Figure 2: Facial nerve injection. (Photo provided / Xu Youjun)
Text / Xu Youjun
Facial nerve palsy is the most common facial nerve disorder! They often come to the door because of abnormal life and rest, high pressure, and weakened immune system.
Patients often panic because of sudden drooling, drooping mouth corners, and inability to close eyes tightly, mistaking it for a stroke. In fact, such peripheral nerve lesions are not the same as stroke originating from the central nervous system, and early treatment can speed up recovery.
Mr. Gu has been busy with work recently, often working overtime and staying up late, and eating irregularly. I looked in the mirror one morning and found that the right side of my face was drooping, my eyes could not be closed tightly, and the corners of my mouth were drooping, but there was no weakness in my hands and feet. Frightened, he rushed to the doctor. Physical examination by a physiotherapist found that the right eyebrow was weakly raised, and the right corner of the mouth could not be closed. The diagnosis was facial nerve palsy (Figure 1). Under moderate hyperthermia, muscle electrical stimulation, laser and other rehabilitation treatments, as well as several individual muscle massages and exercise treatments, he slowly recovered his right face movements with almost no asymmetry.
Figure 1: The patient’s right eyebrow could not be lifted up, unable to close his eyes, and the right corner of his mouth could not be closed. (Photo provided / Xu Youjun)
More than 80% can be fully recovered
The cause of facial nerve palsy is currently unknown, but it is generally believed to be related to viral infection. About 80% of patients can fully recover, but there are still a few cases with residual facial muscle weakness.
In the acute stage, short-term steroids and high units of vitamin B should be taken first, and rehabilitation should be coordinated. Hyperthermia can increase blood circulation in the face and reduce fibrosis, while electrotherapy can stimulate paralyzed muscle contractions and slow muscle atrophy. Facial massage and active movement use symmetrical muscle movements to induce muscle contractions on the affected side and reduce unnatural expressions in the future.
Exercises at home can be done by raising eyebrows (creating forehead lines), frowning, closing eyes, pouting and blowing, and puffing up cheeks, so that patients can return to their own facial movements as soon as possible.
It is recommended that patients wear eye masks and eye drops while sleeping to prevent excessive dryness of the eyes and the occurrence of corneal ulcers.
If there are still obvious symptoms after the above treatment, under the guidance of high-resolution ultrasound, proliferative therapy, high-concentration platelet plasma, vitamin B, or appropriate amount of steroids can be used for nerve injection (Figure 2) to improve symptoms.
Some foreign scholars have published interventional therapy in the acute phase, and there is also an opportunity to shorten the course of treatment. All in all, a multi-pronged treatment approach and reducing physical and mental stress are the only way to heal.
(The author is a part-time attending physician of the North Nursing Branch of National Taiwan University Hospital and the president of Shunxin Rehabilitation Clinic)
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