The facial nerve, which controls the movement of the facial mimic muscles, emerges from the brainstem and travels through the temporal (ear) bone. It exits through a small opening behind the ear and spreads to the right and left sides of the face. The facial nerve also has branches that go to the salivary glands, tear glands, and the front part of the tongue, controlling movements of the forehead, eyebrows, eyelids, nose, and lips.
The branches of the facial nerve that reach the face allow us to smile, cry, grin, or frown, essentially functioning as the nerve of facial expression. Any lesion occurring in this nerve or its branches causes weakness in the facial muscles and leads to varying degrees of facial paralysis.
What is Facial Paralysis (Facial Palsy)?
Facial paralysis is a clinical condition that usually occurs on one side, caused by the loss of function of the facial nerve which controls facial movement and sensation. Also called facial palsy, it can appear in two main types: central or peripheral. In central facial palsy, the damage is in the brain cells that send signals to facial muscles, while in peripheral facial paralysis, the damage is in the main nerve controlling the facial muscles.
What Causes Facial Paralysis?
Facial paralysis may result from central nervous system causes such as head trauma or blockages in brain vessels, or peripheral causes like injury to the facial nerve from head and neck tumors. The most common causes are:
- Bell’s palsy: The most frequent and idiopathic form of facial paralysis. It develops suddenly and affects muscles on one side of the face. Its cause is unknown.
- Stroke: Another serious cause, originating from the central nervous system, without direct damage to the facial nerve itself.
Other causes include:
- Brain injuries, brain hemorrhages, and brain tumors affecting the central nervous system,
- Diseases like Multiple Sclerosis (MS) and Guillain-Barré syndrome affecting the brain and spinal cord,
- Congenital paralysis caused by birth trauma,
- Middle ear infections and fractures of the ear bone,
- Various blunt or sharp injuries to the face.
What Are the Symptoms of Facial Paralysis?
There are many symptoms of facial paralysis. Loss of control in mouth, eye, and forehead movements appears on the affected side. Other symptoms may include decreased tear production, facial muscle twitching, altered taste sensation on the tongue, speech difficulties, excessive saliva, and tear production.
How is Facial Paralysis Diagnosed?
Diagnosis is usually made by the doctor based on clinical examination and the patient’s symptoms. Further investigations to determine the cause should be conducted. These include hearing tests, balance tests, tear production tests, radiological imaging methods (CT, MRI), and electromyography (EMG) for differential diagnosis.
How Should Facial Paralysis Be Treated?
Corticosteroid medications have been shown to positively contribute to treatment in Bell’s palsy. Corneal damage caused by dry eyes must be prevented by eye closure or artificial tears. General treatment principles should also be applied.
Patients with permanent facial paralysis must undergo physical therapy and rehabilitation. To accelerate recovery, facial muscle exercises along with massage are recommended. Physical therapy and rehabilitation significantly contribute to the healing process.
At Rommer, we have experienced staff specially trained in facial paralysis rehabilitation.
Thermal therapy (hot water bags, infrared) can increase local blood flow through superficial heat application and be effective.
Facial exercises should be performed in front of a mirror 3-5 times a day, along with massage. EMG, biofeedback, electrical stimulation, and electrotherapy can also be applied. Surgical treatment methods may be preferred depending on the cause.
Generally, facial paralysis improves spontaneously in about 80% of patients within 2-3 weeks without treatment. However, 10% of patients may develop permanent facial paralysis.