How to distinguish from a stroke
This is the most important question, and there is a simple reference point - the forehead.
- Neuritis of the facial nerve (peripheral paresis): the entire half of the face, including the forehead, does not work. A person cannot raise an eyebrow and wrinkle his forehead, the eye does not close completely
- Stroke (central paresis): the forehead wrinkles normally, the eyebrow rises, mainly the lower half of the face is affected. There are almost always other symptoms - weakness in an arm or leg, speech impairment
Why does it occur
The facial nerve passes through a narrow bony canal in the temporal bone. Any swelling of the nerve in this canal leads to its compression - and the function is lost. In most cases, the exact cause cannot be established, and they talk about Bell's palsy, which is most often caused by reactivation of a viral infection.
- Herpes simplex virus reactivation is the most likely mechanism for Bell's palsy
- Varicella-zoster virus - Ramsay Hunt syndrome, with ear rash and pain
- Hypothermia, draft, air conditioning are common triggers
- Otitis and other inflammatory processes of the middle ear
- Diabetes mellitus, pregnancy, arterial hypertension - increase the risk
- Temporal bone injuries, parotid tumors, borreliosis
Symptoms
- Facial asymmetry: smoothed nasolabial fold, drooping corner of the mouth
- Inability to close the eye (lagophthalmos), the eyeball moves upward when trying
- Watery eyes or, conversely, dry eyes
- Fluid leaking from the corner of the mouth, food getting stuck behind the cheek
- Taste disturbance in the anterior two-thirds of the tongue
- Increased sensitivity to loud noises on the affected side
- Pain behind the ear, often preceded by a day or two of weakness
Treatment: why the first 72 hours are important
The basis of treatment is a short course of glucocorticosteroids, which relieves swelling of the nerve in the bone canal. Their effectiveness is greatest when started within the first 72 hours of symptom onset; later the result is noticeably worse. This is why facial neuritis is a condition that cannot be “waited until Monday.”
- Short course of glucocorticosteroids according to the doctor’s regimen
- Antiviral drugs - if a herpetic nature is suspected, especially with Ramsay Hunt syndrome
- Eye protection is a must: moisturizing drops during the day, gel and eyelid sealing at night, glasses when outdoors
- Gymnastics for facial muscles - begin after the acute period subsides, as prescribed by a doctor
- Physiotherapy and massage as auxiliary methods in the subacute period
Recovery and prognosis
With Bell's palsy, the prognosis is generally favorable: in most patients, function is restored within a few weeks, most often the first signs of improvement appear in the second or third week. Complete recovery is more likely with incomplete paresis and early treatment.
Complete paralysis is restored worse, in cases of Ramsay Hunt syndrome, in the elderly and in patients with diabetes mellitus. If there is no improvement after 3-4 months, further examination is required to rule out another cause.
- Regular gymnastics in front of the mirror in small approaches several times a day
- Mandatory protection of the cornea all the time until the eye is closed
- Controlling blood sugar in diabetes - the speed of recovery directly depends on it
- Patience: the nerve recovers slowly over weeks and months, and this is normal