bubble_chart Overview

Facial palsy, also known as Bell's palsy, is an acute non-suppurative facial nerve lesion of unknown cause within the stylomastoid foramen on one side.

bubble_chart Etiology

The exact cause and mechanism of the disease remain incompletely understood. It is generally believed that the condition is related to viral infections and exposure to cold. Furthermore, it is thought that these factors lead to the contraction of the nutrient blood vessels of the facial nerve, resulting in nerve ischemia, edema, and compression, thereby triggering the disease.

bubble_chart Pathological Changes

Mainly characterized by neural edema, demyelination, and axonal degeneration.

bubble_chart Clinical Manifestations

The onset is acute, often noticed during morning grooming or conversations with others, with symptoms peaking within hours or 1–2 days. It primarily manifests as unilateral peripheral facial muscle paralysis. The forehead wrinkles become shallow or disappear, the palpebral fissure widens, the nasolabial fold flattens, and the corner of the mouth droops. Examination reveals an inability to frown or raise the eyebrows, incomplete or absent eye closure, and Bell's phenomenon (where the eyeball on the affected side rolls upward and outward when attempting to close the eyes, exposing the white sclera). When showing teeth, the mouth deviates toward the unaffected side; blowing air or whistling results in air leakage from the affected side. Rinsing the mouth causes water to spill from the affected side, and food may accumulate between the teeth and cheek on that side while eating. If the facial nerve affects the chorda tympani fibers, there may be ipsilateral loss of taste.

The disease can occur at any age, is more common in men than women, and bilateral cases are rare. Some patients may experience pain behind the ear a few days before onset.

bubble_chart Auxiliary Examination

No significant abnormalities were found in the peripheral blood picture, cerebrospinal fluid, or mastoid and internal auditory canal radiographs.

bubble_chart Diagnosis

1. Acute onset of unilateral peripheral facial nerve palsy.
2. Good general condition, no other neurological signs.

bubble_chart Treatment Measures

The treatment principles are to improve local blood circulation, reduce nerve edema, and promote functional recovery. Treatment methods commonly include medication and physical therapy. For cases that do not heal over a long period, surgical treatment may be considered. Medications commonly used in the acute phase include:

1. Prednisone 10mg, three times daily for two weeks.
2. Dibazol 10mg, three times daily.
3. Fursultiamine 20mg and vitamin B12, 100μg intramuscular injection, once daily for 2–3 weeks.

Physical therapy may involve hot compresses or infrared irradiation in the stylomastoid foramen area, or ultrashort wave diathermy. Generally, 10 days constitute one treatment course, after which further options are considered based on the condition. For patients unable to close their eyes, care should be taken to protect the cornea.

In the stage of convalescence,

1. Galantamine 2.5mg may be added via intramuscular injection, once daily, starting 7–10 days after onset and continuing for two weeks.
2. Massage paralyzed muscles, 3–4 times daily for 5–10 minutes each session.
3. Acupuncture therapy can be somewhat effective during the stage of convalescence, but care must be taken to protect the eyes to avoid injury.

For patients with prolonged non-recovery, facial-hypoglossal or facial-accessory nerve anastomosis may be performed based on the patient's request.

bubble_chart Prognosis

Recovery usually begins within 1 to 2 weeks and completes in 1 to 2 months. In a few cases, recovery is slower, and if no improvement is observed after 6 months, the likelihood of full recovery is minimal.

bubble_chart Prevention

Avoid exposing the face and ear roots to cold. When traveling or taking public transport in winter, it is advisable to wear a mask. Upon waking up in the morning, avoid immediately opening windows directly facing you.

bubble_chart Differentiation

1. Guillain-Barré syndrome, peripheral deviation of the mouth is mostly bilateral, often accompanied by symmetrical, flaccid paralysis of the limbs and the cerebrospinal fluid protein-cell dissociation phenomenon, making it easy to differentiate.
2. Peripheral deviation of the mouth caused by otitis media, mumps, or mastoiditis—the focal lesions of these diseases are quite obvious, making differentiation straightforward.
3. Peripheral deviation of the mouth caused by acoustic neuroma, nasopharyngeal carcinoma metastasis, etc.—these conditions develop slowly, accompanied by primary disease damage and other cranial nerve impairments, and are also easily distinguishable.