Facial neuritis – symptoms, causes, diagnosis and treatment in the best clinics

What is neuritis? This is a pathological condition of the peripheral nerve, characterized by its inflammation. Depending on which nerve is involved in the inflammatory process, doctors distinguish neuritis of:

• trigeminal nerve – an inflammation of three branches of this nerve at once (optic, maxillary and mandibular), which is characterized by simultaneous acute, burning and sharp pain in the forehead, eyes, cheeks and jaw. The pain may worsen when touching the face, chewing, or moving facial muscles;
• jaw nerve – it manifests itself as pain in the mouth, teeth, chin and sometimes in the ears;
• auditory nerve – it is an inflammation, manifested by intense pain in the area of ​​the auricle, near the tragus of the ear, radiating to the parotid region, the back of the head and even to the area above the shoulders;
• facial nerve – since this nerve causes facial muscles to move, such inflammation is accompanied by severe pain in the facial muscles and disturbances in facial expressions.

Simultaneous inflammation of several nerves is called “polyneuritis” or “polyneuropathy.” If only one nerve is affected, it is called “mononeuritis.”

Neuritis of the facial nerve – why is it dangerous?

The danger of inflammation of the facial nerve is that, in addition to severe pain, serious complications may develop, for example:

• paresis, and subsequently paralysis of the facial muscles – partial or complete loss of sensitivity and the ability to make facial movements. Due to prolonged inflammation or improper treatment, the muscles on one side of the face (the one on which the nerve is damaged) remain immobile. The corner of the mouth lowers, the cheek relaxes, the folds smooth out and the eye opens wide.
• synkinesis is involuntary muscle contractions on the healthy side of the face when trying to move the affected side of the face. For example, when trying to smile, one or both eyes are closed.
• deterioration of vision, up to blindness. Due to inflammation of the nerve, dry eye occurs, which leads to damage to the cornea. As a result, complete or partial blindness is likely.

Synkinesis comes in a variety of forms, but they are all united by the inability to perform the desired facial movement in full and the addition of another (involuntary) movement of the facial muscles.

Causes of inflammation of the facial nerve

Neuritis (inflammation) of the facial nerve can have a variety of causes, but most often it occurs due to:

• hypothermia, for example, due to prolonged exposure to low temperatures, wind or drafts;
• infectious diseases (mumps, measles, enterovirus, herpes virus, etc.);
• injuries to the facial nerve, for example, with traumatic brain injury;
• inflammatory processes in adjacent tissues, such as otitis, sinusitis, etc.;
• circulatory disorders in the vessels of the face;
• diabetes mellitus;
• multiple sclerosis.

Neuritis of the facial nerve can be primary (develops after hypothermia) and secondary (caused by all other reasons).

What pain does trigeminal neuritis cause?

The pain is acute. It can be compared to an electric shock – sharp, burning, sometimes unbearable. Depending on which branch of the nerve is affected, the pain can radiate to the upper or lower jaw, temples and forehead, manifest as acute “toothache”, and provoke migraines.

Severe and sharp pain can occur in response to touching the face, brushing teeth, facial muscle movements, or shaving. At the same time, an attack differs from a toothache in duration (a toothache usually lasts from 10 minutes to several hours).

At the same time, pain attacks last about 3 minutes on average; there can be up to 200 such attacks per day. According to statistics, in approximately 7% of all patients, pain attacks last up to 3 days.

It is impossible to ignore such pain, so you need to see a doctor as soon as possible.

Inflammation of the facial nerve in children

Inflammation of the facial nerve in children is a fairly common occurrence, especially with the onset of cold weather. Due to the proximity of the nerve to the surface of the skin in children, it is easy to become cold or injured.

The cause of facial neuritis in children may be:

• hypothermia;
• infectious disease (mumps, chickenpox, measles, etc.);
• inflammatory processes in the mouth (caries);
• otitis and sinusitis;
• traumatic brain injury.

Inflammation of the facial nerve in children begins with an unpleasant stabbing sensation in the back of the head, a feeling of tension, tingling and “shooting” in the area of ​​the eyes, cheekbones and forehead.

After some time, the tingling develops into an attack-like pain, which can be provoked by brushing your teeth and washing your face, sometimes even by a light blow of wind. Often the pain appears in the evening and interferes with night sleep.

Attacks of pain occur from several times a day to several times a week, after which a short remission occurs. Then the pain returns with renewed force, becoming sharp and intense, affecting the area of ​​the eyebrows, eyes, cheekbones, and cheeks.

There is also congenital neuritis of the facial nerve, which is manifested by paresis of the facial muscles. Its cause is improper development of the brain in the prenatal period.

Ignoring symptoms, as well as self-medicating, is very dangerous. Complications from the disease can develop very quickly, especially in children.

Symptoms of facial neuritis

The specificity of facial neuritis is that the disease develops abruptly, literally within a few hours. Symptoms of neuritis are divided into early and late.

Early symptoms of neuritis include:

• feeling of tension in the back of the head;
• pain and swelling on one side of the face;
• pain near the ear and eye;
• impaired sensitivity of areas of the face;
• taste and hearing disorders;
• increased salivation.

Subsequently, due to severe swelling and pinching of the nerve in the bone canal, numbness and paresis of the facial muscles develop. Paresis differs from paralysis in that muscle mobility is severely limited and does not disappear completely. The following happens:

• facial wrinkles are smoothed out, muscles are relaxed, the face looks like a mask;
• on the side of the affected nerve, the eyebrow, lower eyelid, corner of the mouth are lowered, the wing of the nose is relaxed;
• inability to completely close the eye, lacrimation is observed (in approximately ⅔ of all cases) or dry eye;
• hearing impairment (about 30% of patients complain that loud sounds begin to cause pain) and taste (loss of sensitivity in the anterior ⅔ of the tongue).

Types of facial neuritis

Depending on the cause, doctors distinguish two types of neuritis of the facial nerve:

• Primary neuritis of the facial nerve (Bell’s neuritis or Bell’s facial palsy) – develops due to hypothermia of the facial nerve, exposure to drafts or wind. It is also sometimes called cold neuritis for the same reason.
• Secondary neuritis of the facial nerve is caused by all other reasons (viral infections, trauma, inflammatory processes, diseases of the teeth and oral cavity, as well as strokes and tumors).

Diagnosis of facial neuritis

To diagnose neuritis of the facial nerve, a doctor first of all conducts an examination, pays attention to how pronounced the asymmetry of the face is, and determines pain in trigger points.

The symptoms of the disease are so vivid that diagnosing neuritis of the facial nerve, based on examination data and the patient’s complaints, is usually not difficult. Doctors pay special attention to how quickly the symptoms grew, how quickly the paresis appeared, whether there were concomitant occurrences, as well as what specifically preceded the onset of the disease and what concomitant injuries or pathologies may be associated with the resulting neuritis.

Additional research methods are also used to diagnose and establish the cause of neuritis:

• Electroneuromyography (ENMG) is a reliable method that determines the conduction of impulses through muscles and nerves, determines the degree of their damage and makes it possible to make a prediction regarding recovery.
• MRI, CT are methods that visualize circulatory disorders or a neoplasm that could provoke the appearance of neuritis of the facial nerve.

How to treat inflammation of the facial nerve?

Treatment is selected individually for each patient after diagnosis and establishment of the type and cause of neuritis. At the beginning of treatment, drug therapy is prescribed, which includes medications and medical procedures aimed at reducing nerve inflammation, relieving swelling and restoring facial movements. Your doctor may also prescribe antibiotics or antiviral drugs if the neuritis is bacterial or caused by a virus.

As paralysis develops, the damaged muscles shorten, which makes it difficult to perform full facial movements. In order to restore facial expressions, physiotherapy is prescribed. Botox injections, in combination with physical therapy, can overcome overstrain of the facial muscles and teach the muscles to move again.

Surgical treatment of facial neuritis

If conservative treatment does not produce positive results, the next step towards recovery is surgery. Surgical treatment for facial neuritis varies depending on the degree of damage to the nerve. The most commonly used types of operations are:

• Microsurgical plastic surgery – a doctor connects damaged areas of the nerve (for example, damaged by injury).
• Nerve grafting – a surgeon uses the nerve that provides movement of the muscles of mastication or the tongue, connecting it to the facial nerve;
• Cross nerve transplantation is the transplantation of a healthy section of nerve (most often the material is taken from the patient’s own calf muscle). The surgeon implants this section into the facial tissue at the site where the nerve was irreversibly damaged.
• Face, eyebrow and eyelid lift is an operation to improve the position of the lower eyelid and the mobility of the eyelids in which platinum and gold weights are used to close the eyelids, transfer of tendons or neck muscles. This operation improves facial symmetry and overcomes the ophthalmological and aesthetic consequences of neuritis;
• Closing the nerve gap after tumor removal – in this case, nerve tissue from the leg is used, which connects the gap formed after tumor removal.
• Selective neurectomy – cutting selected sections of the nerve to relax tense facial muscles.

What drugs are prescribed for acoustic neuritis?

Common practice is to prescribe non-steroidal anti-inflammatory drugs, which have anti-inflammatory and analgesic effects. Painkillers may also be prescribed additionally.

For intense pain and severe nerve damage, doctors may recommend a short course of glucocorticosteroids to relieve inflammation and alleviate symptoms of the disease.

If the cause of neuritis is an infection (bacteria or virus), antibiotics or antivirals are prescribed.

If dry eyes occur, special drops are recommended to moisturize the eyes, or it is possible to cover the eyes with a special bandage at night.

The treatment does not require the patient to stay in the hospital and can be carried out at home, under the supervision of the attending physician.

Which doctor treats facial neuritis?

Facial neuritis is a disease that is treated by a neurologist.

To achieve success in treatment and rehabilitation, you may also need the help of related specialists – a neurologist-rehabilitation specialist, dentist, otolaryngologist, traumatologist, ophthalmologist, and for children, a consultation with a pediatrician is also required.

Prevention of facial neuritis

There are a number of measures that will help prevent inflammation of the facial nerve. These include:

• regular hardening of the body;
• hypothermia must be avoided;
• timely treatment of ENT and dental diseases;
• balanced diet;
• reduce stress levels;
• avoid skull injuries.

Rehabilitation of facial neuritis

For rehabilitation, physiotherapeutic procedures, laser, heating and massages are used, aimed at restoring the nerve and motor activity of facial muscles.

While 3 weeks (sometimes up to several months) are often enough to overcome pain, restoring facial expressions after paresis or paralysis is a more complex process that takes a longer time. However, if you contact specialized rehabilitation clinics that use the best equipment and have qualified doctors, the rehabilitation process will go faster. In this case, there is a much greater chance of complete restoration of facial movements and facial symmetry.

Facial neuritis – forecasts

The prognosis depends on many factors, such as the cause of inflammation, which part of the nerve is damaged, and whether there are complications.

If symptoms gradually subside during the first three weeks after treatment, this is a good sign. In this case, you can expect a complete recovery. In 75% of all cases, complete recovery occurs.

If the disease lasts longer than 3 months, the chances of full recovery of facial expressions are somewhat reduced.

With relapses of facial nerve neuritis, each subsequent episode of exacerbation will be more difficult.

The best clinics for the treatment of facial neuritis

MedTour employees have many years of experience helping patients with a wide variety of diseases and conditions. Our medical coordinator will help you choose the best clinic for diagnosis and treatment of neuritis in Ukraine or abroad.

The MedTour company cooperates with leading clinics in Ukraine and abroad, having the opportunity to quickly contact them and determine the most comfortable conditions for treating patients.

Published: 29.05.2024

Updated: 01.06.2024

Medical author:

Ilona Baidiuk

Medical author, Medical editor:

Olena Kursabaieva