Facial paralysis derives from an affectation of the facial nerve, which is responsible for the mobility of almost all the muscles of the face, as well as innervating the lacrimal glands and picking up the sensitivity of the taste buds of the tongue. That is why its affectation produces difficulty to move correctly the face, decrease or excess of lacrimation and alteration of the taste.
There are several types of facial paralysis, but the most frequent is Bell’s palsy, which lasts from 4 to 8 weeks. It is an idiopathic paralysis (i.e. its causes are not known), although nowadays it is thought to be related to the herpes simplex virus type 1. Other causes that can produce a facial paralysis are Herpes Zoster, ear infections, trauma and tumors.
How to treat facial paralysis?
For Bell’s palsy, the initial treatment is corticosteroids, although the specialist may request complementary studies (such as magnetic resonance imaging or X-rays), especially if a cause other than Bell’s palsy is suspected. Electromyogram is another complementary test that helps to know the extent of the nerve lesion.
Another important care is to protect the cornea of the eye from the beginning of the palsy with artificial tears, epithelializing ointment and nightly occlusion with a patch.
If the paralysis does not recover completely, a doctor specializing in Physical Medicine and Rehabilitation should be consulted for specific exercises and sometimes even botulinum toxin injections. These exercises are the basis for the treatment of facial paralysis that has left sequelae, and learning them will once again provide control of facial movement.
Even so, it is very important for the patient to be aware of which movements should be avoided in order to avoid muscle overload or sending erroneous information to the injured facial nerve. For example, one should not eat chewing gum, blow up balloons or perform “mass movements” (moving many muscles of the face to perform a single gesture).
What are the complications?
Sometimes, recovery from facial paralysis is incomplete because the nerve is damaged and is not able to function normally. Complications such as hemifacial spasm (when some muscles are permanently contracted) or synkinesias (when, when performing a voluntary movement, another unwanted one appears) may appear.
Fortunately, both complications can be improved with appropriate rehabilitative treatment: facial neuromuscular reeducation exercises or, in some cases, botulinum toxin injections.