Facial Paralysis

Peripheral paralysis of the facial nerve

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Peripheral paralysis of the facial nerve is the most common paralysis of facial muscle in clinic. The representing is the paralysis of all the muscle of face in same side .The place of traumatic is the core of facial nerve or under the core of facial nerve.

Cause and classify According to cause and clinic symptoms ， the disease will be classify to 8 types: 1. Congenital : rarely . for example :abnormality of congenital facial nerve. Hypoplasia of facial nerve and the core of facial nerve. paralysis of congenital facial nerve

2. Idiopathic: common, take up 80% of Peripheral paralysis . for example: ①Bells palsy. The cause is unknow. It may be relate to a disturbance of the microcirculation leading to a serous inflammation with the formation of edema.

Bells palsy

②Convulsion of blood vessel. ③Immunity of oneself. ④factor of descendiblity and disturbance of incretion.

. 3. Infection: common. ①An immediate complication of an acute otitis media

mastoiditis which is treated by antibiotics and immediate mastoidectomy .

②A middle ear cholesteatoma invading the bony facial canal may arise facial paralysis.

③neurotropic viruses such as herpes zoster, neuroallergic polyradiculitis ,infection of flu virus, cephalitis virus and lues. Herpes zoster is a frequent diease in clinical, this diease is characterized by herpetic vesicles arranged in groups on the auricle, the external auditory meatus and occasionally the tympanic membrane. In severe cases disorders of hearing balance and facial paralysis may occur.

Herpes zoster

4. Traumatic facial paralysis: few . ①most common cause is a fracture of the skull blast and gunshot injuries ②fracture of temporal bone. ③injuries of face

5. Pressure: few. ①Cholesteatoma of idiopathic. ②acoustic neuroma tumour of meninges and so on.

6. Disease of metabolize: rarely for example : diabetes, and so on 7. Poisoning: rarely Most common is caused by some substance of chemistry, such as arsenic poisoning , take some medicine. 8. Medical cause : Comman, for example : ①Mastoidectomy ②Operation for temporal bone ③operation for acoustic neuroma ④Operation for parotid and so on

Symptoms  The secretion of tears and the sensitivity for taste are affected  Hyperacusis may occur due to disruption of the stapedius reflex  Expression moving of face will disappear in disease side  Disappear of forehead lines

Investigation of the facial nerve Estimate of facial nerve function: Estimate of quantify: GradeⅠ: facial nerve function is normal GradeⅡ: normal when quiet, slight not symmetry when moving GradeⅢ: no distinctness abnormal when quiet, he must strongly movement for keeping symmetry when moving GradeⅣ: No abnormity when quiet, not symmetry when moving and can not close the eye. GradeⅤ: not symmetry both facial muscle when quiet and there is slight moving GradeⅥ: completeness paralysis of facial muscle and no any moving

Examination of orientation Taste examination : Because of the anterior two-thirds of the tongue is innervated by the chorda tympani , so the test stimulus is 20% sugar , 10%saline , or 5% citric acid solution. Spread the anterior two-thirds of the tongue and compare the different. If having different , it shows that traumatic is locaed in the upper of chorda tympan.

Schirmers test: If the reduction of the secretion of tears, it indicates the disease lie in upper ganglion

Electrodiagnosis . Every facial paralysis should be tested as early as possible by electrodiagnostic methods .It can expression that information of the disease and prognosis Other examination: Electromyography, Electroneuronography, nerve excitability, Maximum simulation test.

Treatment 1.The treatment for cause of disease : If there is a definitude cause , we should treat it at first .Such as the patient have chronic purulent otitis media with facial paralysis , we should immediately do mastoidectomy and relieve the disease.

2. Medicine treatment : this includes injection of steroids , and low-molecular-weight intravenous infusion of dextran. Some china tradition medicine is useful for this disease.

3.

Operation treatment Immediatly decompression of the nerve should be undertaken . The principle of treatment is to decompress the nerve fibers by exposure of the nerve and slitting of its sheath.