2) short (up to two days) slight pain behind the ear before prosoparesis appearance – due to the presence of close links between the fibers of the facial nerve and sensory branches of the trigeminal nerve in the area of mastoid processus.
Facial neuropathy symptoms depend on the injury level:
1. Impairment of facial nerve nucleus in pons Varolii (at stroke): prosoparesis,
+ impairment of pyramidal ways in pons Varolii – alternating Millard-Gubler’s syndrome (ipsilateral peripheral facial neuropathy and contralateral central hemiparesis), or pyramidal ways and n. abducens nucleus – alternating Foville’s syndrome (ipsilateral peripheral facial neuropathy and contralateral central hemiparesis, ipsilateral horizontal gaze palsy),
+ dryness of eye (damage of tear nerve (n. petrosus major) – branches of n. intermedius, that goes together with n. facialis),
+ absence of taste feeling(ageusia) on front 2/3 of tongue (damage of taste nerve (chorda tympani) – branches of n. intermedius).
2. Impairment of facial nerve root in ponto-cerbellar angle (at acoustic neuroma): prosoparesis,
+ cerebellum ataxia,
+ disorders of hearing, balance (damage of n. vestibulo-cohlearis),
+ double-vision, strabismus convergent (damage of n. abducens),
+ ipsilateral facial hemihypesthesia (damage of n. trigeminal)
+ dryness of eye (damage of tear nerve (n. petrosus major),
+ absence of taste feeling (ageusia) on front 2/3 of tongue (damage of taste nerve (chorda tympani).
3. Hunt’s syndrome – herpetic impairment of n. facialis ganglion: prosoparesis
+ strong pain in ear with irradiation in face, neck,
+ herpetic eruption in the area of auditory way,
+ absence of taste feeling(ageusia) on front 2/3 of tongue (damage of taste nerve (chorda tympani) – branches of n. intermedius),
+ disorders of hearing, balance (damage of n. vestibulo-cohlearis).
4. Impairment of facial nerve above n. petrosus major: prosoparesis,
+ dryness of eye (damage of tear nerve (n. petrosus major),
+ hyperakusis – unpleasant auditory feeling (damage of n. stapedius),
+ absence of taste feeling on front 2/3 of tongue (damage of taste nerve (chorda tympani).
5. Impairment of facial nerve above n. stapedius: prosoparesis,
+ eyewatering (a tear flow out from eye, because there is a weakness of m. orbicularis oсuli),
+ hyperakusis – unpleasant auditory feeling (damage of n. stapedius),
+ absence of taste feeling on front 2/3 of tongue (damage of taste nerve (chorda tympani).
6. Impairment of facial nerve above chorda tympani: prosoparesis,
+ eyewatering (weakness of m. orbicularis oсuli)
+ absence of taste feeling on front 2/3 of tongue (damage of taste nerve (chorda tympani).
Facial neuropathy diagnosis:
- clinical symptoms,
- electroneuromyography (EMG),
- CT or MRI to detect focal lesions of the brain, which could cause lesions of the facial nerve.
Treatment of facial neuropathy:
1. Do not apply heat at place of facial nerve exiting on face through the stylomastoid foramen.
2. Corticosteroids – at the first 72 hours of illness - to reduce the inflammatory edema and nerve compression in the bone canal: dexamethasone topically (mastoid process region) or i/v, 10 days.
3. Diuretics - to reduce the inflammatory nerve edema: triampur, furosemide, glycerol, 3-5 days.
4. Preparations for the improvement of microcirculation - trental, acidi nicotinici.
5. Vitamin B.
6. Anticholinergics - - only after 10-14 days from the onset of the disease to improve the conduction of excitation along the nerve (early application may trigger the development of facial muscles contractures) – proserin 1,0 i/m, neuromedin 0,5% 1,0 i/m.
7. Neurotrophic medications (actovegin 5,0 i/v).
8. From the first days of the disease - a gentle massage, facial muscles exercise, acupuncture, after 1-2 weeks - electrophoresis, heat procedures.
9. At viral Hunt’s syndrome – antiviral drugs (Aciclovir).
10. Eye care to protect the affected eye from becoming damaged, due to it not being able to close - artificial tears, wet tape at night.
11. In the case of congenital neuropathy, trauma, if conservative treatment is not effective after 9 months - surgery: neurolysis. Botox injections are sometimes used (at synkinesis).
Complications. Full recovery occurs in 75% of cases of facial neuropathy. The greatest chance for recovery present at injury in the outlet of the skull. With long-term course of the disease (over 3 months) the probability of full recovery is greatly reduced. Around 3 in 10 people with Bell’s palsy will continue to experience weakness in their facial muscles, and 2 in 10 will be left with a more serious long-term problem:
- a contracture - permanently tense of facial muscles with facial disfigurementse (often caused by early application of anticholinergics - proserin, neuromedin)
- loss or reduced sense of taste, speech problems (as a result of facial muscles damage), eye drying and corneal ulceration, tears when eating, known as 'crocodile tears'
- eye-mouth synkinesis (it can cause patient eye to wink when eating, laughing or smiling).
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| Facial neuropathy. | | | Fig. 4. Herpetic eruptions. |