Paralysis of facial muscles - symptoms and treatment

Often you can meet people with an interesting facial expression: it is asymmetrical, as if distorted, emotionless, perhaps accompanied by small muscle twitches.
All these signs are united by a common name - facial neurosis. This condition can have a different nature of occurrence and is provoked by both objective reasons and factors of a psychogenic nature.

Unusual sensations

It happens that a person can feel phenomena in the face and head that are unusual for the usual state. They are called paresthesias and are manifested by the following symptoms:

• tingling;
• burning;
• "goosebumps"
• numbness;
• itching and rashes.

Often facial paresthesias have an organic basis and become a sign of the disease:

• neuritis, neuralgia of the cranial nerves;
• multiple sclerosis;
• stroke and other circulatory disorders in the brain;
• shingles;
• migraine;
• diabetes;
• epilepsy;
• hypertension.

In certain cases, unusual sensations are observed in certain parts of the face. For example, similar manifestations in the language may appear for the reasons listed above, but often have a different etiology. They are provoked by cancer of the tongue and larynx, as well as trauma by a splintered tooth or denture.

Dental procedures cause numbness and other unusual feelings, especially after tooth extraction. Another reason for their appearance may be an uncomfortable position during sleep or an unsuitable pillow. But the sensations caused by such phenomena usually pass soon.

Another group of provoking factors consists of psychogenic and neurogenic disorders.

Risk factors

There may be a hereditary predisposition. Acute neuritis associated with a complicated family history is found in 4% of cases. The disorder may be associated with autosomal dominant gene transmission. The presence of other neurological diseases in close relatives, such as trigeminal neuralgia and multiple sclerosis, increases the patient's risk of developing the disease. Doctors also consider the influence of other conditions and symptoms, including lifestyle factors.

Known risk factors:

1. Age. Neuritis is most often diagnosed in patients aged 15 to 60 years. In children, secondary facial paralysis is usually detected.
2. Diabetes. Elevated blood glucose levels lead to damage to small vessels that supply nerve fibers.
3. Traumatic brain injury. With TBI, damage to the brain matter and deformation of the skull bones with subsequent compression of the facial nerve are possible.
4. Pregnancy. Facial paralysis occurs especially often during the last trimester or a week after childbirth.
5. Chronic infections of the upper respiratory tract. From the respiratory tract, viruses can spread to neighboring tissues.
6. Pre-existing neurological diseases, including multiple sclerosis, ophthalmoplegia and essential tremor.
7. Congenital or acquired decreased immunity. Usually we are talking about HIV infection and its complications, which increase the risk of developing a herpetic or cytomegalovirus form of the disease.

Preventive measures aimed at eliminating risk factors are effective for secondary neuralgia.

Disorders of facial innervation

A neurotic face may develop due to damage to the nerves that innervate it. Most often these are the trigeminal and facial nerves.

The trigeminal nerve is the 5th pair of cranial nerves. It is the largest of all 12 pairs of these nerve fibers.

N. trigeminus arises symmetrically on both sides of the face and consists of 3 large branches: the ophthalmic, maxillary and mandibular nerves. These three large processes innervate a fairly large area:

• skin of the forehead and temples;
• mucous membrane of the oral and nasal cavities, sinuses;
• tongue, teeth, conjunctiva;
• muscles - chewing, floor of the mouth, palatine, tympanic membrane.

Accordingly, when it is damaged, pathological sensations arise in these elements.

Facial nerve – 7th pair of cranial nerves. Its branches surround the temporal and ocular region, the zygomatic arch, and descend to and behind the lower jaw. They innervate all facial muscles: auricular, orbicularis and zygomatic, chewing, upper lip and corners of the mouth, cheek. As well as the muscles of the lower lip and chin, around the mouth, the muscles of the nose and laughter, and the neck.

N. facialis is also paired, and is located on both sides of the face.

In 94% of cases, the damage to these nerve fibers is unilateral, and only 6% is a bilateral process.

Disruption of innervation can also be primary or secondary.

Primary is the lesion that initially involves the nerve. This could be hypothermia or strangulation.

Secondary damage develops as a consequence of other diseases.

Another reason for the development of facial neurosis is neurogenic and mental disorders. When unpleasant sensations in the face and head occur against the background of psycho-emotional arousal, shock, or as a result of stressful situations.

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Facial nerve neurosis

Neuritis (neurosis N. Facialis) or Bell's palsy occurs due to inflammation of the nerve fiber. Reasons leading to this condition:

• pinched nerve as a result of narrowing of the channel through which it passes. This may be a congenital phenomenon or result from inflammation;
• hypothermia;
• other diseases and infections: herpes, mumps, otitis media, stroke, cancer, central nervous system infections;
• injury N. Facialis.

The onset of the disease is usually gradual. Manifested by pain in the behind-the-ear area. After a couple of days, neurological facial symptoms appear:

• smoothing of the nasolabial fold, drooping of the corner of the mouth;
• the face becomes asymmetrical with a skew towards the healthy side;
• eyelids do not droop. When you try to do this, your eye rolls;
• any attempt to show at least some emotion ends in failure, since the patient cannot move his lips, smile, or manipulate his eyebrows. Such manifestations can worsen to the point of paresis and paralysis of the facial muscles, that is, to partial or complete immobility of the affected part of the face;
• taste sensitivity decreases, salivation appears;
• the eyes are dry, but there is lacrimation when eating;
• hearing on the affected side worsens.

The severity of pathological symptoms depends on the degree and area of ​​damage to the nerve fiber. If the disease is treated inadequately, complications may arise in the form of muscle contractures (immobility).

Since the disease is inflammatory in nature, its treatment is aimed at eliminating it. For this, the patient is prescribed hormonal anti-inflammatory drugs - glucocorticoids, as well as decongestants.

Other methods include:

• prescription of vasodilators and analgesics, B vitamins;
• anticholinesterase agents to increase nerve conduction;
• drugs that improve metabolism in nervous tissue;
• physiotherapy;
• massage, exercise therapy in the recovery stage.

And only in extreme cases, when conservative therapy is ineffective, neurosurgical intervention is resorted to.

Treatment

The etiology of facial asymmetry is very diverse. Many diseases accompanied by this symptom can pose a serious threat to the patient’s health, especially if treatment is started late. Self-medication in such cases is unacceptable; the appearance of this symptom should be considered as a reason to immediately seek medical help.

Conservative therapy

The treatment plan varies depending on the characteristics of the pathology. In many cases, a special diet is recommended. For dental diseases, treatment of caries, pulpitis, and periodontitis can be carried out. Patients with facial asymmetry are prescribed medications of the following groups:

• Analgesics
  . Indicated for severe pain syndrome. Intramuscular injections or tablet forms are possible.
• NSAIDs
  . Required to reduce the severity of inflammation, swelling, and pain. General action drugs are taken in short courses to reduce the risk of side effects from the liver and gastrointestinal tract.
• Antibiotics
  . Necessary for general bacterial infections and local inflammatory processes. First, broad-spectrum drugs are used; after receiving the results of microbiological analysis, the antibiotic treatment regimen is adjusted taking into account the sensitivity of the pathogen.
• Antiseptics
  . Local medications are used in the form of rinses. Recommended in the presence of inflammation, wounds on the mucous membrane, after surgery.

In some cases, drug therapy is supplemented with physical therapy. When treating diseases that cause facial asymmetry, electrical stimulation, UHF, medicinal electrophoresis, and other methods may be prescribed. For oncological pathologies, chemotherapy and radiation therapy are performed.

Trigeminal neuralgia

This is another lesion of the nerve fiber structure, which is often chronic and accompanied by periods of exacerbation and remission.
It has several causes, which are divided into idiopathic - when a nerve is pinched, and symptomatic.

The main symptom of neuralgia is paroxysmal sensations in the form of pain on the face and in the mouth.

Pain sensations have characteristic differences. They are “shooting” and resemble an electric shock; they arise in those parts that are innervated by the n.trigeminus. Having appeared once in one place, they do not change localization, but spread to other areas, each time following a clear, monotonous trajectory.

The nature of the pain is paroxysmal, lasting up to 2 minutes. At its height, a muscle tic is observed, that is, small twitching of the facial muscles. At this moment, the patient has a peculiar appearance: he seems to freeze, but does not cry, does not scream, and his face is not distorted from pain. He tries to make a minimum of movements, since any of them increases the pain. After the attack there is a period of calm.

Such a person performs the act of chewing only with the healthy side, at any time. Because of this, compaction or muscle atrophy develops in the affected area.

The symptoms of the disease are quite specific, and its diagnosis is not difficult.

Therapy for neuralgia begins with taking anticonvulsants, which form its basis. Their dose is subject to strict regulation and is prescribed according to a specific scheme. Representatives of this pharmacological group can reduce agitation and the degree of sensitivity to painful stimuli. And, therefore, reduce pain. Thanks to this, patients have the opportunity to freely eat and talk.

Physiotherapy is also used. If this treatment does not give the desired result, proceed to surgery.

Real life examples

Some famous people, whose fame sometimes trumpets all over the world, were also hostage to the pathology of the facial nerve.

Sylvester Stallone, who is known for his enchanting roles, was injured at birth. The actor's mother had a difficult birth and he had to be pulled with forceps. The result is damage to the vocal cords and paresis of the left side of the face. Because of this, Stallone had problems with speech, which became a reason for ridicule from his peers.

The actor grew up as a difficult child. But, in spite of everything, he managed to overcome his defect and achieve considerable success, although partial immobility of his face remained.

Domestic showman Dmitry Nagiyev received facial asymmetry, which was nicknamed “Nagiyev’s squint”, due to paresis of the facial nerve. The illness happened unexpectedly. As a theater student, one day he felt that his face was not moving.

He spent 1.5 months in the hospital to no avail. But one day in his room a window broke due to a draft. Fright provoked a partial return of mobility and sensitivity of the facial part, but the left part retained its immobility.

Diagnostics

Determining the cause of facial asymmetry is most often carried out by dentists or neurologists. If appropriate symptoms are detected, the patient is referred to otolaryngologists, oncologists, endocrinologists, and other specialists. The examination plan may include the following diagnostic procedures:

• Questioning, physical examination
  . The doctor establishes the time and circumstances of the onset of the symptom and asks the patient about other manifestations of the disease. Evaluates the severity of asymmetry at rest, during facial and chewing movements. Detects other changes: swelling, redness, blanching, increased local temperature, tumor formations.
• Dental examination.
  Includes studying the condition of teeth, gums, hard and soft palates, mucous membranes of other areas, and bones of the facial skeleton. Allows you to confirm the presence of diseased teeth, inflammation, injury, suppuration, tumors.
• Neurological examination.
  The specialist studies the innervation of the facial muscles, asking the patient to perform certain movements: wrinkle his forehead, raise and lower his eyebrows, puff out his cheeks, show his tongue, bare his teeth, follow the movements of the neurological hammer with his eyes. The neurologist then palpates the available nerve exit points.
• Otorhinolaryngological examination.
  Provides for special research. If pathology of the paranasal sinuses is suspected, echosinusoscopy or diagnostic puncture can be performed. In case of complaints of hearing impairment, audiometry, tuning fork examination, etc. are performed. For vestibular disorders, vestibulometry and rotational tests are recommended.
• Radiography
  . Taking into account the identified pathological changes, the patient is prescribed an X-ray of the tooth, an X-ray examination of the jaw or paranasal sinuses. In some cases, radiographs of the skull and cervical spine are necessary.
• Ultrasonography
  . During the examination, sonography of the salivary glands, paranasal sinuses, and soft tissues may be performed. If signs of brain compression are detected, echoencephalography is indicated.
• Other visualization techniques
  . Most often, CT or MRI are used to clarify the diagnosis and to study in detail the nature of the changes, the volume and location of the pathological focus. For neurological pathology, PET-CT and SPECT of the brain may be prescribed.
• Lab tests
  . A general blood test determines the presence and severity of inflammation; the results of a microbiological study determine the pathogen and its sensitivity to antibiotics. In case of space-occupying formations, histological and cytological examination of smears, punctures, and biopsy specimens is carried out.

Elimination of facial asymmetry

Migraine

This condition is accompanied by attacks of unbearable headache. It is also associated with disruption of the trigeminal nerve, or more precisely, with its irritation in one part of the head. This is where the pain is subsequently localized.

The onset of migraine includes several stages:

• initial;
• aura;
• painful;
• final one.

Paresthesia of the head and face appears with the development of the aura stage. In this case, the patient is bothered by a feeling of tingling and crawling, which occurs in the arm and gradually moves to the neck and head. The person’s face becomes numb and it becomes difficult for him to speak. I am concerned about dizziness and visual disturbances in the form of light flashes, floaters and a decrease in the field of vision.

Facial paresthesia is a precursor to migraine, but often the attack occurs without the aura stage.

Psychogenic causes of facial neurosis

Undoubtedly, disturbances in facial sensations quite often become a consequence of pathology of internal organs and blood vessels.

But often they are caused by psychological disorders and pathological thoughts that arise in our heads.

Facial paresthesias can be situational in nature and develop during episodic nervous excitement: as a result of quarrels, prolonged and intense screams. Such phenomena cause overstrain of the muscles, especially the cheeks and those located around the mouth. As a result, we experience facial numbness and even mild soreness.

The feeling of fear causes us to breathe quickly and shallowly, or to hold our breath. Disturbances in the respiratory rhythm can also provoke impressions that are atypical for us. A feeling arises that is characterized as a “chill running through.” Moreover, it is more concentrated at the roots of the hair. In this case they say: “chills to the marrow of the bones.” The face also becomes cold, a slight tingling appears in its area.

Such phenomena are disturbing when we are overwhelmed by strong emotions. But they accompany people suffering from mental disorders systematically.

A special type of neurotic facial manifestations is a nervous tic. It is characterized as an uncontrolled and systematic contraction of the facial muscles.

The disorder more often accompanies men. And it manifests itself with the following symptoms:

1.Motor:

• frequent blinking, winking;
• setting the lips with a tube;
• nodding head;
• constant spitting or sniffing;
• opening or upturning of the corner of the mouth;
• wrinkling of the nose.

2. Vocal:

• screaming;
• grunt;
• coughing;
• repetition of words.

There are also signs – precursors – that signal the appearance of a tic.
These include itching, facial heat and other paresthesias. Naturally, these signs are considered pathological if they occur in an inappropriate situation. It happens that only the patient himself feels them, but they are not visible to others.

But often twitching and other nervous symptoms become noticeable by other people, and they cause a lot of discomfort to the patient.

Tics can be simple, when there is only one symptom, or complex, which combines several manifestations.

The most common, main cause of tics is mental stress. It can be caused by a strong stress factor of one-stage action. Perhaps you were very scared of something, or broke up with your loved one. That is, the shock was so strong for you that your nervous system lost control.

Or, on the contrary, disorders develop as a result of prolonged monotonous exposure. Symptoms often appear due to lack of sleep and overwork.

Their duration varies. A situational nervous tic disappears a few hours or days after the cause is eliminated. In another case, it persists for years or haunts the patient throughout his life. In such a situation, in addition to eliminating the provoking factor, subsequent psychological work with the patient is required. This type of disorder is called chronic.

A nervous tic can be one of the signs of mental disorders such as neurosis, obsessive thoughts and phobias, depression.

Another group of provoking factors include:

• diseases - stroke, brain injury, infections or poisons;
• neurodegenerative diseases - Huntington's chorea. Characterized by destruction of brain tissue. Accompanied by uncoordinated, sudden movements, as well as neurological disorders of the face. Of these, the first sign is slow eye movements. Then a muscle spasm of the face occurs, which manifests itself in grotesque facial expressions - grimacing. Speech, chewing and swallowing are impaired;
• burdened heredity;
• parasitic infestations;
• eye fatigue due to prolonged eye strain;
• unbalanced diet, when the body receives little magnesium, calcium, glycine. These elements participate in the normal conduction of nerve impulses and are responsible for the coordinated functioning of the nervous system.

Why is the face distorted after a stroke?

Facial distortion with partial paralysis is a characteristic symptom of a developing stroke. A stroke can be ischemic or hemorrhagic; if the left side of the brain is affected, then paralysis covers the right side of the face.

Asymmetrical facial distortion occurs for two reasons:

• damage to facial muscles;
• paralysis of the central facial nerve due to inflammation caused by cerebral edema.

Facial distortion after a stroke is not a death sentence; there are entire techniques and a set of special exercises for restoring the facial muscular system.

Nervous tics in children

There are several types of such disorders in childhood.

Transient tic disorder begins to manifest itself during early school age. Its duration ranges from 1 month to 1 year. Motor types of tics occur more often. Mainly typical for children with developmental delays and autism.

Chronic disorder occurs before age 18. And lasts from 1 year and above. In this case, either motor or vocal tics develop. The earlier the pathological symptoms appear, the easier and faster they pass.

Tourette syndrome is a multiple tic disorder characterized by both motor and movement types. A serious disease, which, however, softens with age.

A special type of disease, which is also characterized by signs of the nervous type, is minor chorea. It develops against the background of infections caused by streptococcus: sore throat, tonsillitis, rheumatism. Accompanied by pathological changes in nervous tissue.

Along with hyperkinesis, emotional instability, irritation, restlessness and anxiety, this condition corresponds to neurotic changes in the face. They are expressed in tension and spasms of the facial muscles, which is often mistaken for grimacing. There is also a spasm of the larynx, manifested in inappropriate screams.

At school, such children, not knowing the true cause of facial hyperkinesis, and even in combination with increased activity, are reprimanded and kicked out of class. Such an attitude towards the child forces him to miss school classes and avoid going to school. Treatment for chorea minor, along with sedatives, includes antibiotics to fight infection and anti-inflammatory drugs.

A nervous tic leaves a heavier imprint on a child’s psyche than on an adult. It often causes anxiety and detachment, withdrawal, and even provokes depressive disorders. Causes sleep disturbances, speech difficulties, and learning difficulties.

Tic disorders lead to distorted self-perception and decreased self-esteem.

Parents of such children are advised not to focus the child’s attention on the problem. On the contrary, they recommend finding ways to shift attention and increase self-esteem. A special place is given to support groups for such people and communication in general.

How to get rid of nervous tics

In order to free yourself from unpleasant sensations, you must first eliminate their problem. Sometimes all it takes is a good night's sleep. In another case, you need to change the situation for a while, get out of the destructive environment.

Among the auxiliary methods used are herbal soothing teas, baths with the addition of aromatic oils, swimming, walks in the fresh air or sports: running, yoga.

Add ingredients with a high content of calcium and magnesium to your menu. These include fermented milk products, buckwheat, bran bread, red fish, eggs, and meat. Vegetables and fruits include beets, currants, dried fruits, nuts and parsley.

If these foods do not fit into your diet, consider taking appropriate vitamin supplements. Do not overuse strong tea and coffee.

And most importantly: remain optimistic and calm in any situation!

In cases where the condition worsens, psychotherapy is sought. Cognitive behavioral therapy is especially effective in helping to stop tic disorders at the stage of their precursors.

Habit reversal therapy teaches patients movements that help prevent the development of neurological facial symptoms.

Medications include anticonvulsants and muscle relaxants, Botox injections, and antidepressants.

If the above methods are ineffective in combating nervous tics, they turn to deep brain stimulation. A device is installed in the GM that controls electrical impulses.

How to remove teak yourself

If a nervous facial tic is situational and is not too intense, but at the same time obsessive, you can try to get rid of it using physical methods.

One way is to try to disrupt the pathological muscle rhythm by overexerting it. For example, if your eye twitches, try to close your eyes tightly.

It is possible to calm an overexcited muscle through a light massage. Or apply cold to it. The temperature difference will also help. Wash your face alternately with cold and warm water.

Face massage

Facial massage after a stroke is included in therapeutic measures to restore facial muscles. Even if the massage is performed at home, it should only be done by a specialist. If the procedure is performed at a professional level, the result will give a stable remission.

It is not recommended to massage yourself; incorrect exposure to certain facial points can cause a relapse or worsen the patient’s condition. A correctly performed procedure normalizes blood circulation, restores the motor ability of the facial muscles and the swallowing reflex.

Dermatillomania

Neurosis of the face and scalp can manifest itself in a behavioral disorder such as dermatillomania.

Its main manifestation is scratching the skin of the face and head, not because of itching, but because of dissatisfaction with its appearance. This also includes an obsessive zeal to squeeze out pimples, scratch off scabs, and pull out hair. Self-injurious actions cause a short-term feeling of pleasure, followed by feelings of shame, frustration, and dissatisfaction.

The face of such patients is covered with scars and scars due to constant trauma to the skin. This process is uncontrollable and can occur at any time of the day. But most often traumatic actions are carried out in front of a mirror.

Symptoms of the disorder also include the habit of biting the lips and mucous membranes of the cheeks. Patients are not deterred by the prospect of redness, bleeding, and scarring of the skin. They repeat the ritual day after day. It lasts from a few minutes to an hour.

Such actions can be provoked by feelings of fear, anxiety, and close examination of one’s skin because there is nothing to do.

Dermatillomania has been described as a state of addiction. It begins with concentrating on what the patient thinks is a skin defect. Gradually, attention is increasingly focused on this detail. A person begins to think that he is sick with something serious. This provokes irritability and nervousness in him, leading to obsessive actions.

The root cause of the disease is rooted in the psychological state of a person and lies in self-dissatisfaction, anger, feelings of shame and malice. Traumatic rituals are a way of punishment, self-flagellation.

Treatment of this pathology requires the intervention of a psychotherapist and a dermatologist.

The main method of treating addiction is psychotherapy, in particular cognitive behavioral therapy.

Yoga, physical exercise, relaxation procedures, as well as any hobby that absorbs a person and helps redirect attention will help reduce anxiety, distract and relax.

The help of a dermatologist is necessary to eliminate skin lesions in order to prevent infection and reduce the degree of dermatological defect.

Neuroses

This is a large group of diseases, manifested primarily in psycho-emotional disorders, as well as malfunctions of the autonomic nervous system. They do not cause pathological disorders of the nervous tissue, but have a significant impact on the human psyche.

There are several types of disorders in which the symptoms are visible.

Muscular neurosis is manifested by muscle tension, spasm and convulsive twitching. Neurosis of the facial muscles makes itself felt with the following manifestations:

• nervous tic;
• lip tension, clenching;
• convulsive contraction, the face seemed to move;
• tingling, burning sensation;
• muscle pain;
• Tension of the neck muscles is manifested by a feeling of lack of air, a lump in the throat.

When we find ourselves in a stressful situation, our body produces stress hormones. They, among many other reactions, cause muscle tension. Now imagine, if we are exposed to chronic stress, what happens to our muscles, and specifically to the muscles of the face. Being systematically in hypertonicity, they overexert themselves. This is what causes their nervous twitching, spasms, and convulsions.

Another type of neurosis is skin. It causes paresthesias in the facial skin of the following type:

• severe itching, burning in the facial and scalp without clear localization;
• sensation as if something were touching the face. And it's terribly annoying;
• the appearance of red spots on the face and neck. Possible rash.

The causes of such phenomena are nervous and mental overstrain, chronic stress, sleep disturbances, as well as disruptions in hormonal regulation.

With neuroses associated with disruption of the autonomic nervous system, various manifestations may also occur. Malfunctions in the functioning of the vascular network occur, and a vascular neurotic disorder develops.

Vascular neurosis of the face is manifested by flaking and dryness, a feeling of tightness of the skin. She becomes pale, sometimes cyanotic, and her sensitivity worsens. In addition, sneezing appears, the nose is stuffy, the eyes become red and watery, the skin itches and itches. This indicates the development of vegetative-allergic reactions.