What is facial paralysis and what causes it?
Facial paralysis is loss of movement in half of the face. It can be due to a stroke or a brain tumor, in that case, we call it central facial paralysis. Central paralysis is important to be ruled out before talking about facial paralysis rehabilitation.
Fortunately, most causes of facial paralysis are not due to a stroke, but rather to a cause outside the brain. We call these causes “peripheral”.
Here are some of the most common causes of facial paralysis:
– Bell’s palsy: paralysis due to an infection with the herpes virus. Usually painless.
– Ramsay-Hunt syndrome: paralysis due to an infection with the varicella virus, usually characterized by vesicles or lesions around the ear canal. Often associated with pain and a worse grade of facial paralysis.
– Zoster sine herpete: paralysis due to an infection with the varicella virus but without a rash or vesicles. Still associated with severe pain and a worse grade of facial paralysis
– Tumors of the facial nerve or the nerves of hearing and balance can cause facial paralysis
– Severe ear infections
– Lyme disease: patients with a history of camping and a possible tick bite can sometimes present with facial paralysis
– HIV can sometimes cause facial paralysis
– Cancer of the salivary glands such as the parotid gland
– Many other rare causes such as Melkersson-Rosenthal syndrome, sarcoidosis, and other.
The facial nerve passes through a salivary gland: the parotid gland
Source: Moubayed et al., Facial Plastic and Reconstructive Surgery: Concepts, Questions, Answers, 1st ed.
How do we treat acute facial paralysis (when it initially appears)?
An evaluation by a doctor is mandatory for treatment of facial paralysis.
The most important aspect of treatment of facial paralysis is protecting the eye. When the face is paralyzed, the eye often cannot close completely. This is called lagophthalmos. The inability of the eye to close causes the cornea to dry up and can cause keratitis, with a permanent loss of vision. Therefore, protecting the eye with artificial eye drops every hour and artificial tear ointment every night is essential until the eye can close completely.
When the cause is identified, the treatment of facial paralysis is specific to the cause:
– Causes due to viral infection (Bell’s palsy, Ramsay-Hunt, or Zoster sine herpete) are treated with oral corticosteroids and oral antiviral medication.
– Severe ear infections are treated with antibiotics, ear tubes, and sometimes ear surgery called mastoidectomy
– Tumors are treated by removing the tumor
– Lyme disease is treated with antibiotics.
How do you treat chronic facial paralysis?
The most common causes of facial paralysis are viral, such as Bell’s palsy. These patients most often recover in first few weeks. When patients do not recover completely and spontaneously, chronic facial paralysis can develop.
There are two general categories of chronic facial paralysis:
Flaccid facial paralysis results in absence of facial tone and movement. For patients where spontaneous recovery is not a possibility, we offer reanimation surgery. Reanimation can be performed using gold weights inserted into the eyelid to enable it to close, nerve transfers originating from other nerves in the face, or muscle transfers from elsewhere in the face or body. Fascia transfers originating from the leg are also possible.
The other category is hyperkinetic facial paralysis, which is a complication of facial paralysis where nerves have grown back in a disorganized fashion, causes facial spasms or discomfort. These patients are treated with neuromuscular therapy and botulinum toxin injections.