The facial nerve, which has the longest bone canal among the nerves that move the muscles in the body, is one of the nerves most commonly paralyzed. Approximately 90% of these paralysis occur due to diseases in the ear bone through which the nerve canal passes. Although the most common cause of facial paralysis is Bell's palsy, which is a self-limiting disease with an unknown cause, it should be kept in mind that pathologies such as bone-destructive inflammations or tumors originating from the middle ear can also cause paralysis. Since the treatment of diseases in this region is included in the field of ear, nose and throat medicine, patients diagnosed with facial paralysis must be evaluated by an ENT specialist.
Some of the nerve fibers coming from the brain to the upper half of the face with the facial nerve go to the same half of the face, while some of them go to the brainstem. It crosses over and goes to the opposite half of the face. However, all the nerve fibers that operate the lower half of the face cross over after leaving the relevant center in the brain and stimulate the muscles in the opposite half of the face. For this reason, in pathologies that occur on one side of the brain, although the muscles in the lower half of the face on the opposite side are affected by the event, the upper face region is not affected because the brain receives stimulation from the other healthy side.
This type of paralysis affecting the part of the face below the eye is called "central". Paralysis that occurs due to pathologies in the brainstem and lower regions and affects only one half of the face is called "peripheral type facial paralysis". Although this finding is important in the differential diagnosis, it should not be forgotten that there may be situations in which the stimulation in the upper half of the face is preserved in peripheral type pathologies of the nerve.
After the facial nerve leaves the brain, it follows the auditory and balance nerves and enters the ear bone. In pathologies in this region called the inner ear canal (internal acoustic canal), facial paralysis may be accompanied by hearing and balance complaints.
As the facial nerve progresses in the canal within the ear bone, it stimulates the lacrimal gland, stimulates the muscle of the stirrup bone in the middle ear and 2/3 of the tongue. In its front part, it gives off branches that receive the sense of taste and activate the salivary glands under the jaw. nerve k After leaving the tympanic bone, it extends forward and divides into branches that pass through the salivary gland (Parotid gland) under the ear and stimulate the facial facial muscles. These are helpful findings in determining the level.
Although the causes of facial paralysis are diverse, the most common ones can be divided into two groups: acute, rapidly developing and chronic-slowly progressive.
Acute Rapidly Developing Paralysis:
Nerve inflammations
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Bell's palsy (facial paralysis of unknown cause)
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Herpes Zoster virus infection
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Guillain-Barré syndrome
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Auto immune facial paralysis
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Lyme disease
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AIDS
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Kawasaki disease
Trauma
<Ear bone fractures
Pressure trauma
Birth trauma
Middle ear infections
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Acute bacterial infections
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Chronic bacterial infections
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In chronic otitis media, bone-dissolving tissue (Cholesteatoma) formation
Sarcoidosis
Neurological nervous system diseases
p>Chronic-Slowly Progressive Paralysis:
Malignant tumors
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Buccal salivary gland (Parotid) tumors
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Tumors that spread from other places (metastatic)
Benign tumors (glomus tumor, schwannoma)
Chronic middle ear infections (Cholesteatoma)
Facial Paralysis Treatment
Treatment of facial paralysis varies depending on the causative factor. Purpose of treatment; It is the provision of normal facial appearance, facial symmetry during voluntary movement, emotional movements and muscle functions around the mouth, nose and eyes.
Bell's Paralysis: Acute facial paralysis for which no obvious cause can be detected, such as trauma, tumor or infection, is called Bell's palsy. . Although the exact cause is not known, it is accepted that it occurs due to viral inflammation and an immune mechanism. limit yourself Bell's palsy, which is a side pathology, is not progressive and usually resolves spontaneously.
For the treatment of Bell's palsy, patients who apply within the first 3 days after the stroke are given an appropriate dose of cortisone intravenously, if there is no obstructive condition, and then oral cortisone treatment is started by slowly reducing the dose every 2-3 days for an average of 15 days. . Gastroprotective treatment should be given to prevent the side effects of cortisone on the gastrointestinal system. Since the causative agent is likely to be a virus, oral anti-viral medication is added to the treatment. In cases where facial nerve functions are completely lost, heat application, massage and facial exercises are applied to prevent thinning of the facial muscles during the recovery period. Preventive treatments are applied to prevent complications such as keratitis, which occurs due to drying of the eye due to being open.
In cases where cortisone use is undesirable (uncontrolled diabetes, pregnancy, etc.), treatment to increase capillary circulation can be given. If there is improvement after three weeks in the follow-up of the patient, supportive treatment is continued and electrical muscle stimulation test (EMG) is performed in patients who do not show clinical improvement. Monitoring with medical treatment is continued in patients with improvement findings in EMG, and magnetic resonance examination is performed in patients with total loss of stimulation and no recovery findings.
In patients in whom the location of the pathology is detected in this examination, surgery is performed to release the nerve within the canal with an appropriate surgical technique. As the duration of paralysis increases, the quality of recovery decreases. It is accepted that performing surgical intervention as soon as possible is the most important factor in regaining optimal facial functions. Therefore, early diagnosis and appropriate treatment have an important effect on recovery in patients with facial paralysis.
Trauma: It is the second most common cause of facial paralysis. Ear bone fractures may be surgical trauma (injuries that inevitably occur during surgery) or unintentional surgical trauma.
Ear bone fractures: Facial paralysis that occurs immediately after trauma is considered to be a cut or injury to the nerve. In this case, perform surgery as soon as possible. Depending on the condition of the pathology, the pressure on the nerve should be removed with the appropriate surgical technique and repair should be performed if necessary. Paralysis that begins some time after the trauma may occur due to swelling or bleeding within the nerve canal. In this case, the treatment is like Bell's palsy. Surgery is considered in cases that do not respond to treatment.
Acute and chronic middle ear infections: In the treatment of facial paralysis seen during acute middle ear infection, intravenous antibiotics should be started and a hole is made in the eardrum to remove the inflammation accumulated in the middle ear. discharge must be ensured. Additionally, cortisone treatment can be applied.
In paralysis accompanied by chronic otitis media, there is a high chance of having an inflammatory mass called cholesteatoma, which grows by dissolving the bone. Paralysis occurs due to cholesteatoma compression on the nerve or regional inflammation. In these cases, urgent surgical intervention is required.
Herpes Zoster Oticus: (Ramsey Hunt Syndrome) It occurs due to the Varicella Zoster virus. It is usually accompanied by herpes-like blistering lesions on the auricle, scalp, face or lips. Its difference from Bell's palsy is that the symptoms are more serious and usually cause complete degeneration of the nerve. This disease is especially common in people with cellular type immunodeficiency. The full recovery rate is low and values are given between -22. Anti-viral medication specific to this virus should be used in treatment. The other treatment protocol is the same as in Bell's palsy.
Pathologies outside the ear bone: It usually occurs due to trauma or tumors originating from the cheek salivary gland (Parotid). Different surgical methods are used in the treatment depending on the cause.
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