Causes, Analysis and Differential Analysis, Ayurveda Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

 In some neurological illnesses, there may be facial deviation. Because the symmetry between either side of the face is misplaced, it’s referred to as ‘Facial Asymmetry’. Additionally it is referred to as Facial Droop.

Why it occurs – Facial asymmetry happens attributable to facial deviation, when the muscle tissue on one aspect of the face get paralyzed or weakened. Facial deviation ends in asymmetry of face, drooping on the nook of the mouth or lack of ability to completely shut one eye.

Causes – Facial Asymmetry usually happens attributable to both –

1. Higher Motor Neuron Lesions (UMN) or
2. Decrease Motor Neuron Lesions (LMN)

The opposite frequent circumstances which trigger facial asymmetry are (generally recognized) –

1. Bell’s Palsy – the commonest trigger for facial deviation (additionally a LMN Lesion)
2. Stroke – a life-threatening situation which might trigger facial deviation (additionally a UMN Lesion)

The principle objective can be to differentially diagnose these circumstances and label them correctly, particularly UMN and LMN lesions.

Differentiating the circumstances inflicting Facial Asymmetry

Initially allow us to begin with differentiating UMN and LMN Lesions, which is essential on this route in order to rule them in or out.

Do Not Miss the FOREHEAD – In differentiating between UMN and LMN Lesions inflicting facial deviation, it is extremely vital to start out with the ‘FOREHEAD’. This ‘Brow Check’ shortly helps us to slender down the reason for facial deviation.

Golden Rule – ‘LOOK AT HOW MUCH THE FACE IS AFFECTED’

1. UMN Lesions – Central Causes – FOREHEAD IS SPARED

There may be deviation of solely the LOWER HALF of the face whereas the brow often nonetheless strikes.

Purpose – The higher half of the face receives the nerve indicators from either side of the mind.

To maintain it quick – Brow is unaffected. There may be paralysis and deviation of the decrease half of the face.

UMN Causes to look out for – They’ve their origin within the mind, often indicating a CNS (central nervous system) difficulty. These circumstances will current with no or minimal facial deviation (asymmetry) or weak point.

The UMN causes to think about facial asymmetry are –

1. Stroke / CVA (Cerebrovascular accident) – There isn’t a brow weak point. Facial droop in stroke is sudden. It’s typically accompanied by arm or leg weak point, problem in speech (slurred speech) and lack of steadiness.
2.   Transient Ischemic Assault (TIA) – The signs are similar to a stroke however they resolve inside 24 hours or so.
3. A number of Sclerosis (MS) – Marked by intermittent episodes of facial weak point precipitated attributable to central pathways being affected by demyelinating plaques and is commonly accompanied by numbness or imaginative and prescient issues.
4.   Intracranial Tumors or Lesions / Mind Tumor – The tumors compress the motor cortex or brainstem. On this, there could also be a sluggish onset of facial weak point. Related options embody steadiness points, imaginative and prescient adjustments or persistent complications.

2. LMN Lesions – Peripheral Causes – FOREHEAD and ENTIRE FACE (One Facet) is AFFECTED

There may be paralysis and therefore deviation of the entire ONE SIDE of the face together with the brow.

Purpose – Your entire identical aspect of the face is managed by LMN.

To maintain it quick – Brow is affected. One half of the face together with the brow of that aspect are paralyzed and deviated.

LMN Causes to look out for – They have an effect on the facial nerve after the nerve has left the mind stem. These circumstances will certainly current with facial deviation or weak point.

The LMN causes to look out for in facial asymmetry instances are –

1. Bell’s Palsy – That is the commonest (60-75% of instances) trigger for facial deviation / asymmetry. The illness is characterised by sudden onset of unilateral facial paralysis. The situation is idiopathic. There may be fast onset and the signs peak often inside 48 hours.
2.   Ramsay Hunt Syndrome / Herpes Zoster Oticus – This situation is attributable to reactivation of shingles virus. The doctor must look out for painful blisters within the ear canal or mouth roof. The situation presents with extreme ache within the ear, a vesicular rash within the ear canal or mouth and in addition points with listening to and steadiness.
3. Lyme Illness – The trigger is a ‘tick chew’ (Borrelia burgdorferi tick). It clearly begins off with a rash (bull’s eye rash) which is adopted by facial palsy. The palsy might be bilateral – facial diplegia.
4.   Tumors – Primarily look out for a parotid gland tumor or acoustic neuroma because the chief trigger. There may be sluggish and progressive weak point of 1 aspect of the face and is commonly accompanied by a palpable lump close to the jawline. Localized twitching or listening to loss may additionally be related.
5. Trauma / Iatrogenic – Direct damage to the face as happens in accidents or a temporal bone fracture are sometimes causal. Nerve injury from dental work or surgical procedures together with parotid gland or mastoid are additionally causa.

Different Uncommon Systemic and Autoimmune Causes

1. GBS (Guillain Barre Syndrome) – Bilateral facial paralysis is a function on this autoimmune dysfunction. The illness has a fast onset and infrequently begins off with leg weak point. The illness is progressive and would contain progressive symmetrical limb weak point, areflexia. 
2. Sarcoidosis – It’s an inflammatory illness which may have an effect on the facial nerve. It might trigger bilateral palsy or parotid enlargement (Heerfordt Syndrome) when the illness impacts the facial nerve.
3. Melkersson Rosenthal Syndrome – It’s a uncommon genetic situation which causes recurring facial palsy. There may additionally be related lip swelling and a fissured tongue. MRS Triad consists of – recurring facial palsy, fissured tongue and facial / lip swelling.
4. Infections Meningitis or Otitis Media – On this situation, there may be direct unfold of bacterial or viral infections affecting the nerve inside the temporal bone.

Alarming Indicators

One ought to think about facial deviation as a scientific emergency when it’s accompanied with different warning indicators as under talked about (any of them( –

–        Limb weak point

–        Numbness

–        Problem in strolling

–        Slurred speech

–        Concussion

–        Blisters across the ear

–        Extreme vertigo

–        Double imaginative and prescient

Diagnostic Strategy

Correct and well timed analysis could be very important in facial deviation circumstances since it might point out a medical emergency or a critical systemic an infection. It shall be assessed with the assistance of a number of of the under talked about diagnostic instruments

–        Neurological examination – an intensive take a look at of cranial nerves with particular emphasis in the direction of seventh cranial nerve i.e. facial nerve

–        Otoscopy – for vesicles (to rule out Ramsay Hunt Syndrome)

–        Imaging – when the trigger is just not clear and if there may be sluggish development of weak point over many weeks or when a tumor / central lesion is suspected as causal for facial deviation, MRI or CT scans are prompt

–        Blood Work – is finished to check for inflammatory markers, Lyme antibodies and HIV and so forth.

Circumstances described in Ayurveda depicting ‘Facial Deviation’ or ‘Facial Asymmetry’

Facial Deviation or Facial Asymmetry, based on Ayurveda is a situation attributable to aggravated Vata. Additionally it is a Vata Nanatmaja Vyadhi – a particular situation attributable to aggravation of solely Vata.

Ardita, a situation described in Ayurveda treatises resembles the outline of facial paralysis / palsy or Bell’s Palsy whereby facial deviation, asymmetry or crookedness of the face (vakram bhavati vaktra ardham) has been clearly talked about amongst the signs.

One other situation which must be thought-about herein is Pakshavadha or Pakshaghata. Although Pakshavadha describes hemiplegia, the weak point of half face and its deviation too shall be thought-about. The outline of Pakshavadha additionally consists of Ekanga Vata and Sarvangna Vata (aggravated vata affecting half or full physique respectively), that are additionally mentioned to be the synonyms of Pakshavadha.

Due to this fact, this Ardita-Pakshavadha situation in totality describes each single situation described within the differential prognosis of facial deviation above.

Associated Studying 

Paralysis – Ayurveda Understanding – Simple Ayurveda Article

Charaka Samhita – Vata Vyadhi Chikitsa by Simple Ayurveda

Facial Paralysis – Simple Ayurveda Article

Madhava Nidana – Vata Vyadhi Nidanam

AIAPGET Questions

1. Facial deviation related to lack of ability to wrinkle the brow suggests:

1. Higher motor neuron lesion
2. Decrease motor neuron facial palsy
3. Trigeminal neuropathy
4. Glossopharyngeal palsy

Reply: B. Decrease motor neuron facial palsy

Rationalization: Bell’s palsy impacts the complete ipsilateral face together with brow muscle tissue.

2. Which of the next signs is least seemingly in Ardita?

1. Deviation of Face
2. Speech Problem
3. Deviation of nostril
4. Full lack of consciousness

Reply: D. Full lack of consciousness

Rationalization: Consciousness stays intact in Ardita.

3. In fashionable neurology, preservation of brow actions with facial deviation signifies:

1. Bell’s palsy
2. LMN facial nerve lesion
3. UMN lesion above facial nucleus
4. Trigeminal neuralgia

Reply: C. UMN lesion above facial nucleus

Rationalization: Brow receives bilateral cortical innervation.

4. A affected person presents with facial asymmetry, hyperacusis, decreased lacrimation, and lack of style in anterior 2/3 of tongue. The lesion is most certainly in:

1. Trigeminal nerve
2. Facial nerve proximal to chorda tympani
3. Hypoglossal nerve
4. Oculomotor nerve

Reply: B. Facial nerve proximal to chorda tympani

Rationalization: Facial nerve carries style fibers and provides stapedius.

5. Which Nidana is particularly talked about for Ardita in classical texts?

1. Extreme publicity to chilly wind
2. Extreme blood loss
3. Extreme fasting alone
4. Extreme sleep alone

Reply: A. Extreme publicity to chilly wind

Rationalization: Sheeta, Ativata-sevana, and publicity to chilly are vital Vata-provoking causes.

6. Facial deviation occurring together with contralateral hemiplegia is classically suggestive of:

1. Bell’s palsy
2. Remoted facial neuropathy
3. Central facial palsy attributable to stroke
4. Trigeminal neuropathy

Reply: C. Central facial palsy attributable to stroke

Rationalization: UMN lesions typically produce facial weak point with hemiplegia.

7. Essentially the most applicable Ayurvedic Panchakarma process in persistent Ardita dominated by Vata-Kapha is:

1. Virechana solely
2. Raktamokshana solely
3. Nasya Karma
4. Tikta Kshira Basti solely

Reply: C. Nasya Karma

Rationalization: Nasya is taken into account the prime remedy for illnesses above the clavicle (Urdhvajatrugata Vikaras), together with Ardita.

8. Intermittent episodes of facial weak point in A number of Sclerosis is attribute of –

1.   Higher Motor Neuron Lesion
2.   Decrease Motor Neuron Lesion
3.   Each
4.   None

Ans – Higher Motor Neuron Lesion.

Rationalization – The involvement of the brow is spared.

9. Facial deviation in Ramsay Hunt Syndrome is attribute function of –

1.   Decrease Motor Neuron Lesion
2.   Higher Motor Neuron Lesion
3.   Each
4.   None

Ans – A. Decrease Motor Neuron Lesion.

Rationalization – The brow can also be concerned.

10. When facial deviation happens following surgical procedure of parotid gland, it displays –

1.   Higher Motor Neuron Lesion
2.   Decrease Motor Neuron Lesion
3.   Each
4.   None

Ans – B. Decrease Motor Neuron Lesion.

Rationalization – The brow can also be concerned.