A Simple Guide to Facial Palsy

A Simple Guide to Facial Palsy
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What is Facial Palsy?
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Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.

It is usually temporary.

What are the causes of Facial Palsy?
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Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:

Supranuclear(within the Brain)
1.Cerebral vascular lesions

2.Cerebral tumours

Infranuclear(outside the brain)
1.Bell's palsy - most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.

2.Trauma- Birth injury,fractured temporal bone, surgery of the ear

3.Tumours- Acoustic neurofibroma, parotid tumours, malinant disease of the ear,
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme's disease

5.Autoimmune disease-Gullian-Barr Syndrome, sarcoidosis,

6.Multiple sclerosis

What are the symptoms and signs of Facial Palsy?
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The onset of facial palsy is usually very sudden.

The most important part of the diagnosis is to distinguish between the supranuclear and infranuclear causes of facial palsy.

Supranuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations

2.Depressed taste ( lesion above chorda tympani)

3.hyperacusis ( lesion above nerve to stapedius)


Infranuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.

2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.

3.dribbling of saliva

4.difficulty in speaking

5.loss of taste at the front of the tongue

6.dryness or watering of the affected eye

7.eyeball rolled up and inward on attempted closure of affected eye

8.ectropion or turned out lower eyelid

9.sharp hearing on the affected side

10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.

What are the investigations required in Facial Palsy?
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1.Physical examination
a.test muscle movement of the forehead to determine whether cause is
supranuclear(muscle movement present) or
infranuclear( no movement of forehead muscles)

b.test closing of the eye - to test weakness of eyelid muscles

c.ask patient to smile - to check for weakness of the cheek muscles

2.Investigations:
a.Blood for infections, HIV, Lyme's disease

b.MRI of brain to exclude tumours

c.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Facial Palsy?
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1.Start on a course of steroids like prednisolone(about 40-60mg/a day at first, then tapering off the dosage) to hasten rapid recovery.

The steroid usually reduce swelling of the nerve.

2.antiviral drugs such as acyclovir can help recovery especially when the cause is suspected herpes virus

3. Protection of the affected eye (which cannot be closed properly) by wearing glasses or an eyepad.

Use artificial eyedrops during the day to keep the eye moist.

Tape the eye at night to keep it closed.

4.Physiotherapy of the facial muscles -
facial massage,
facial exercises, and
acupuncture may help restore the facial muscle tone.

5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.

Plastic surgery may improve permanent facial drooping

What is the prognosis of Facial Palsy?
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80-90% of patient with facial palsy recover spontaneously and completely within three weeks.

The remainder usually takes up to six months to recover.

Very rarely do you get permanent paralysis of the facial nerve.