Neuritis of the facial nerve. Neuralgia, neuropathy, paresis, inflammation of the facial nerve

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.

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.

Symptoms

Manifestations of the disease occur acutely, within a few hours, for a maximum of 3 days. The gradual appearance of signs is most typical of compression of the nerve by a tumor growing from the surrounding tissue.

Depending on the severity, neuritis of the facial nerve is accompanied by the following symptoms:

• movements of the facial muscles are weakened, up to barely noticeable, disruption of conjugate contractions of symmetrical areas of the face;
• facial asymmetry, even disfiguring;
• difficulty closing the eyes; in severe cases, the palpebral fissures do not close completely;
• disorders of swallowing, chewing, speech;
• when the disease is complicated by keratitis, vision loss gradually develops;
• taste disturbance, weakening or strengthening of sound sensations;
• lacrimation;
• with simultaneous damage to the trigeminal nerve - severe pain in the facial area.

Signs of intoxication and fever are uncharacteristic and usually occur due to the infectious nature of neuritis of the facial nerve.

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.

Facial nerve neuropathy: modern approaches to diagnosis and treatment

Facial nerve neuropathy is an extremely relevant pathology of the peripheral nervous system today. The number of people suffering from this disease is constantly growing. The frequency of facial nerve neuropathies is, for example, in European countries 20 cases, in Japan 30 cases per 100 thousand population. According to WHO, the most common type is mononeuropathy of the facial nerve, which ranks 2nd in frequency among diseases of the peripheral nervous system. The incidence ranges from 8 to 240 cases per 100 thousand population in different countries of the world [1, 2]. The relatively high incidence of damage to the facial nerve is due to its topographic and anatomical features [1, 3]. The facial nerve unites two nerves: the facial nerve itself, formed by motor nerve fibers, and the intermediate nerve, which is sensitive taste and autonomic (parasympathetic) nerve fibers. In the fallopian canal of the temporal bone, three branches arise from the facial nerve: the greater petrosal nerve, the chorda tympani, and the stapedius nerve. After leaving the stylomastoid foramen, many motor branches depart from the facial nerve to the facial muscles. The intermediate nerve contains afferent fibers (taste sensitivity) going to its sensory nucleus, and efferent fibers (secretory, parasympathetic) coming from its autonomic nucleus [4, 5]. According to I.Ya. Sendulsky distinguishes between the labyrinthine (intracrural), tympanic (intratympanic), tympanomastoid (intermediate) and mastoid sections of the bony canal of the facial nerve. The labyrinthine section, 3 mm long, runs from the internal auditory opening to the geniculate canal of the facial nerve. It begins in the medial part of the superior fossa of the bottom of the internal auditory canal, then goes under the anterosuperior surface of the pyramid. Here the canal passes between the transition point of the main curl of the cochlea into the second and the ampulla of the superior semicircular canal. This part of the channel has a horizontal direction, perpendicular to the axis of the pyramid. The intrarocky part of the canal is located near the labyrinth, which creates the danger of nerve damage in labyrinthine pathologies. The tympanic section occupies the space from the knee of the facial nerve canal to the pyramidal protrusion. Its length is 8–11 mm. It does not run parallel to the axis of the pyramid, but goes from the front and top - back and down. Its beginning is covered by a spoon-shaped process. The main part of this section passes between the eminence of the external semicircular canal and the oval window. At this point, the horizontal part of the facial nerve canal passes at an angle (second knee) into the descending part (according to Schwartz). Passing from the labyrinthine wall of the tympanic cavity to its posterior wall, the facial nerve canal forms the inferomedial side of the aditus (threshold). Trauma to the facial nerve during radical ear surgery, during removal of granulations of the tympanic cavity, usually occurs in this place. The tympanomastoid section is part of the facial nerve canal, located in the posterior wall of the tympanic cavity within the pyramidal eminence. This part of the canal is closely connected with both the tympanic cavity and the mastoid process. On the back wall the canal is covered with a pyramidal elevation. The mastoid portion of the facial nerve canal occupies the space from the pyramidal protuberance to the stylomastoid foramen. Its length is about 12.0–13.5 mm. This section corresponds to the descending part of the facial nerve canal according to Schwartz. There are 3 types of channel passage: 1st type - normal vertical, 2nd type - flat, 3rd - medium oblique. The steeper the facial nerve canal descends, the deeper it lies in the bone, and vice versa. The facial nerve canal may be 1–10 mm distant from the posterior wall of the bony external auditory canal. But still, in the majority of cases, the direction of the canal is vertical and the distance from it to the posterior wall of the external auditory canal, as a rule, does not exceed 2–4 mm. The distal mastoid portion of the facial nerve canal is at risk of injury during resection of the mastoid apex and surgery on the jugular bulb [4, 6]. Anomalies in the position of the facial nerve canal are rare, but have very important surgical significance. Kettel, using material from 125 operations on the facial nerve, described three variants of deviations of the facial nerve from its normal location. The blood supply to the facial nerve is carried out by the stylomastoid artery passing through the fallopian canal. Poor circulation plays a major role in nerve pathology [6]. There are many causes of facial nerve damage. The first place among them is occupied by the inflammatory factor: neuritis, otogenic damage. The second place is occupied by iatrogenic causes, which is due, on the one hand, to the complexity of the topographic anatomy of the facial nerve, on the other hand, to the need for frequent interventions, and the peculiarity of the growth of tumors of the ear and base of the skull. The incidence of facial nerve damage during otological operations ranges from 0.2 to 10%. In some cases, its function is persistently impaired after surgery, despite the preservation of anatomical integrity. The presence of facial muscle paresis before surgery, as well as tumor sizes greater than 3 cm, are poor prognostic signs regarding the preservation of facial nerve function. The use of microsurgical techniques to remove tumors of the cerebellopontine angle currently allows the majority of patients to preserve the anatomical integrity of the facial nerve, but its function is preserved or restored only in no more than 50% of patients. The facial nerve is also often damaged during surgical interventions on the neck, maxillofacial operations and during operations on the parotid salivary gland, since it is located in the thickness of its tissue, where it forms the so-called parotid plexus [7]. Post-traumatic injuries of the facial nerve take 3rd place. Facial nerve injury occurs in approximately 15% of patients with traumatic brain injury and basal skull fracture. Traumatic injuries to the facial nerve account for 5–7% of all its lesions. Transverse fractures of the temporal bone pyramid are complicated by damage to the facial nerve in 30–50% of cases, longitudinal fractures in 10–25%, but 70–90% of facial nerve paresis recover on their own. The facial nerve can also be damaged by wounds and closed injuries to the face and neck. The frequency of injuries to the maxillofacial area among head injuries is 16.5%. Considering the high level of general traumatism and its tendency to increase, the problem of traumatic injuries of the facial nerve is undoubtedly relevant and socially significant [8]. Of all lesions of the facial nerve, 6.5% are based on single causes, among them rare infectious diseases, diseases of the central nervous system, and metastatic lesions [6, 8]. It should be noted that there are several anatomical prerequisites for such frequent damage to the facial nerve: phylogenetically, the nerve is one of the youngest cranial nerves, has a long and tortuous course in a narrow bone canal, a feature of the blood supply to the nerve is that the main vessels in a narrow bone bed behave similarly to the terminal ones [2, 7]. So, etiologically, the following types of lesions of the facial nerve can be distinguished: - idiopathic neuropathy, or Bell's palsy (the most common form - up to 75% of cases), when the exact etiological causes cannot be established. This form is characterized by seasonality, the development of the disease after cooling and during common colds; – otogenic neuritis (up to 15% of cases), in which the trunk of the facial nerve is often damaged during operations on the middle ear (general cavity operations, operations on the mastoid process for purulent mastoiditis); – infectious neuritis, which occurs much less frequently: with Herpes zoster (Hunt syndrome), polio, influenza, mumps, etc. Considering the large number of lesions of the facial nerve of otogenic origin, this problem should be considered relevant not only for neurologists, but also for otolaryngologists. Knowledge of the anatomy, topography and blood supply of the facial nerve helps in correct topical diagnosis and in prescribing correct and timely treatment, which helps reduce the number of complications. To assess the degree of damage to the facial nerve, the House–Braakman scale is used (Table 1).

Paralysis of the facial muscles leads not only to cosmetic defects and painful experiences for the patient, but also to impaired swallowing and chewing functions, as well as to phonation. Neuroparalytic keratitis, which is caused by lagophthalmos and impaired tear production in patients with damage to the facial nerve, leads to scarring of the cornea, reduction and loss of vision. Thus, damage to the facial nerve significantly reduces the quality of life of patients. Topical diagnosis of nerve lesions at different levels is based on the identification of peripheral paralysis and other symptoms. When the nucleus of the facial nerve is damaged, peripheral paralysis of the facial muscles on the side of the lesion can be combined with spastic hemiparesis on the opposite side. If the pathological focus spreads to the inner knee of the facial nerve, then the function of the nucleus of the abducens nerve is also disrupted. In this case, alternating Foville syndrome develops: on the side of the lesion there is peripheral paralysis of the facial muscles and the external rectus muscle of the eye, and on the opposite side there is spastic hemiplegia. When the root of the facial nerve in the cerebellopontine triangle is damaged, paralysis of the facial muscles is accompanied by symptoms of dysfunction of the trigeminal, abducens and vestibulocochlear nerves. When the facial nerve is damaged in the internal auditory canal, paralysis of the facial muscles is combined with a taste disturbance in the anterior two-thirds of the tongue, dry eyes and deafness in this ear. Damage to the facial nerve in the bony canal before the origin of the greater petrosal nerve is manifested by prosoplegia, taste disturbance in the anterior two-thirds of the tongue, dry eye and hyperacusis. Damage to the facial nerve in the facial canal above the level of the origin of the stapedius muscle is accompanied by lacrimation, hyperacusis and taste disturbance. When the facial nerve is damaged at the level of exit through the stylomastoid foramen, the clinical picture consists only of paralysis of the facial muscles and lacrimation. In some cases, the pathological process extends not only to the facial nerve, but also to the branches of the trigeminal nerve. In such cases, peripheral paralysis of the facial muscles is accompanied by excruciating pain in the lateral area of ​​the face. When the corticonuclear fibers are damaged on one side, paralysis of only the lower facial muscles on the opposite side develops [3, 7]. When treating facial nerve injuries, it is advisable to consider both surgical and conservative approaches. In the treatment of persistent dysfunction of the facial nerve, surgical methods are most effective [1, 7]. Surgical aids for neuropathies of the facial nerve can be divided into two groups: interventions on the facial nerve in order to restore its conductivity and voluntary motor function of the facial muscles, plastic surgery (static and dynamic) on the skin, muscles and tendons of the face in order to reduce cosmetic defects and replace function paralyzed muscles [1, 9]. The facial nerve is the first nerve on which neuroplasty was performed, which consists of suturing the peripheral segment of the facial nerve with the central segment of another, specially transected motor nerve. For the first time, reinnervation of the facial nerve by the accessory nerve was performed by Drobnik in 1879, and by the hypoglossal nerve by Korte in 1902. Soon these operations began to be used more often. In addition to the accessory and hypoglossal nerves, the glossopharyngeal nerve, phrenic nerve, and descending branch of the hypoglossal nerve were used as donor nerves for reinnervation of the facial nerve; 2nd and 3rd cervical nerves, the muscular branch of the accessory nerve to the sternocleidomastoid muscle. To date, considerable experience has been accumulated in operations of extracranial reinnervation of the facial nerve. Reinnervation of the facial nerve by the accessory nerve.

The main effect of the operation is to prevent muscle atrophy and restore their tone.
Hypoglossal nerve reinnervation of the facial nerve is the most commonly used technique for extracranial facial nerve reinnervation. Many authors, preferring this technique, emphasize that there are functional relationships between the motor areas of the face and tongue in the central nervous system [1, 6, 9]. Cross-face anastomose
, cross-face nerve grafting
was first described in the works of L. Scaramella (1971), JW Smith (1971), H. Andrel (1972). The essence of the operation is the reinnervation of the affected facial nerve or its branches with individual branches of the healthy facial nerve through autografts, which makes it possible to create connections between the corresponding branches of the facial nerves. Typically, 3 autografts are used (for the muscles of the eye, cheek and mouth circumference). The operation can be performed in 1 or 2 stages, as early as possible, and surgical technique is of great importance for a positive outcome. To improve results, facial plastic surgery is also used, which can be divided into static and dynamic. The purpose of static operations is to reduce facial asymmetry; for this purpose, tarsorrhaphy is performed to reduce lagophthalmos, and tightening of the facial skin [1, 9]. Multidirectional suspension techniques have been proposed to correct brow drooping, lagophthalmos, and cheek and corner of the mouth drooping. For this purpose, fascial tapes cut from the fascia lata of the thigh are used. There are even cases of implantation of a metal spring into the upper eyelid. However, as the authors themselves note, in such cases a rejection reaction is possible. If there is no good fixation, the spring can be pushed out, even perforating the skin. A similar complication occurs when magnets are implanted into the eyelids (rejection reaction in 15% of cases) [1, 6]. The goal of dynamic surgery
is to replace the function of paralyzed muscles.
In 1971, a free muscle-tendon autograft was transplanted for the first time. Transplantation of free muscle-tendon autografts has been performed by many surgeons. The authors note that transplanted muscles often undergo cicatricial degeneration. With the development of microsurgical technology, muscle transplantation with microvascular and neural anastomosis and the transfer of muscle flaps from the temporal or subcutaneous muscles of the neck began to be used more widely [6, 7]. Contraindications to plastic surgery are the presence of purulent inflammatory foci on the scalp, neck, ear, tonsils and paranasal cavities; inflammatory processes of the parotid and submandibular glands, lymph nodes and neck area, mastoid process. Plastic surgery should not be performed when initial signs of restoration of facial nerve function appear [7]. In addition to surgical treatment methods, conservative therapy, including drug therapy and physiotherapeutic methods, is of great importance. Exercise therapy during surgical treatment of facial nerve injuries can be divided into 3 periods: preoperative, early postoperative, late postoperative [10]. In the preoperative period, the main task is to actively prevent asymmetry of the healthy and diseased sides of the face. The sharp asymmetry of the face that was created on the first day after the main operation requires immediate and strictly targeted correction. Such a correction is achieved by two methodological techniques: the desired position is given using adhesive tape tension and special gymnastics for the muscles of the healthy half of the face. Treatment by tension.
Adhesive plaster tension is carried out as follows: the adhesive plaster is applied to the active points of the healthy side of the face - the area of ​​the quadratus muscle of the upper lip, the orbicularis oris muscle (on the healthy side) - and with a sufficiently strong tension directed towards the sore side, it is attached to a special helmet-mask or to side straps of the postoperative dressing. The tension is left for a period of 2 to 6 hours a day with a gradual increase in time from day to day. Such a bandage is especially necessary during active facial actions - while eating, talking, in emotional situations, since weakening the asymmetric traction of the muscles of the healthy side of the face improves the general functional state of the paralyzed muscles, which plays a huge role in the postoperative period, especially after germination of the stitched nerve. Treatment with tension in the area of ​​the orbicularis oculi muscle on the affected side is considered separately. In this case, an adhesive plaster is applied like a “crow’s foot” to the middle of the upper and lower eyelids and pulled outward and slightly upward. At the same time, the palpebral fissure narrows significantly, which ensures almost complete closure of the upper and lower eyelids when blinking, normalizes tear production, and protects the cornea from drying out and ulceration. During sleep, the main adhesive plaster tension is removed and left in the eye area. Special gymnastics in this period is also mainly aimed at working the muscles of the healthy side - training is carried out on active muscle relaxation, dosed and, of course, differentiated tension of the main facial muscle groups - the zygomatic, orbicularis oris and eye muscles, triangular muscles. Such exercises with the muscles of the healthy half of the face reduce facial asymmetry, prepare these muscles for such a dosed tension, which in the future will be the most adequate, functionally beneficial for slowly recovering paretic muscles. The second period, early postoperative, is from the moment of plastic surgery to the first signs of nerve sprouting. At this time, basically the same rehabilitation measures continue as in the first period: tension treatment and special gymnastics, aimed primarily at dosed training of the muscles of the healthy side of the face. A necessary addition to these exercises are reflex exercises - static tension of the tongue muscles and forced swallowing training. Tension of the tongue is achieved as follows: the patient rests the tip of the tongue against the line of closed teeth for 2-3 seconds, then relaxes the tongue muscle and again rests against the gum - now above the teeth. After relaxation, emphasis should be placed on the gums below the teeth. Similar series of tensions (emphasis in the middle, up, down) are done 3-4 times a day, 5-8 times during each series. Swallowing training is also carried out in series of 3-4 sips in a row. You can combine normal swallowing with drinking fluids, especially if the patient experiences dry mouth. Combined movements are also possible - static tension of the tongue and, at the same time, swallowing. Combined exercises require a longer rest (3–4 minutes) than after individual exercises. During this period, various types of restorative treatment can be recommended: vitamin therapy, massage of the collar area, etc. Massage of the face, especially the affected side, is considered inappropriate during this period. The third, late postoperative period begins from the moment of the first clinical manifestations of nerve sprouting. Movements of the laughter muscles and one of the portions of the zygomatic muscle appear earlier than others. During this period, the main emphasis is on therapeutic exercises. Static exercises for the muscles of the tongue and swallowing movements continue with a significant increase in the number of classes to 5-6 times a day and the duration of these classes. Before and after exercises, it is recommended to massage the affected half of the face. Particularly valuable is massage from the inside of the mouth, when a physiotherapy instructor massages individual muscle groups with a hand in a surgical glove - the quadratus muscle of the upper lip, the zygomatic muscle, the orbicularis oris muscle, the buccal muscle. As the amplitude of voluntary movements increases, exercises are added with symmetrical tension on both sides - healthy and affected. Here, an important methodological principle is to equate the strength and amplitude of contraction of the muscles of the healthy side with the currently limited capabilities of the muscles of the affected side, but not vice versa, since paretic muscles, even with maximum contraction, do not reach the capabilities of healthy muscles - compliance with this rule ensures facial symmetry. Only equating healthy muscles with paretic ones eliminates asymmetry and thus increases the overall effect of surgical treatment. Movements of the orbicularis oculi muscle appear much later and are initially the result of synergy of contractions of the muscles of the lower and middle parts of the face. This synergy will be achieved within 2–3 months. should be strengthened in every possible way (by joint contractions of all muscles of the affected side), and after achieving a sufficient amplitude of contraction of the orbicularis oculi muscle, it is necessary to achieve differentiated contractions of all muscles. With proper sequential training, the skill of separate contraction of the muscles of the healthy side (see the first period) should transfer to the affected side. During the same period, it is recommended to carry out tension treatment according to the method outlined above, reducing the time to 2–3 hours, every other day [1, 5, 6]. Drug therapy methods include: analgesics, decongestants, anti-inflammatory drugs, vitamins, antiplatelet agents [10]. Neurobion contains a combination of B vitamins: pyridoxine (B6), thiamine (B1) and cyanocobalamin (B12). These vitamins act as coenzymes in intermediate metabolism in the central and peripheral nervous system. It should be noted that the combined use of vitamins B1, B6 and B12 is advisable due to their special role in the metabolic processes of the nervous system [11–13]. This combination of coenzymes accelerates the regeneration of damaged nerve fibers, since it has been proven that the effectiveness of the combination of drugs is superior to the effectiveness of individual components. The therapeutic use of B vitamins is aimed, on the one hand, at compensating for existing deficiency, and on the other hand, at stimulating natural mechanisms for restoring the function of nerve tissue. The analgesic effect of the B vitamin complex has also been proven, which has a beneficial effect on the quality of life of patients [14, 15]. The main indication for use of the drug Neurobion is neuropathy of the facial nerve. Contraindications include hypersensitivity to the components of the drug, childhood, pregnancy and breastfeeding [11]. Among the side effects of the drug Neurobion, in some cases with parenteral administration of vitamin B1, sweating, tachycardia and allergic reactions in the form of skin itching and rash were noted. In rare cases, a hypersensitivity reaction may occur - exanthema, difficulty breathing, anaphylactic shock (after parenteral administration of vitamin B1), acne, eczema and urticaria were observed with the administration of vitamin B12 (mainly through intravenous infusions). When used simultaneously with levodopa, vitamin B6 reduces the antiparkinsonian effect of levodopa. An increased need for vitamin B6 may occur with simultaneous administration of D-penicillamine and cycloserine. Vitamin B1 is destroyed when interacting with solutions containing sulfites [11, 14, 16]. Vitamins B1, B6 and B12 have a wide therapeutic range. Overdose symptoms are not observed when the drug is used in recommended doses and regimen. When high doses of vitamins are administered intravenously for a long time (>2 months), symptoms of intoxication may occur. Neurobion is available in solution for intramuscular administration and in tablet form. In cases of severe pain, it is recommended to begin treatment with intramuscular administration of 3 ml/day until acute symptoms subside. After the symptoms have weakened or in cases of moderate severity, switch to administration of 3 ml 2-3 times a week for 2-3 weeks. For maintenance therapy, to prevent relapse or continue the course of treatment, the drug Neurobion in tablet form is recommended. The drug Neurobion should be taken 1 tablet 3 times a day. The duration of treatment is determined by the doctor and averages 1–1.5 months. Currently, the results of a number of clinical studies of the drug Neurobion are known. A randomized, double-blind study, “Neurobion versus placebo in the prevention of relapse of spinal pain syndrome with B vitamins,” conducted by G. Schwieger, showed a lower rate of relapse of neuropathy - 32% - compared to the placebo group, where the relapse rate reached 60% [11 , 16]. Thus, treatment of diseases of the facial nerve should be comprehensive and include both surgical and medicinal methods. Moreover, systemic drug therapy should occupy a leading place, prescribed individually and depending on the phase of rehabilitation and the concomitant use of surgical aids or physiotherapeutic techniques.

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.

Pharmacotherapy

Numerical studies of LLN, including meta-analyses, have compared steroid therapy in patients treated with acyclovir or placebo. One of them, having accumulated the results of four published studies, showed a significant improvement in facial weakness with the use of glucocorticoids. Another meta-analysis, which included randomized controlled follow-up studies, showed that the initiation of hormone therapy at intervals of up to 7 days led to the development of permanent paralysis of half the face. There was a 17% increase in swelling (P = 0.005) compared with placebo. Evidence is available to show that corticosteroids reduce the incidence of permanent mimetic paralysis, although further research is needed to determine whether their use with antiviral drugs may be changing vagi.

The purpose of the rest for Bell's paralysis seems entirely logical. Acyclovir, a nucleotide analogue, blocks HSV DNA polymerase and suppresses replication. As a result of its low bioavailability (15–30%), new drugs are being tested, zocrema valacyclovir, famciclovir and sorivudine, which may have a better dosing regimen and therapeutic response in the treatment of herpetic infections ій.

The remaining systematic analysis shows that patients with NLN, treated with a combination of acyclovir and prednisolone, have a slightly better prognosis than those who found it without hormone therapy, although the results are not they looked around at Cochrane. The main determinant of the differential therapeutic response was the treatment of the ear at intervals of up to 3 days before the onset of the disease. There was also no difference in effectiveness between different routes of administration of the above-mentioned drugs. Their systemic administration should be considered in case of immunosuppression or massive herpetic infection of the central nervous system.

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

The first step in making a correct diagnosis is to determine whether the mimetic paralysis is central or peripheral. Be very careful about being careful and setting up a lot of power (Fig. 1, 2, 3 and Table 1). Central paralysis (unilateral weakness of the lower limbs of the face) (Fig. 1A) is due to the influence of the orchial nucleus of the facial nerve in the pons (most importantly in the contralateral ligament), which picture is explained by the fact that the motor neuron and the lower half of the well-known core, which, It is important to innervate the lower parts of the ligament and maintain circulatory impulses along the cortico-nuclear tracts from the prosthetic ligament. What is the matter with your upper half, then there is a double-Cirque representation. Thus, the one-sided expression of the measles and the related cervical-nuclear fibers immediately calls out the contralateral complete central paralysis of the facial muscles in conjunction with hemiplegia, but with spared function mucus and sapiness and savory sensitivity (Table 2).

Picture 1.

Central and peripheral paralysis of facial muscles. In response to the refrain “Break your teeth,” patients in Figures A and B demonstrate weakness of the lower lobes of the right half of the face. The man in Figure A demonstrates central facial paresis, which can be inferred from the dual sparing of the frontal folds and the dual ability to close the eyes. In the woman in the picture, the frontal folds on the right are wide, and the cleft is wider, which at the same time due to the defect of the lower lobes of the homolateral half of the face indicates a peripheral palsy of the VII cranial nerve, causing decay at the pons. The patient in the picture suffers from facial hemispasm, which occurs not only after peripheral paralysis, but also during any large-scale process (such as swelling or aneurysm), which stimulates the visual nerve. In this case, the round meat of the eye and the meat of the lower sections and half of the skin are shortened. Be careful not to worry about the weakness of the mimetic muscles of the proximal (left) side.

Figure 2.

Quite a central paralysis of the mimetic muscles is more pronounced, less fleeting. Central facial palsy can be permanent, temporary or permanent. The remaining one is due to the massive effect of the contralateral ligament. If the weakness of the muscles is significant or fleeting, then the affected area of ​​the brain can be identified on the basis of the patient’s reaction to the “Break your teeth” type (assessment of volitional control) and nutrition “If you would have worked, given more pig in my bath?” (revelation of a spontaneous smile, which is an assessment of a fleeting reaction). The doctor is not guilty of asking the sick person to smile, since this causes volitional action. Weakness, which manifests itself with a fairly short-lived mimetic pain, rather than after a fleeting reaction (such as spontaneous laughter), indicates a cervical level at the level of the lower third of the protilegal precentre. of the spinal cord, or in the subcarpal region - from the formation of motor fibers that go from the cortex to the roch nucleus of the visceral nerve . The response to the slogan “Break your teeth” of the patient in Figure A demonstrates central paralysis of the muscles of the right half of the face (only the lower limbs are burned). With a spontaneous smile, causing the question “What would you do if you soaked a pig in your bathtub?” (Fig. B), the weakness of the facial muscles is not obvious; Based on the evidence of central paralysis of the facial nerve, the flesh of the lower lobes of the face symmetrically disappears after a fleeting emotional reaction. In such a situation, computed tomography reveals an infarction of the left ventricle due to the damage to the cortex and pedicles (Fig. C). Based on the fact that the central paralysis is more pronounced and less fleeting, one can think that in this case the cerebral cortex is functionally more affected, the lower substructures.

Figure 3.

Mimovilny central paralysis of mimetic muscles is more pronounced, less severe.
The response to the refrain “Break your teeth” in the patient in Fig. And the flesh of the lower branches of the guise is rapidly disappearing. This shortening is much greater on the right, on the basis of which one can think about a mild left-sided central palsy of the facial nerve. With a spontaneous smile, causing the question “What would you do if you soaked a pig in your bathtub?” (Fig. B), the left central paresis of the mimetic muscles will intensify, which indicates a deep deformation of the contralateral ligament. In such cases, magnetic resonance imaging reveals a deep infarction of the right hemisphere (Fig. C). Nina does not know how steps mediate the fleeting innervation of the facial muscles. Table 1. Differential diagnosis of central and peripheral facial nerve palsy

Table 2. Clinical and anatomical correlations of facial nerve expression at different levels

Peripheral facial paralysis and paresis (Fig. 1B) is caused by disturbances in the homolateral facial nerve or the nucleus of the brain. It is not paradoxical that in the remaining episode, the “central” impact on the level of the bridge causes a peripheral motor defect. The weakness of the flesh is best assessed by examining the patient’s reaction to passing like “Close your eyes” (upper sections) and “Break your teeth” (lower sections). Denervation of the round muscles of the eye may be a successor to the phenomenon of the hare's eye (lagophthalmos), and the muscle of laughter (m. risorius) is the denervation of the looseness of the cuticle of the mouth.

Hyperacusis is caused by paralysis of the stapes muscle, which changes the oscillation of the ossicles of the middle ear, through which the pressure on the side of the perception of sounds increases. Also, fragments of the perineal nerve contain both specific sensitive and parasympathetic fibers, which are obtained from stimulation of the salivary ligament, in patients with lesions of the facial nerve of the proximal ganglion of the valgus. there is a constant loss of taste and dryness in the taste (Fig. 4 and Table 2 ). Recognizing the remaining symptoms is even more important, since such patients will require artificial tears to moisten the cornea and insulate the eyes to stop the infection. Peripheral facial paralysis can be confused with facial hemispasm, in which the cuticle rises and the eye closes frequently as a result of a fleeting shortening of the facial muscles (Fig. 1C). After acute palsy of the facial nerve, the preganglionic parasympathetic fibers that begin to travel to the submandibular ganglion may undergo aberrant regeneration and grow into the great petrosal nerve. This causes intense tear formation after savory stimulation (crocodile tear syndrome).

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.

Diagnostics

Treatment of facial nerve neuritis is prescribed after an examination, which includes:

• general blood and urine tests, blood glucose levels;
• if the infectious nature of the disease is suspected (Lyme disease, HIV infection, syphilis and others) - appropriate serological tests;
• if sarcoidosis or brucellosis is suspected, chest X-ray;
• in the case of a prolonged course (more than 3 weeks), if damage to the brain stem or cerebellopontine angle is suspected, MRI is prescribed, and if the pathological process is localized in the area of ​​the temporal bone, computed tomography is more informative;
• Electroneuromyography is used to assess the effectiveness of treatment;
• If a nerve tissue infection is suspected, a lumbar puncture and cerebrospinal fluid examination are performed.

If the patient has already been diagnosed with ear diseases, or has discharge from the ear canal or hearing loss, he should definitely consult an ENT doctor.

Facial neuritis is differentiated from Lyme disease, Ramsay Hunt syndrome, Melkersson-Rosenthal syndrome.

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.

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.

Facial hemispasm. Paraspasm. Blepharospasm

These are diseases similar to diseases of the facial nerve. Even doctors often confuse them. We will definitely understand the causes of the disease and provide the necessary treatment.

Facial hemispasm is attacks of involuntary contraction or twitching of the facial muscles on one side, similar to a nervous tic of the eye (read more about the causes and treatment of neural tics (including the eyes) here). It may look like squinting, closing your eyes, retracting the corner of your mouth or tip of your nose, or lowering your chin. More information about nervous tics (including the eyes and its causes)

Facial paraspasm is an attack of involuntary contraction of facial muscles on both sides. It occurs much less frequently than hemispasm and more often has common causes with it. More details

Blepharospasm is a disease that begins with rapid blinking, which subsequently develops into intense uncontrolled squinting of the eye or both eyes. More details

We will be happy to help you find the cause and treatment of facial hemispasm (nervous tic of the eye), facial paraspasm, blepharospasm.

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.

Treatment

There is no special treatment for facial nerve neuropathy and treatment is most often symptomatic.

Corticosteroids: Although corticosteroids have many side effects, they can be effective in reducing symptoms of facial neuropathy.

Antiviral drugs such as acyclovir (Zovirax) may be prescribed along with corticosteroids to promote rapid recovery.

Surgical Treatment Options: Patients with intractable facial nerve neuropathies may be treated with surgical treatments such as muscle transpositions, muscle transfers, or nerve transpositions to help restore facial muscle movement.

Facial care: Daily exercise of the facial muscles can cause an increase in the range of movement in the face. By practicing raising the affected eyebrow, opening the affected side of the mouth, smiling, voluntarily closing both eyes, etc. can help improve muscle coordination and elasticity and improve muscle response.

Improving dietary habits: reducing milk intake, increasing water intake and consuming foods rich in vitamin B (B1, B6 and B12) helps stimulate nerve regeneration.

Daily massage: It is necessary to carry out a daily facial massage; Protecting the face from wind and harsh sunlight is also one way to protect the nerve from further damage.

Controlling your blood sugar: Diabetic neuropathy may increase your chances of developing complications of facial neuropathy. Monitoring and maintaining blood sugar levels at normal levels also plays an important role in preventing the development of progressive facial palsy.

Treatment of the eye for neuropathy

Nerve palsy in the face can limit the movement of the eye muscle and can make it nearly impossible to close the eyes voluntarily. If the eye is left open for a long period of time, the cornea will dry out and this will lead to serious complications. To reduce the risk of further damage to the eye, artificial tears and moisturizing eye ointments may be used. Wearing dark glasses can also help shield your eyes from dirt particles. The patient can manually cover the eye gently with a finger or a small bandage to avoid damaging the eye in any way.

Although facial neuropathy affects nearly 40,000 people in the United States each year, it is a condition that can be treated if diagnosed early. If facial nerve palsy is detected at the earliest stage, complete recovery of the nerve can be expected. Additionally, by diagnosing tumors early, the condition can be completely cured by removing the tumor that is compressing the facial nerve.

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.