Before the onset of acute peripheral facial paralysis, Bell's palsy seems to have no obvious inducement, but most of them have deficiency of vital qi, deficiency of both qi and blood, imbalance of camp and defense, exterior yang consolidation (such as mental fatigue, listlessness, tight nape, cold limbs, pale fur and tight pulse) as their internal causes, and the evil of six evils takes advantage of it, and most of them are the evil of wind-cold invading the head, face and meridians. Hunter syndrome (such as herpes simplex virus) accounts for 7%, trauma (such as surgery, traffic accident, work-related injury, exercise, forceps, postpartum, especially traffic accident), if there is ear bleeding at that time, it is necessary to put the prevention of impending facial paralysis in the same important position as saving life, otherwise, facial paralysis will occur after 3 days) accounts for 1%, and otitis media (such as malignant otitis externa and cholesteatoma otitis media) accounts for 3. Congenital (such as pons dysplasia) accounts for 1%, others account for [such as poisoning (such as alcoholism), neurometabolic disorder (such as diabetes), intrafacial hemorrhage (such as hypertension), granuloma infiltration (such as leprosy, tuberculosis), vascular embolism caused by vasculitis (such as systemic lupus erythematosus), tumor (such as facial nerve schwannoma, malignant tumor, and chronic peripheral facial paralysis). In particular, the most common causes of this disease are: pulling out ears, picking teeth, filling teeth, pulling teeth, drinking alcohol, being angry, being in a bad mood, being tired, catching cold or herpes zoster, especially when sleeping in the wind should be a big taboo in life, cut! Cut! On this basis, it leads to spasm and contraction of the nutrient vessels of the facial nerve, which leads to nerve ischemia, edema and compression, leading to nerve dystrophy and edema, demyelination and axonal degeneration. Nerves lose their proper functions and can't control the corresponding muscle movements and become paralyzed. Under normal circumstances, the tension on the left and right sides of the face is equal, so the mouth is not crooked. Taking the left facial muscle paralysis as an example, the tension on the left side is reduced due to the loss of normal innervation, so it is pulled by the right side and the mouth is crooked to the right. In addition, under normal circumstances, people's muscle tension is greater when they are awake than when they are asleep, which is why the mouth of patients with facial paralysis is not crooked when they are awake, and the eyes of patients with mild illness can not be closed when they are awake but can be closed when they are asleep. According to the theory of traditional Chinese medicine, taking unilateral type as an example, phlegm is accumulated in Yangming, wind is in the outside of the sun, and wind phlegm is blocked in the meridians of the head and face, so the menstruation is unfavorable and the muscles and muscles are nutrient-deficient, so it is unnecessary and slow; Where there is no evil, qi and blood can still run, which is relatively urgent, and the slow one is pulled by the urgent one, so the mouth is crooked and the eyes are slanting. As for hemifacial spasm, the most fundamental cause is still peripheral stroke. According to modern medicine, after facial vascular stroke, the facial nerve is slightly compressed by the stroke blood vessels for a long time, so that the myelin sheath with insulating properties shrinks and thins at the compressed part, and the action current between efferent nerve fibers and afferent nerve fibers is short-circuited, which leads to the onset of symptoms. Husband's qi is the handsome of blood, and blood is the mother of qi. Qi can produce blood, and blood can carry qi. Treating wind first cures blood, and blood will self-extinguish. The general principle is painless, but pain is unreasonable. Treatment should expel blood stasis, strengthen vital energy, dispel wind and phlegm, stop spasm and dredge meridians, then the disease can be cured. If the disease persists for many years, and the thrombus is not completely softened and organized, calcium can be deposited and calcified, forming hard vein stones in veins, and facial muscle cells gradually shrink due to long-term low nutritional level until death calcification, and the skull bone tissue correspondingly shrinks.

Facial paralysis is a kind of disease with unilateral or bilateral facial nerve paralysis and facial paralysis caused by trauma, surgery, facial neuritis and space occupying diseases, which mostly occurs in one side. Those who have not fully recovered within 2 years of illness are called early facial paralysis, and those who have been ill for more than 2 years are called late facial paralysis.

Surgical treatment is mainly aimed at advanced facial paralysis. Surgical treatment can be divided into static treatment and dynamic treatment. Static treatment is mainly to transplant fascia lata into the face in strips. After treatment, bilateral facial expressions are symmetrical under static conditions, but the affected side cannot move with the healthy side under dynamic conditions. Dynamic therapy is generally divided into two stages. In the first stage, the nerve removed from the patient's calf is anastomosed with the nerve on the healthy side, and the end of the transplanted nerve is placed on the affected side. After the nerve grows from the healthy side to the affected side for 6 months to 1 year, the second stage operation is carried out, that is, the muscle with vascular nerve is transplanted. The selected muscle can be rectus femoris, gracilis, latissimus dorsi, etc. After 3 months to 1 year of treatment, both static and dynamic expressions can be symmetrical.

We put forward the theory of designing the muscle donor site according to the distribution of nerves, blood vessels and tendons in skeletal muscle, and observed that the nerves and blood vessels of rectus femoris are anatomically constant, the caliber of which is suitable for facial blood vessels and nerves, and the tendons of its muscles are conducive to maintaining the normal muscle tension of the transplanted muscle flap and the reduction and fixation of facial squabble, and it is convenient to remove the muscle flap surgically, without blood vessels and nerves injury and dysfunction of the muscle donor site. There are now 21 patients with facial paralysis who have been treated with free straight femoral motility. After applying the above surgical methods, all patients' facial swelling subsided about 1 ~ 3 months after operation, and their bilateral spats were symmetrical in static state. Two patients recovered their voluntary movement of spats 8 months after operation, and the rest showed their independent expression movements 1 ~ 12 months after operation.

generally speaking, the treatment of facial paralysis: the first is to remove the cause. The second is symptomatic treatment, improving circulation and eliminating facial edema. The third is to nourish the nerves. Once the acute facial neuritis is diagnosed, it should be treated as soon as possible, with hormones and symptomatic treatment. If the best treatment opportunity is delayed, it is easy to cause sequelae of facial paralysis.

In the past, traditional treatments for facial paralysis, sequela of facial paralysis, hemifacial spasm and trigeminal neuralgia were acupuncture, sticking medicine, cupping, cutting, fire needle, electroacupuncture, physical therapy, nasal congestion medicine, interventional therapy, facial injection medicine, and some folk methods such as rubbing eel blood. These traditional methods have made great contributions to the development and prosperity of the Chinese nation and the elimination of diseases, and are the pinnacle of the Chinese medicine library.

However, there are serious and even insurmountable sequelae in the treatment of facial muscle diseases such as facial paralysis, sequelae of facial paralysis, hemifacial spasm and trigeminal neuralgia, which are the source of great pain for a large number of patients all their lives.

The facial muscles are flat, flat and thin skin muscles and strip-shaped flat muscles. These muscles originate from different parts of the skull and are distributed around the fissure of the eye, the fissure of the mouth and the nostril. The flat annular muscles and flat radial muscles are connected with the surrounding muscle tissues. When these muscles contract and relax, they can enlarge and narrow the eyes, mouth and nostrils. At the same time, it affects facial skin activities, showing various expressions such as joy, anger, sadness and joy. There are about 26 facial muscles. They overlap with each other and have their own functions. If acupuncture, cupping, sticking medicine, electroacupuncture, fire needle and nerve-nourishing drugs are injected into the face, intervention treatment will be carried out. These treatments will definitely cause injury, bleeding, fibrosis and inflammatory reaction of these muscles. < P > Treatment:

1. Self-massage < P > Here are the methods of massage along the muscle direction: < P > 1. Patients with frontalis and abdomen of occipital frontalis muscle or others gently massage with their thumb or forefinger from brow arch to head and from head to brow arch along the frontalis and abdomen of occipital frontalis muscle. When you massage, you can gently push and pull from the eyebrow arch to the hairline on the top of your head, or rub it slowly.

2. Most patients with orbicularis oculi showed eye closure dysfunction and tears. The main reason is that the orbicularis oculi muscle can't contract effectively, so it is pulled down from the protruding eyeball and closed. Let the patient close his eyes first, and then massage with his fingertips along the depression between the upper and lower eyelids or the lower edge of the orbit. Gently pushing and pulling on the upper and lower eyelids from the inside out, and then from the outside in, is helpful to the recovery of upper eyelid function. This method also helps to close your eyes. General peripheral facial paralysis is mainly manifested as upper eyelid closure disorder. Severe pathological facial paralysis may lead to lower eyelid lift disorder. A few patients have mild ectropion of the lower eyelid, which is mainly caused by the relaxation of the lower eyelid after facial paralysis. You can also use the above-mentioned finger push-pull method for treatment. Ask the patient to close his eyes and gently push and pull along the skin of the lower eyelid from inside to outside with the thumb and the pulp of the index finger, and then from outside to inside. A few patients have left the upper eyelid with incomplete closure after most of facial expression muscles are recovered. Massage therapy with this method can avoid or alleviate the recovered eyelid contracture.

3. levator labialis muscle levator labialis muscle, also called quadratus labialis, originated from the maxilla above the suborbital foramen and the lower edge of the orbit, which is located in the deep part of the orbicularis oculi muscle. Part of the muscle fibers of the levator labialis muscle enter the skin on the lateral side of the upper lip downward, and other fibers are interwoven with the muscle fibers of the orbicularis oris. Therefore, the upper orbicularis oris muscle of the affected side should be massaged to the alar and zygomatic region, and then massaged to the zygomatic region along the nasolabial groove or the squabble. Massage with the thumb or forefinger and middle finger to massage the zygomatic region or push and pull along the muscle direction.

4. Zygomatic muscle Zygomatic muscle is divided into zygomatic major muscle and zygomatic minor muscle, which starts from zygomatic bone and ends at squabble. It is mainly mentioned that the squabble can be pulled outward, and it can be pushed and pulled or rubbed along the muscle fiber from the side of the squabble to the cheekbone.

5. orbicularis oris muscle at the upper mouth: massage with the pulp of the index finger and thumb along the squabble of the affected side toward the middle sulcus, and then along the middle sulcus toward the squabble. Musculus orbicularis inferior oris: Use the index finger and thumb to finger the abdomen, massage along the affected side corner to the center, and then massage in the direction of the affected side corner.

6. Gently massage and push and pull the lower lip quadratus muscle with the thumb pulp from the lower corner of the mouth to the inner side and downward, which is helpful for the recovery of the functions of the lower lip quadratus muscle, mental muscle and deltoid muscle.

Second, rehabilitation training of facial expression muscles

Effective rehabilitation training of facial expression muscles can obviously improve the curative effect after facial expression muscles move. The main facial muscles involved in facial paralysis are frontotemporal muscle, orbicularis oculi muscle, levator labialis muscle, zygomatic muscle, levator oris muscle, orbicularis oris muscle and quadratus labialis muscle. Functional training of these main muscles can promote the motor function of the whole facial expression muscle to return to normal. During training, the following treatment methods should be selected according to the different symptoms of patients, training 2~3 times a day, and training 1~2 times for each movement. The specific training methods are as follows:

1. Eyebrow lifting training The completion of eyebrow lifting mainly depends on the movement of forehead and abdomen of occipital frontalis muscle. In apraxia, mild and moderate pathological facial paralysis, the motor function of the frontotemporal muscle is the easiest to recover. The patient can be instructed to raise eyebrows on the healthy side and the affected side, which is helpful to the recovery of eyebrow lifting motor function.

2. The function of eye closing training mainly depends on the movement and contraction of orbicularis oculi muscle. When training to close eyes, ask patients to close their eyes gently at the beginning, and close their eyes 1~2 times at the same time. If they can't completely close their eyelids, they can gently massage with the fingertips along the lower edge of the orbit when they are exposed, and then close their eyes hard for 1 times, which is helpful to the recovery of eyelid closure function.

3. Nose-shrug training The nose-shrug movement is mainly accomplished by the movement and contraction of the upper lip muscle and the nose depressor muscle. Nose shrug training can promote the recovery of motor function of nasal depressor and levator labialis muscle. There are a few patients who can't shrug their noses, so they should pay attention to exerting force in the direction of nose during training.

4. Tooth-indicating training: Tooth-indicating actions are mainly accomplished by the contraction of zygomatic major and minor muscles, levator pollicis muscle and smiling muscle. The motor dysfunction of these four muscles is the main reason for the skew of the mouth. Ask the patient to move the spat to both sides at the same time, so as to avoid practicing a habitual spat deflection movement only to one side.

5. Make signal with the lips training. Make signal with the lips mainly depends on the contraction of orbicularis oris muscle. When doing lip-kissing training, you should shrink your lips and make lip-kissing forward, and make lip-kissing hard. After the orbicularis oris muscle is restored, the symptoms of patients being able to drum their cheeks, leaking their teeth or drooling after eating disappear. The motor function of levator labialis muscle, quadratus labialis muscle and mental muscle was trained at the same time when training the lips.

6. Bubbling training is helpful to the recovery of the motor function of orbicularis oris and buccal muscles. When the gills are leaking, hold the orbicularis oris muscle of the affected side up and down with your hands for gills-bulging training. The patient can perform cheek drum exercise, which shows that the motor function of orbicularis oris and buccal muscles can return to normal, and the symptoms of water leakage, drooling and food stagnation disappear. This method is helpful to prevent and treat contracture of upper lip quadratus muscle.

The training of each of the above actions is designed for the dyskinesia of different muscle groups. Therefore, when observing the dyskinesia of patients' facial expression muscles, training should be aimed at the affected muscle groups. If the affected muscle groups cannot be effectively judged, the motor function training can be carried out according to the above procedures, and good rehabilitation effects can be obtained.