drips from this side. Because the tear spot everts with the lower eyelid, tears can't flow out according to normal drainage.
Facial paralysis caused by facial neuritis is mostly unilateral, and the right side is more common. Most patients often wash their faces and gargle in the morning and suddenly find that one cheek is not working and their mouth is askew. Some patients may have pre-lingual 2/3 taste disorder and auditory allergy.
Peripheral facial neuritis caused by trauma can be divided into early-onset (facial paralysis immediately after injury) and late-onset (facial paralysis 5-7 days after injury). According to the occurrence of facial paralysis after injury, the degree of facial nerve injury can be evaluated and the prognosis can be judged.
cheque
1. Static check
(1) Check styloid process and mastoid process for pain or pain in one temple and face.
(2) Check the forehead to see whether the skin wrinkles on the forehead are the same, shallow or disappear, and whether the lateral eyebrows droop symmetrically.
(3) Check the size of the eye fissure, whether the two sides are symmetrical, smaller or larger, whether the upper eyelid droops, whether the lower eyelid everts, whether the eyelid twitches and swells, whether the conjunctiva is congested, and whether there are symptoms such as tears, dryness and acid swelling.
(4) Ear check for tinnitus, stuffy ears, hearing loss or allergies.
(5) cheek check whether nasolabial groove becomes shallow, disappears or deepens. Whether the cheeks are symmetrical, flat, thickened or twitching. Does your face feel tight, stiff, numb or atrophied?
(6) Check whether the quarrel is symmetrical, drooping, tilted or twitching; Whether the lips are swollen or not, and whether people are skewed.
(7) Check whether the taste is influenced by the tongue.
Step 2 practice checking
(1) Eyebrow lifting exercise was used to check the motor function of frontoccipital muscle. In severe cases, the forehead is flat, the wrinkles generally disappear or become obviously shallow, and the outer side of the eyebrows is obviously drooping.
(2) frown to check whether the frowning muscles can move and whether the movements of the eyebrows on both sides are consistent.
(3) When closing your eyes, you should pay attention to whether the squabble on the affected side is moving, whether the affected side can be closed and the degree of closure.
(4) Shrug your nose to see if there are wrinkles in the descending nasal muscles and whether the movements of the upper lips on both sides are consistent.
(5) Observe the motion range of bicuspid angle, whether the mouth crack is deformed, and the number and height of exposed upper and lower teeth.
(6) Use lips to indicate whether the distance between the two parties to the quarrel is the same, and whether the shapes indicated with lips are symmetrical.
(7) Drum gills mainly check the motor function of orbicularis oris muscle.
treat cordially
1. Non-surgical treatment
Principle: Promote the early regression of local inflammation and edema, and promote the recovery of nerve function.
(1) For peripheral facial paralysis caused by facial neuritis, antiviral, neurotrophic, glucocorticoid, B vitamins and other drugs can be used for virus infection.
(2) To protect the exposed cornea and prevent conjunctivitis, eye patch, eye drops and ointment can be used;
(3) Massage: The patient massages the facial muscles of facial paralysis by hand in front of the mirror for 5 ~ 10 minutes several times a day.
(4) Physiotherapy, commonly used are ultrashort wave, low intermediate frequency electrotherapy, laser, drug introduction, etc.
(5) Acupuncture treatment.
2. Surgical therapy
After three months of conservative treatment, facial paralysis has not recovered, and there is no response to the measurement of facial nerve conduction velocity and facial muscle electromyography, that is, potential activity, which can be treated surgically.
nurse
1. Eye care
Less outdoor activities in the acute phase, keep your eyes clean; Eye mask can be used to cover the affected eyes or apply eye ointment to prevent conjunctival and corneal infection; Try to use your eyes less.
2. Diet care
Patients with taste disorder should pay attention to the degree of cold and hot food; Avoid hard food; Try to put food behind a healthy tongue and chew it slowly; Pay attention to rinse your mouth in time after meals and keep your mouth clean.
3. Rehabilitation nursing
Hot compress can be applied on the affected side to promote local blood circulation. When facial muscles begin to recover, it is necessary to do muscle strength training of facial muscles, mainly to train facial muscles, and do actions such as opening eyes, frowning, sucking, pouting, smiling, lifting the corners of the mouth, whistling, pouting lips, and pulling the jaw. About 20 minutes each time, 1 time every day, until the final recovery.