Facial Paralysis - What to Expect, Course of Recovery, and Cure

Introduction:

Facial paralysis, also known as facial palsy or Bell's palsy- is a disfigurement of the face and weakening of the facial muscles due to a partially or fully damaged facial nerve. The affected side of the face will droop down, lacking movements on that side. Also, one cannot smile or shut their eyes. Facial paralysis can be temporary or permanent and can happen to an individual at any age. The condition can last for a while, depending on the degree of damage that occurred to the nerve.

How Does the Facial Nerve Control the Muscular Movements of the Face?

There are five muscular zones on the face; when one zone moves, all the other zones relax. When eyebrows are raised, a frown is built. In the eye zone, it closes and blinks the eye so that the eye is protected and lubricated often. In the cheek zone, it lifts the top lip and makes us smile, whereas, in the mouth zone, it allows us to pucker the lips and whistle and pout. Also, it helps to make a seal around the lips when we drink something and speak properly. In the chin and neck zone, muscles pull the lower lip down. Inside the cheek, another muscle sucks the cheek in towards the teeth. When the facial nerve turns nonfunctional, all the above activities get impaired.

What Are the Causes of Facial Paralysis?

The facial nerve is the electrical wire that sends signals from the brain to the facial muscles, telling them to move. When the nerve is damaged, the muscles no longer receive signals and stop working. The facial nerve leaves the brain as one wire and travels through the skull in a little tunnel before it enters the face. It divides into five branches to supply all facial muscles used to create facial expressions. It also controls the production of tears and saliva. Damage to the facial nerve can also affect the sense of taste, as it controls a part of the tongue.

Anything that injures or develops swelling or pressure on the facial nerve can damage it. The major causes of damage are:

• Traumatic injuries that damage or cut the nerve.

• Infections caused by viruses, such as Herpes simplex, HIV, Herpes zoster, and Epstein-Barr.

• Infections like Lyme disease due to tick bites.

• Inflammatory conditions such as sarcoidosis.

• Growths and tumors on and around the nerve.

• Ramsay Hunt syndrome, where people suffer from herpes infection, hearing loss, and facial paralysis.

• Certain surgical procedures, like removing a tumor next to the facial nerve.

• A stroke can cause facial palsy, though this is by injury/tumor in the brain rather than damage to the facial nerve.

• If and when the blood supply to the nerve gets cut off.

• Some people may have facial palsy from birth as well.

What Are the Symptoms And Complications of Facial Paralysis?

There are different degrees of facial paralysis - sometimes only the lower half of the face is affected, sometimes the whole side of the face is affected, and rarely both sides of the face can be affected. The symptoms vary at each stage of the disease. Let us look at them one by one;

1) Stage 1: Flaccid Paralysis: The early stage of facial palsy is called flaccid paralysis- when the face is floppy with no movement. Though symptoms vary between individuals, commonly faced issues at this stage are:

1. Loss of movement and expressiveness on the affected side of the face.

2. Difficulty communicating effectively.

3. A dry eye that does not close properly.

4. Sometimes, there is uncontrolled tear production.

5. Dryness of the mouth.

6. Altered taste- problem with eating and drinking.

7. Difficulty in speaking.

8. The trouble with noises sounding too loud in the affected ear.

9. Some might experience a burning type of ache in the face.

10. Sometimes, there can be a pain in or around the ear.

2) Stage 2: Paresis: This is the second stage, where the nerve starts to get repaired bit by bit. At this stage, people notice that:

1. The symmetry of the face looks better when the face is relaxed.

2. Muscles feel firmer.

3. The face begins to have tiny movements.

3) Stage 3: Synkinesis: This stage is prominent in patients with a much more severe injury to the nerve and who are undergoing a slow recovery. They tend to suffer:

1. Mostly all the symptoms of flaccid paralysis.

2. Additional twitches or spasms- These are involuntary linked movements of the face, such as; the eye narrowing at the time of eating and cheek lifts while closing the eyes. It is caused by the nerve, which gets connected to the wrong muscle at regrowth.

How Does Facial Paralysis Affect People at a Psychosocial Level?

Facial palsy causes not only problems at a functional level but also at a cosmetic level. In reality, people with facial palsy experience a wide range of physical and emotional problems that affect their everyday functioning. For example, they tend to feel self-conscious, and as a result, many people avoid going out and about, making them feel isolated and low in mood.

How to Recover From Facial Paralysis?

People for whom the nerve is only mildly inflamed or compressed usually recover in the first three to six weeks. If there is no noticeable improvement within this time, the pressure on the nerve is likely more severe. And it may take longer to heal. Also, facial movement on that side of the face may not be as easy to control as before due to apparent synkinesis. More severe swelling and pressure on the facial nerve means the nerve has to regrow from where it was compressed. Nerves regrow at a rate of one millimeter per day, so the first signs of facial nerve recovery are often not seen until about four months have passed.

How Is Facial Paralysis Diagnosed and Treated?

A thorough examination clinically by the doctor diagnoses what area of the face is affected, what could be the underlying cause for nerve damage, and what is the degree of damage. The injury site can be further assessed by computed tomography scanning (CT) and magnetic resonance imaging (MRI). Clinicians also run electrophysiological studies to determine the extent of damage so that they can additionally decide on the recovery rate and plan the treatment accordingly.

Surgical Correction: In patients where the nerve got cut somewhere on its path, recovery will not happen unless the nerve is surgically repaired or other procedures are carried out to make the muscles move again. These include:

1. Micro neurovascular surgery to reconstruct the facial nerve.

2. Trans facial nerve grafting by using the facial nerve from the unaffected side.

3. Decompression procedures relieve the facial nerve of whatever structure compresses it.

4. For long-term facial paralysis patients, conducting cosmetic corrections restores the muscular functions that lift the drooping eyebrows and mouth.

Medical Management: The doctor may prescribe corticosteroids such as Prednisolone to control the swelling and inflammation in the area of injury for a speedy recovery. They also provide antiviral and antibiotic drugs if the underlying cause is an infection.

Physical and Occupational Therapy: In the early stages of facial paralysis, exercising should be avoided when the face is entirely floppy and flaccid. However, some gentle exercise can begin once an individual gets to the paresis stage. This include:

1. Minimal, precise movements patients can perform with the help of a therapist to gain maximum strength in their facial muscles.

2. Movements that help grow the nerves back efficiently after undergoing surgical corrections like nerve grafting and nerve replacement.

3. Those suffering from uncontrolled movements of the face (synkinesis) may improve with therapeutic facial movements; facial retraining helps them get the flexibility and mobility back into muscles that have contracted short, tight, and stiff due to being overused as they were moving together all the time.

Other Treatment Modalities:

1. One can undergo electrical nerve stimulation for faster recovery.

2. Botulinum toxin injections.

3. Acupuncture.

4. Practice meditation and mindfulness to control spasms.

5. Take up speech and language therapy to communicate better.

6. Being a part of support groups also tends to help reduce isolation and benefit recovery.

Conclusion:

Individuals with partial facial paralysis have better recovery potential than those with total paralysis. Again, those who are young bounce back faster from palsy compared to the elderly. Understanding the underlying cause of nerve injury is critical for better treatment outcomes. A qualified medical professional can help the affected attain faster recovery.