Facial paralysis or facial nerve palsy is the paralysis of the 7th cranial nerve (nervus facialis), which allows the facial muscles to move. The paralysis usually manifests on one side of the face, and is typically characterized by a drooping corner of the mouth and a lack of facial expression. Treatment of facial nerve palsy is based on the cause.
What is facial paralysis?
Facial paresis, or facial paralysis, is a complete or partial paralysis or weakening of the facial nerve so that the facial muscles can no longer move adequately. A distinction is made between central and peripheral facial paralysis. Central facial palsy is caused by damage to the site of origin of the nerve, namely the brain. Peripheral facial palsy occurs due to damage directly to the nerve. Often, however, the cause of the paralysis is unknown, in which case it is called idiopathic facial palsy, meaning: without an identifiable cause. Idiopathic paralysis is also called Bell’s palsy after the English physician Charles Bell.
Causes
The most common facial paralysis is idiopathic, meaning that in most cases the cause of the facial paralysis is unknown. Peripheral palsy, when the damage is directly to the nerve, can have several triggers. Inflammation is often present, such as otitis media or zoster oticus, a herpes infection of the ear. Injuries such as fractures to the skull bone can also affect the nerve’s function. Similarly, tumors in the ear that press on the facial nerve as they grow can be responsible for peripheral facial nerve palsy. Central facial nerve palsy is caused by damage to the brain where the nerve originates. The facial nerve remains intact and is not itself damaged, it just can no longer carry information to and from the brain. Common causes of central facial nerve palsy are stroke or brain tumor. In stroke, the area of origin of the facial nerve is damaged by hemorrhage or undersupply; in brain tumor, the growing tumor presses on the area so that functions are disrupted and facial nerve palsy occurs.
Symptoms, complaints, and signs
Because the facial nerve supplies the mimic muscles, failure results in characteristic, hemifacial changes in facial expression. In mild facial nerve palsy, symptoms are only discrete; asymmetric changes become more pronounced in more severe palsy. Peripheral and central facial nerve paresis can be distinguished from each other in terms of symptoms. Both central and peripheral paresis are accompanied on the affected side by a drooping corner of the mouth and incomplete or lifted eyelid closure. Things like whistling, smiling or drinking become difficult to impossible. The term “bark phenomenon” is used to describe the fact that the typical upward rotation of the eyeball becomes visible when trying to close the eyelid. In peripheral, as opposed to central, paralysis, patients are additionally unable to frown on the affected side. Since the facial nerve is also responsible for part of the taste sensations on our tongue, taste disorders may be present as a result of damage. Another symptom is a reduced saliva and tear secretion. In combination with incomplete eyelid closure, this poses the risk of corneal damage due to dehydration of the eye. Some patients also complain of noise hypersensitivity with pain on the affected side behind the ear.
Diagnosis and course
The typical symptom of facial nerve palsy is unilateral flaccid facial muscles. One corner of the mouth droops, one eye cannot be fully closed, and frowning is not possible. The entire facial expression looks slightly displaced. If central facial nerve palsy is present, other symptoms may also be present. Salivation becomes less and since the nerve also supplies the tongue, there may be a reduction in the ability to taste (see taste disorder). Likewise, the formation of lacrimal fluid may be reduced, and the eye on the affected side becomes dry. Pronunciation also suffers from facial nerve palsy, as the lip and tongue muscles cannot articulate properly, meaning the sounds can no longer be formed correctly.The physician already sees the first indication of facial nerve palsy through the obvious signs of paralysis. Further information is provided by the patient’s medical history and various tests, a blood test to rule out infections, X-rays of the skull, an electromyography to measure nerve conductivity or a cerebrospinal fluid (CSF) examination (fluid sampling from the spinal column). These examinations will first find the cause and then the proper treatment for facial nerve palsy.
Complications
The complications to expect with facial nerve palsy (facial paralysis) depend on what caused the paralysis. Otitis media (middle ear infection) is often the trigger for facial palsy. The inflammation, which is caused by bacteria, can be accompanied by severe pain and a number of other complications. Because of the proximity of the facial nerve to the ear, there is a risk that the infection will spread and permanently damage the facial nerve if the infection is severe. However, facial nerve palsy can also be the result of Lyme disease. The bacterium that causes the infection, Borrelia Burgdorferi, is transmitted by ticks. The disease progresses in stages. Initially, the so-called migratory redness (erythema migrans) and non-specific signs such as headache and pain in the limbs, feeling of weakness and fever appear. In the next stage, paralysis may occur along the injection site or facial paralysis in conjunction with swelling of the lymph nodes. Lyme disease can also cause permanent damage to the facial nerve. In severe cases, facial expressions are permanently impaired, the face may appear crooked, and the corners of the eyes and mouth may droop. Occasionally, the trigger of shingles, the herpes zoster virus, affects the ear and ear canal. The virus can then spread to the facial nerve and cause temporary paralysis. Permanent damage to the nerve is rare in these cases. However, the infection is usually extremely painful.
When should you see a doctor?
When signs of facial paralysis are noticed, a doctor must be consulted. In most cases, the complaints are based on a serious disease, which must be clarified without fail. Only a physician can determine whether the condition is facial paralysis. A visit to the doctor is necessary at the latest when complications arise. If, for example, an inflammation develops, this must be clarified immediately and treated if necessary. Medical advice is also required if symptoms of Lyme disease appear. Signs such as headache and pain in the limbs, fever and the typical wandering redness indicate that the facial paralysis is based on an infectious disease that must be treated. Individuals who suffer from facial deformities due to facial paresis that has been treated too late should consult a specialist. Those at risk – including people who have recently had a herpes infection in the ear, middle ear infection, or a tumor in the ear – should talk to their primary care physician immediately if they experience the warning signs mentioned above. Patients suffering from corresponding complaints after a stroke or a brain tumor are best to consult the responsible physician. Medical treatment is required in any case of facial paralysis.
Treatment and therapy
About 70 percent of facial nerve palsies that occur heal completely. Treatment is always based on the presenting cause. If facial nerve palsy is caused by a bacterial infection, antibiotics are usually given. In the case of viral inflammation (caused by viruses), so-called virostatics help, which prevent the virus from multiplying. If the facial nerve is damaged by an injury, surgery can restore the function of the nerve. In addition, accompanying movement exercises are necessary to train the facial muscles. Occupational therapists or physiotherapists are responsible for this. If the facial paresis is caused by a pathological process in the brain, inpatient treatment is inevitable. The dryness of the eye that occurs with facial paresis can be alleviated with an ointment or artificial tears. It is advisable to close the eye with a bandage overnight to prevent it from drying out. If facial nerve palsy is idiopathic, treatment focuses on alleviating the symptoms, and cortisone is administered as a supportive measure.
Outlook and prognosis
The cause of fascial paresis (facial paralysis) determines the prognosis. The severity of the disease as well as the individual symptoms and the age of the affected patient also influence how the disease progresses. In general, it must be assumed that the chance of a complete cure decreases with increasing age. Especially in the case of idiopathic facial paresis, the chance for a cure is quite good. If the therapy is carried out correctly, the symptoms decrease significantly in 90 percent of those affected. Moreover, after about four months, a complete cure can be observed in more than two-thirds of these patients. However, depending on the severity of the seventh cranial nerve injury, complete healing can take several years, although such long therapies are rare. If it is a peripheral or central facial paralysis, however, the prognosis looks poor. Of course, the extent of the damage is also decisive in this case. In case of a complete paralysis, a too late treatment or even a wrong medication, the prognosis is rather negative. In many cases, incomplete regeneration occurs, which is referred to as defect healing. In retrospect, patients may still suffer from twitching, increased tension in the facial muscle or uncontrollable lacrimation. However, it may be conceivable to restore the destroyed nerve fibers in surgery.
Prevention
Direct prevention of facial nerve palsy is not possible because it most commonly occurs with an unknown cause. If a causative condition is present, immediate treatment is recommended to avoid damaging the nerve and potentially preventing facial nerve palsy.
Follow-up
In most cases of facial nerve palsy, there are no special aftercare options available to affected individuals. They rely primarily on proper treatment of the condition to prevent further complications. The focus is on identifying and treating the cause of facial nerve palsy to prevent further spread to the entire body. The earlier the disease is detected, the better the further course of the disease. In most cases, facial nerve palsy is treated with the help of medication. Those affected must pay attention to the correct dosage and also to regular intake, whereby in the case of children it is above all the parents who must monitor intake. In case of side effects or ambiguities, a physician should be consulted. Furthermore, some complaints of facial paresis can be treated with the help of physiotherapy. Many of the exercises from this physiotherapy can also be performed in the patient’s own home to restore the movement of the muscles. Usually, the life expectancy of the affected person is not limited by facial nerve palsy. Contact with other sufferers of this condition is also often useful.
What you can do yourself
In addition to medical treatment, some self-help options are available to those affected. In the case of therapies that are subject to a fee, it is advisable to discuss them in advance with the health insurance company. These include lymphatic drainage, acupuncture, physiotherapy and seeing an osteopath. From homeopathy, the globules Aconitum C9 and Causticum C5 have proven to be effective. Taking vitamin B is also said to provide relief, but this has not been statistically proven. The same applies to treatment by light showers. Facial gymnastics and facial expression exercises can be performed by oneself at any time. Not only straining, but also relaxing the muscles is important. Autogenic training and relaxing facial massages also have a positive effect on the mental state of the affected person. Sufferers should integrate simple but effective exercises into their daily routine. Grimaces, such as raising both eyebrows and the corners of the mouth or forming a kissing mouth, are just as helpful as pressing the lips and eyes together and then back, miming and blowing up the cheeks or a balloon. Any facial expressions from the evil eye to expressions of great joy are helpful.
