Neuritis refers to inflammation of a nerve with pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearing of the reflexes. The VIIth cranial nerve is one of twelve pairs of nerves connected with the brain, which moves facial expression muscles, provides sensory input for taste in the anterior two-thirds of the tongue, and innervates the tear and salivary glands.

In most cases, the cause may be unknown. Identified causes may include: trauma; tumors; hemorrhage into a nerve; lesions; continuous pressure on a nerve; exposure to cold or radiation; viruses; or infectious disease such as Lyme disease. Other causes include: systemic malignancy; leprosy; metabolic diseases such as diabetes mellitus; collagen blood disorders; toxic agents such as lead or mercury poisoning; certain medications; nutrition deficiencies; metabolic disorders such as alcoholism; and genetics.

[Signs and symptoms may depend on the location of the lesion along the nerve. These manifestations may include: facial edema; drooping of the corners of the mouth; the eyelids may remain open; the lower eyelid may sag; and tearing may be abnormal. In addition, saliva may dribble from the corners of the mouth. Other manifestations include: a sense of heaviness or numbness of the face; paresthesias; burning; muscle weakness; contractures; pain behind the ear; loss of taste; and loss of sensation to temperature and pain. There may also be included: sensitivity to loud sounds; or synkinesis.

Diagnostic measures may include: a complete history; physical and neurological examinations; blood studies; sensory and motor tests; spinal tap; electromyography; computed tomography (CT) scan; and magnetic resonance imaging (MRI).

Treatment may include management of the underlying disorder, medications such as anti-inflammatory medications, antibiotics, vitamin therapy, physical therapy, and use of splints.

Recovery may be prolonged, and there may be contractures. Physical therapy may be needed for the duration of recovery, and long-term medication may also be needed. Hemifacial spasm may develop in the future.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

Notes

• Dependent upon relative loss of innervation of facial muscles.

• Disability from lesions of peripheral portions of first, second, third, fourth, sixth, and eighth nerves will be rated under the Organs of Special Sense. The ratings for the cranial nerves are for unilateral involvement; when bilateral, combine but without the bilateral factor.

• Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. (38 CFR 4.123)