Weakness of the muscles of the face is observed with central or peripheral paresis of the facial nerve due to neuritis, trauma, stroke, tumor processes, congenital anomalies, infectious diseases. The condition is detected in myasthenia gravis, multiple sclerosis, and some other pathologies. It can be one- or two-sided, spread to the entire face or part of it. The cause of the symptom is established by the results of the survey, neurological examination, data from neurophysiological studies, CT, MRI. Treatment includes antimicrobial and vasodilators, neuroprotectors, immunosuppressants, exercise therapy, massage, and surgery.
Develops due to hypothermia or other diseases. The most common form of facial neuritis is Bell's palsy. Pathology manifests with pain in the behind-the-ear region. After 1-2 days, asymmetry appears: drooping of the corner of the mouth, smoothing of the nasolabial fold, distortion of the face in a healthy direction. The affected side does not participate in movements: attempts to grin, smile, raise or frown an eyebrow. Lagophthalmos is revealed. There is a violation of taste sensations in the anterior parts of the tongue from the side of paresis.
In mumps, the clinical picture of neuritis is formed against the background of intoxication, general hyperthermia, and a visually noticeable increase in the salivary glands. In patients with chronic otitis, the symptom is combined with shooting pains in the ear. With Hunt's syndrome - a lesion of the geniculate ganglion of herpetic genesis, the first manifestation is intense pain in the ear, radiating to the back of the head, neck and face. Herpetic eruptions are found in the external auditory canal and on the auricle.
Paralysis of the facial nerve is detected in 20-50% of patients with a fracture of the pyramid of the temporal bone (depending on the type of damage). Accompanied by dizziness, decreased or loss of hearing, bleeding from the external auditory canal, or outflow of cerebrospinal fluid into the nasopharynx. The cause of weakness of the facial muscles can also be fractures of the jaws and zygomatic bone, accompanied by a violation of the integrity or compression of the nerve branches.
With injuries of the zygomatic bone, the circular muscle of the eye and the muscles of the upper cheek are affected. In case of damage to the upper jaw, there is a violation of innervation in the zone of the buccal branches with paresis of the nasal, buccal, large zygomatic and circular muscles of the mouth, as well as the muscle that raises the angle of the mouth. With fractures of the lower jaw, weakness of the muscles of the chin and lower lip is found. A similar picture is revealed with excessive compression of the lateral branch of the lower jaw during the use of mask anesthesia.
Weakness of facial muscles
Acute weakness of the muscles of half of the face may be due to peripheral paresis against the background of hemorrhage or ischemia in the area of the nucleus of the facial nerve. As a rule, it is supplemented with contralateral hemiparesis. Less often, isolated paralysis of the facial muscles is detected as a result of circulatory disorders in people with arterial hypertension or diabetes mellitus.
Isolated weakness of the muscles of the lower part of the face is sometimes determined with lacunar strokes in the area of cortical structures, primarily in the zone of the radiant crown, bridge and internal capsule. The patient cannot smile, bare his teeth, move the corner of his mouth. The ability to close the eyes is usually preserved. The deviation of the protruding tongue towards the pathological focus testifies to the central nature of the lesion.
Unilateral weakness can be provoked by tumors in the central cortex, posterior pons, or olive of the medulla oblongata. The clinical picture includes cerebral and focal symptoms. Manifestations increase gradually. The cause of bilateral muscle paresis can be a widespread lesion of the basal parts of the brain in Beck's disease and carcinomatosis.
With compression or germination of the facial nerve after it leaves the brain, the symptom is provoked by the following pathologies:
Weakness of individual muscles of the face is sometimes associated with the growth of other tumors of the maxillofacial region, if these neoplasias are located in the area where the branches of the facial nerve pass. The clinic is determined by the type and localization of neoplasms.
Congenital underdevelopment of the nuclei of several cranial nerves is more often bilateral in nature, manifested by strabismus, sucking and swallowing disorders, dysarthria, and dysphonia. The child's face is amimic, with lowered corners of the mouth and a parted mouth. Lagophthalmos is revealed. Combined defects are possible: microphthalmos, micrognathia, cleft palate. Half of the children with Möbius syndrome have anomalies in the development of the limbs.
Bilateral facial muscle weakness is possible with the following infectious pathologies:
In addition, weakness of the facial muscles is detected in basal meningitis of various etiologies. It is caused by the involvement of the nuclei of the cranial nerves. Along with the facial, the oculomotor, trochlear and vestibulocochlear nerves are most often affected. There are excruciating headaches, vomiting, convulsions, impaired consciousness.
Autoimmune pathologies are characterized by symmetrical lesions. The symptom occurs in the following diseases:
The symptom accompanies some muscular dystrophies. With progressive Erba-Roth myodystrophy, the muscles of the pelvic girdle and proximal legs suffer. Subsequently, muscle weakness spreads, against the background of hypomimia, the "face of the sphinx" is formed. With oculopharyngeal muscular dystrophy, the mimic muscles first suffer, then dysphagia, ophthalmoparesis, and weakness of the limbs join.
A neurologist is engaged in establishing the cause of weakness of the muscles of the face. During the survey, the specialist finds out the time of the onset of the symptom, identifies other signs, and examines the dynamics of the progression of the disease. To clarify the diagnosis, procedures such as:
Facial taping
Therapeutic programs include drugs and non-drug therapies. In the treatment of weakness of the muscles of the face, the following agents are used:
To maintain motor ability, improve the function of the affected muscles, exercise therapy and massage are performed. As part of physiotherapy, UHF, ozocerite applications, paraffin therapy, ultrasound, phonophoresis, and electrical stimulation are used. With intense pain, blockades are performed. Patients with oncological processes undergo chemotherapy and radiation therapy.
Complete traumatic rupture of the nerve is an indication for its suturing. When compressed by scar tissue, neurolysis is performed. Facial nerve plasty using an autograft is possible. To eliminate the asymmetry of the face, static suspension of the corner of the mouth, dynamic suspension of the corner of the eye or mouth are carried out.
Injuries can be considered as an indication for reposition of the zygomatic bone or zygomatic-orbital complex, osteosynthesis of the jaws. In case of disorders of cerebral circulation, aneurysms are removed, anastomoses are formed, and reconstructive operations on the vessels are performed. Patients with brain neoplasms require stereotaxic or open excision of the neoplasia. Tumors of the salivary glands are removed in the traditional way or using robotic technologies.