Facial paralysis or facial weakness occurs as a result of damage to the facial nerve. The facial nerve (7th cranial nerve) controls muscles of the face responsible for our facial expression e.g. smile, pout, frown, and wink.
A number of conditions can affect the facial nerve including virus, trauma or disease.
- Virus – This attacks the facial nerve causing nerve degeneration. The most common conditions include Bells Palsy (see below) or Ramsay Hunt Syndrome.
- Trauma – A cut to the facial nerve (e.g. a sharp instrument) may partially or fully sever the nerve.
- Disease – Tumours that lie close to the facial nerve (e.g. acoustic neuroma, parotid tumour) may require surgical intervention. There is risk that the facial nerve maybe traumatised during such a procedure.
The Facial Nerve
The facial nerve divides into five branches all of which supply the muscles facial expression. All or some of the branches maybe affected and therefore the extent of paralysis will vary from person to person.
Symptoms of Facial Paralysis
As a consequence of damage to the facial nerve common symptoms include;
- Paralysis of the muscles controlling facial expression (e.g. smile, surprise, frown, pout and eye closure)
- Excessive tearing (crocodile tears)
- Dryness of the eye
- Altered taste
- Abnormal sensitivity to sound
- Excessive drooling
- Altered sensation on the side of the face affected
- Tightness of the facial muscles
- Mass movement (synkinesis)
Physiotherapy plays a key role in the management of facial paralysis. The first step is to seek a Physiotherapy assessment. It is essential that the assessment is carried out by a Chartered Physiotherapist specialising in facial rehabilitation, experienced in assessing the extent of presenting problems and the ability to manage them through the various stages of recovery. This will ensure that you recovery to the best of your ability.
From this assessment treatment options are discussed and tailored to each person. Response to treatment will depend on a number of factors including the extent of nerve damage, the stage of recovery, presence of secondary complications synkinesis, (see our page xxx on bells palsy), muscle tightness, spasms) and the potential for further recovery.
At the Dublin Physiotherapy Clinic we run a Facial Rehabilitation Clinic providing highly skilled assessment, treatment and monitoring through the various stages of recovery. We combine an array of skills and use surface Electromyography (EMG)/ Biofeedback to facilitate muscle activity and recovery. Frequent problems commonly seen in facial paralysis are:
- Facial asymmetry
- Over activity of the unaffected side.
- Synkinesis (mass movements)
- Muscle tightness
- Oral hygiene/eye care
We often use Trophic Electrical Stimulation (TES), which is particularly beneficial where facial weakness persists. Crucial to this treatment is the size and positioning of the electrodes. Regular reevaluation and repositioning is essential to progress. The benefits to patients are often immediate and therefore monitoring change closely is required. We always use objective markers to measure recovery so that changes made can be clearly seen. Facial disfigurement is not something to be left to chance. Skilled management significantly improves the quality of recovery.
One of the better known causes of facial paralysis is Bells Palsy, which is described in more detail below: