Asymmetry of the nasolabial folds is a sign of a number of neurological diseases, occurs in some dental pathologies, and may be the result of aesthetic operations, cosmetic manipulations. The difference in depth and angles of inclination of the folds ranges from insignificant to pronounced. Pathology is often observed simultaneously with other types of facial asymmetry. The reason for the violation of the symmetry of the nasolabial folds is determined according to the survey, neurological examination, imaging and electrophysiological techniques. Treatment prior to diagnosis is not indicated.
Why does the asymmetry of the nasolabial folds appear?
Physiological causes
The faces of most people are asymmetrical, which is explained by slight differences in the structure of the right and left halves, and the formation of mimic wrinkles. The asymmetry of the nasolabial folds is especially noticeable with the habit of smiling in one corner of the mouth, twisting the mouth, expressing displeasure, sleeping on one side, or chewing gum on one side of the mouth. Symmetry disorders progress with age, but in the absence of other causes do not reach the level of a noticeable cosmetic defect.
Neuritis of the facial nerve
The most common neurological cause of asymmetry of the nasolabial folds is considered to be facial neuritis (Bell's palsy), accompanied by unilateral weakness of the facial muscles. Pathology occurs primarily due to a cold or complicates the course of the following conditions:
- Otitis media. Symptoms develop against the background of shooting pains in the ear.
- Parotitis. The appearance of asymmetry is preceded by an increase in the salivary gland, a change in the contours of the face, and signs of general intoxication.
- herpetic infection. The manifestation of neuritis is due to a special form of herpes zoster - Hunt's syndrome, in which ear pain, skin rashes, hearing loss, and dizziness are observed.
- Facial nerve injury. The nasolabial fold is smoothed out due to a violation of the integrity of the nerve trunk or its compression by scar tissues.
- Melkersson-Rosenthal syndrome. Occurs with periodic relapses. Complicated by neuritis in 2% of patients. Other manifestations include dense swelling of the face and folded tongue.
- alternating syndromes. Facial paresis in Millard-Gubler syndrome is complemented by the opposite hemiparesis, in Gasperini syndrome - strabismus, hearing loss, and sensitivity disorders. Brissot-Sicard syndrome is characterized not by paresis, but by a spasm of the facial muscles with a deepening of the nasolabial fold.
Neuritis is diagnosed with tumors of the brain and the zone of the passage of the facial nerve, for example, neurinoma of the internal auditory canal. In addition, Bell's palsy occurs against the background of neuro infections, which include:
- Encephalitis. A group of diseases of a fungal, bacterial, and viral nature with an intoxication syndrome, and cerebral and focal symptoms.
- Polio. The defeat is caused by the polio virus, observed in the stem form of the disease.
- brain abscess. A limited accumulation of pus in the brain tissues, accompanied by focal symptoms, and severe intoxication.
- Neurosyphilis. In the early stages, focal, cerebral, and general infectious manifestations are detected. Subsequently, mental disorders, progressive dementia, and stroke-like symptoms are found.
- NeuroAIDS. Paresis is combined with aphasia, ataxia, mnestic disorders, and psychopathological manifestations.
- Botulism. It develops acutely after the use of canned food. Paresis and paralysis are typical, and respiratory and cardiac disorders are possible.
In the initial stages of neuritis, asymmetry appears due to the smoothing of the nasolabial fold on the affected side. In the absence of treatment or inadequate treatment, patients develop contracture of facial muscles. In this case, the nasolabial fold on the affected side, on the contrary, becomes more pronounced.
Asymmetry of the nasolabial folds
Cerebral circulation disorders
The asymmetry of the nasolabial folds is of great practical importance in the development of acute cerebrovascular accidents. This symptom is visible and detected at an early stage. Along with other signs (slurred speech, weakness of the limbs, deviation of the tongue to the side), it allows you to quickly determine the nature of the problem, and promptly deliver the patient to a medical facility. It is found in the following types of stroke:
The frequency of occurrence of changes in the configuration of the nasolabial folds in different types of stroke varies. The symptom is quite typical, but not pathognomonic for this pathology, it occurs due to damage to the departments responsible for the functioning of the facial nerve. The absence of a symptom is not a basis for excluding stroke.
Traumatic brain injury
As in the previous case, the asymmetry of the nasolabial folds develops as a result of disruption of the brain centers that regulate the activity of the facial nerve. It can be observed with the following traumatic brain injuries:
- brain contusion (mainly moderate and severe);
- acute compression of the brain;
- diffuse axonal damage;
- intracerebral, subdural, epidural hematomas.
The severity of asymmetry is significantly different. Pathology is most noticeable with acute compression, combined with a "floating cheek" and lagophthalmos.
Innervation disorders in children
The symptom often accompanies various forms of dysarthria in children. Gross changes in most cases are observed in cerebral palsy. A slight asymmetry of the nasolabial folds is found in children with erased dysarthria associated with inferior innervation of the tongue, lips, and soft palate. Several cranial nerves suffer, and asymmetry is supplemented by restriction of movements of the lower jaw and tongue, hypersalivation, and impoverishment of facial expressions.
dental problems
Asymmetry of the nasolabial folds can be congenital or acquired. Caused by the following reasons:
- Absence of teeth. With a long absence of molars and premolars on one side, the contours of the face gradually change, and the nasolabial fold deepens. The bilateral absence of teeth causes deepening of the folds on both sides, and the severity of the asymmetry is determined by the location of the remaining dental units.
- Crossbite. There is a crossing of the dentition when the jaws are closed. The chin moves and the lip sinks, which entails a violation of the symmetry of the lower parts of the face.
- Tumors of the salivary glands. The skew of the nasolabial folds can be determined by adenomas, lipomas, angiomas, neurinomas, sarcomas, and carcinomas, it is formed secondarily against the background of compression or germination of the facial nerve passing near the salivary gland.
- Diseases of the TMJ. Restriction of movements in the temporomandibular joint with arthrosis, ankylosis, and contractures causes lateral displacement of the lower jaw and distortion of the face.
- Tumors of the jaws. Asymmetry becomes one of the first symptoms of a neoplasm of the upper jaw when it is located in the projection of the nasolabial fold.
- jaw defects. Malformations, post-traumatic deformities, defects after tuberculosis, osteomyelitis, and removal of tumors of the upper jaw lead to cheek retraction and smoothing of the nasolabial fold. In patients with mandibular defects, asymmetry is formed due to displacement of the jaw when opening the mouth.
- Injuries. With fresh fractures of the jaws, asymmetry is provoked by edema and displacement of fragments. In the long term, the change in the contours of the nasolabial folds is caused by improper fusion of bone fragments, and excessive formation of callus.
Consequences of aesthetic procedures and surgeries
The lesion is more often potentiated by the introduction of fillers based on calcium hydroxylapatite, polycaprolactone, and L-lactic acid polymer. These funds cause increased formation of fibrin fibers and proliferation of connective tissue. Some time after the procedure, uneven fibrosis or the formation of coarse fibrous bands may be observed, causing asymmetry.
Collagen-based fillers quickly dissolve, which necessitates the introduction of an excess amount of the drug and possible hypercorrection of the nasolabial folds. Sometimes after the application of such fillers, granulomas and compaction zones appear. The formation of granulomas is also noted after the introduction of the patient's adipose tissue.
In some patients, asymmetry occurs after ligature lifting of the nasolabial folds, and the use of various methods of a surgical facelift. The reason for the changes is insufficiently careful planning or violation of the technique of the intervention, non-compliance by the patient with medical recommendations, and complications in the postoperative period.
Diagnostics
The reason for the change in the configuration and depth of the nasolabial folds is established by a neurologist. According to the indications, patients are referred to dentists, maxillofacial, and aesthetic surgeons. The examination program provides for the following diagnostic procedures:
- Questioning, examination. The doctor finds out when and under what circumstances the symptom appeared, and how it changed during the disease. Evaluates the speech, memory, and psycho-emotional state of the patient. Conversation and physical examination reveal other manifestations of the disease.
- Neurological examination. The specialist draws attention to the violation of the symmetry of different parts of the face, the size of the pupils, and palpebral fissures. Explores eye movements, asks to puff out cheeks, bare teeth, frown, and show tongue. Determines reflexes, sensitivity, and muscle tone of various areas of the face and body.
- Radiography. In the case of TBI, an x-ray of the skull is performed, in case of traumatic injuries and diseases of the facial skeleton, pictures of the jaws, and x-rays of the TMJ are taken.
- echoencephalography. Produced at the initial stage of the survey. Allows you to quickly detect volumetric processes (tumors, abscesses, hematomas) that cause displacement of the median structures of the brain.
- CT and MRI of the brain. They are used at the stage of clarifying the diagnosis, they make it possible to clarify the nature, volume, and localization of hemorrhages, neoplasms, and inflammatory processes.
- Electrophysiological studies. Electromyography, electroneurography, and evoked potentials are prescribed to determine the localization of the pathological process, and the severity of damage to the nerve trunk in neuritis of the facial nerve.
Contour plastic - a method of eliminating the asymmetry of the nasolabial folds
Treatment
Help at the prehospital stage
The sudden appearance of asymmetry in the area of the nasolabial folds, combined with speech disorders, and weakness of the limbs, may indicate a stroke and are the reason for an immediate call for an ambulance. Patients with TBI also need emergency hospitalization.
Before the arrival of the medical team, patients with TBI and suspected stroke should be laid in a comfortable position with their heads elevated. Victims in an unconscious state should lie on their side, this facilitates breathing and prevents saliva and vomit from entering the respiratory tract. For patients with fractures of the jaw, a temporary soft bandage is applied.
Conservative therapy
Therapeutic tactics are determined by the nature of the pathology:
- Damage to the facial nerve. Apply glucocorticoids, B vitamins, decongestants and vasodilators, UHF, paraffin applications, ultrasound, electrical stimulation, massage, and exercise therapy. Treat the underlying disease. With severe pain, blockades are performed.
- OK. According to the indications, resuscitation measures are carried out, and symptomatic agents are prescribed. In the treatment of ischemic stroke, antiplatelet agents, anticoagulants, and vasoactive drugs are used. At the recovery stage, massage, electrical stimulation, physiotherapy exercises, and correction of speech disorders are shown.
- TBI. If necessary, life support measures are taken, mannitol is administered to prevent intracranial hypertension, and antibiotics to prevent infection.
- Innervation disorders. Vitamins, nootropics, exercise therapy, massage, physiotherapy, and exercises for the development of coordination of movements are recommended for pediatric patients.
- Dental problems. Treatment and prosthetics of teeth and installation of orthodontic appliances may be required.
Surgery
Taking into account the characteristics of the pathology, the following surgical interventions are performed:
- Facial neuritis: neurolysis, nerve suture, static or dynamic suspension of the corner of the mouth.
- ONMK: thrombolysis, stereotaxic or open removal of the hematoma.
- TBI: transcranial, endoscopic, or stereotaxic removal of intracerebral, subdural, and epidural hematomas.
- Dental pathologies: splinting of teeth, osteosynthesis of the upper or lower jaw, resection of the jaw with a tumor, arthroscopy, arthrocentesis, and endoprosthetic of the TMJ, implantation of teeth, removal of neoplasia of the salivary glands.
- Aesthetic problems: facelift, reconstructive surgeries.