What Is Fourth Nerve Palsy?

Facial neuritis is commonly known as facial nerve palsy (ie, facial nerve paralysis), "crooked mouth", and "hanging wind". It is a disease with facial expression muscle group motor dysfunction as its main feature. It is a common and frequently-occurring disease, regardless of age. The general symptom is a skewed mouth and eyes, and patients often cannot even perform the most basic eyebrow raising, eye closing, and mouth mouth movements.

Basic Information

nickname: Facial neuritis, facial nerve paralysis, crooked mouth, hanging wind
English name: facial paralysis
Visiting department: Neurology

Common causes: Central facial paralysis is caused by cerebrovascular disease, intracranial tumors, inflammation, etc. Peripheral facial paralysis is often caused by infectious lesions, ear-borne diseases, etc.
Common symptoms: Facial facial muscle paralysis, disappearance of forehead wrinkles, enlarged eyes, etc.

Causes of facial paralysis

There are many causes of facial neuritis. Clinically, according to the site of damage, it can be divided into two types: central facial neuritis and peripheral facial neuritis. Central facial neuritis lesions are located in the cortical medulla bundle above the facial nucleus to the cerebral cortex, and are usually caused by cerebrovascular disease, intracranial tumors, brain trauma, inflammation and so on. Peripheral facial neuritis lesions occur in the facial nucleus and facial nerve.

The common causes of peripheral facial neuritis are: infectious lesions, mostly caused by activation of sensory ganglia virus latent in the facial nerve; otogenic diseases such as otitis media; autoimmune response; tumors; neurogenic; Traumatic; poisoning, such as alcohol poisoning, long-term exposure to toxic substances; metabolic disorders, such as diabetes, vitamin deficiency; vascular insufficiency; congenital facial nerve dysgenesis.

Clinical manifestations of facial paralysis

Mostly, the facial facial muscles were paralyzed, the forehead wrinkles disappeared, the cleft eyes enlarged, the nasolabial sulcus was flat, and the corners of the mouth drooped. When you smile or show your teeth, the corners of your mouth and your face are more skewed. The affected side cannot do wrinkle forehead, frowning, closing eyes, gasping, and pursing. When the gills and whistle are blown, the affected side's lips cannot be closed and the air leaks. When eating, food residues often stay in the tooth-cheek space on the diseased side, and saliva often drips from that side. Due to the eversion of the punctae with the lower eyelid, the tears cannot overflow as normal drainage.

Facial paralysis caused by facial neuritis is mostly unilateral, and it is more common on the right side. Most patients often find that one side of the cheek does not work well and the corners of the mouth are skewed when they wash their faces and rinse their mouths in the morning. Some patients may have pre-tongue 2/3 taste disorders and hearing allergies.

Peripheral facial neuritis caused by trauma can be divided into two types: early onset (facial palsy immediately after injury) and late onset (facial palsy 5-7 days after injury). The degree of facial nerve injury can be evaluated to determine the prognosis according to the sooner or later, the degree of paralysis after the injury, electrical excitation and electromyography.

Facial Paralysis Examination

Stationary inspection

(1) Stem papillae Check whether the mastoid process is painful or whether there is pain in one side of the temporal area and face.

(2) Forehead Check whether the skin wrinkles on the forehead are the same, lighter or disappear, and whether the outside of the eyebrow is symmetrical and sagging.

(3) Examine the size of the cracked eyes, whether the sides are symmetrical, smaller or larger, whether the upper eyelids are drooping, whether the lower eyelids are valgus, whether the eyelids are twitching, swelling, whether the conjunctiva is congested, whether there is tearing, dryness, acidity. Swelling symptoms.

(4) Ear Check for tinnitus, ear tightness, hearing loss, or allergies.

(5) Cheeks Check whether the nasolabial folds become lighter, disappear or deepen. Whether the cheeks are symmetrical, flat, thickened, or jerking. Whether your face feels tight, stiff, numb, or atrophied.

(6) Mouth Check whether the corners of the mouth are symmetrical, drooping, lifting or convulsing; whether the lips are swollen, and whether they are skewed in people.

(7) Tongue Check whether the taste is affected.

2. Exercise check

(1) Brow lift exercise Check the function of the frontoccipital muscle. In severe patients, the forehead is flat, wrinkles generally disappear or become lighter, and the outside of the eyebrows is drooping.

(2) Frowning Check whether the frown muscle can move and whether the amplitude of the eyebrow movement is the same on both sides.

(3) Eye closure When closing the eyes, pay attention to whether the mouth angle of the affected side is raised, whether the affected side is closed tightly, and the degree of closure.

(4) Lift your nose and observe if there are wrinkles in the nose muscles and whether the upper lip movements are the same on both sides.

(5) Showing teeth Pay attention to observe the amplitude of the mouth angle motion on both sides, whether the crack is deformed, the number and height of the upper and lower teeth exposed.

(6) Nozzle Pay attention to whether the distance from the sides of the mouth corner to the person is the same, and whether the shape of the nozzle is symmetrical.

(7) Drum cheek Mainly check the motor function of the orbicularis oris muscle.

Facial Paralysis Treatment

Non-surgical treatment

Principle: Promote local inflammation, edema and early resolution, and promote the recovery of nerve function.

(1) For peripheral facial paralysis, antiviral, nutritional nerves, glucocorticoids, B vitamins and other drugs can be used for viral infection.

(2) Protect the exposed cornea and prevent conjunctivitis, use eye mask, eye drops, eye ointment, etc .;

(3) Massage. Massage the facial paralysis muscles by hand, several times a day, 5-10 minutes each time.

(4) Physical therapy, commonly used are ultrashort wave, low and intermediate frequency electrotherapy, laser, drug introduction and so on.

(5) Acupuncture treatment.

2. Surgical treatment

After 3 months of conservative treatment, the nerve paralysis has not recovered, and the facial nerve conduction velocity and facial electromyography have no response, that is, no potential activity, can be treated with surgery.

Facial Paralysis Nursing

Eye care

In the acute phase, reduce outdoor activities and keep the eyes clean; cover the affected eye with eye mask or apply eye ointment to prevent conjunctival and corneal infections; minimize the use of eyes.

2. Dietary care

Patients with taste disorders should pay attention to the heat and cold of food; avoid hard food; try to place food behind the healthy side of the tongue, chew slowly and swallow slowly; pay attention to mouthwash in time after meals to keep the mouth clean.

3. Rehabilitation Nursing

Hot compress can be applied to the affected side to promote local blood circulation. When the facial muscles begin to recover, you need to do facial muscle strength training, mainly training facial expression muscles, such as opening eyes, wrinkles, sucking, raising lips, opening a smile, raising the corner of the mouth, whistling, purging the lips, pulling the jaw , About 20 minutes each time, once a day until recovery.