Principles and methods of treatment of neuritis of the facial nerve

Diagnosis of neuritis of the facial nerve should be made on time, and treatment started as early as possible, because in its absence, neuritis leads to the development of contractures of facial muscles. Such an outcome can be detected as early as 1-1.5 months after the onset of the disease. Contractures tighten the face on the affected side, which is accompanied by involuntary muscle contractions.

At the same time, the patient's face looks paralyzed on one side. Such complications can be avoided by promptly starting adequate treatment of neuritis of the facial nerve. What is the treatment of the disease?

Differential diagnosis before treatment of facial neuritis

The symptoms of neuritis of the facial nerve are quite specific and vivid, so that the diagnosis is established without much difficulty. However, before treatment of neuritis of the facial nerve, it is necessary to exclude Melkerson's syndrome – Rosenthal and Hunt's syndrome. With Hunt's syndrome, a herpetic lesion of the geniculate ganglion occurs, through which the innervation of the external auditory canal, the auricle, tonsils and palate, and the auditory canal is carried out. With the development of inflammation, the process covers the motor fibers of the facial nerve, which are located nearby.

In this case, the disease begins with intense pain in the ear, radiating to the face, back of the head and neck. On the auricle, on the mucous membrane of the pharynx, the anterior part of the tongue and in the external auditory canal, herpetic eruptions are observed. At the same time, paresis of facial muscles is detected on the side of the lesion, the perception of taste in the middle third of the tongue is disturbed. Horizontal nystagmus, tinnitus, and dizziness may occur. In Melkerson-Rosenthal syndrome, there is a dense swelling of the face and a folded tongue.

What are the principles of treatment of neuritis of the facial nerve?

Analgesics are used to eliminate severe pain. At the beginning of the disease, treatment of neuritis of the facial nerve is carried out with the help of glucocorticosteroids, decongestants, vasodilators and B vitamins. In secondary neuritis, treatment of the underlying disease is indicated. From the first days of illness, non-contact heat is applied. A few days later, the UHF course is applied – therapy for 10 days, paraffin therapy and ozocerite applications.

Basic principles for the treatment of neuritis of the facial nerve:

• Therapeutic exercise and therapeutic massage should be started from the second week of illness with a gradual increase in load.
• From the second week, anticholinergic drugs are prescribed to improve conductivity.
• Hydrocortisone phonophoresis or ultrasound may also be used.
• If necessary, drugs are prescribed that improve metabolic processes in the nervous tissue.
• If necessary, conduct electrical nerve stimulation.

When is the effectiveness of the treatment of neuritis of the facial nerve evaluated?

Restoration of all functions should be carried out after 3 months from the start of treatment for neuritis of the facial nerve. In the absence of the effect of treatment, biostimulants and lidase are prescribed. In the presence of contractures, anticholinesterase drugs are canceled, followed by the use of tegretol and medocalm.

In case of congenital neuritis of the facial nerve, surgical treatment is used. Also, surgical treatment of neuritis of the facial nerve is used in case of nerve rupture as a result of injury. If conservative therapy is ineffective for 10 months, as well as in the presence of instrumentally confirmed information about the degeneration of the nerve, then the question of performing an operation is decided.

Indications for surgical treatment of facial neuritis

It is important to remember that surgical treatment of facial neuritis should be carried out during the first year of the disease, since after a year irreversible atrophic changes in the facial muscles begin, the innervation of which can no longer be changed.

In the course of surgery, autotransplantation of the facial nerve is performed. The graft is taken from the patient's own leg. During the operation, 2 branches of the facial nerve are sutured, which are attached to the muscles on the affected half of the face from the healthy side. As a result, an impulse from a healthy facial nerve is transmitted simultaneously to both halves of the face and causes natural and symmetrical movements.