Facial palsy is the condition in which the facial muscles of an individual get weaker, which may cause the short-term to permanent damage. This will prevent them from receiving or sending signals between the facial muscles and brain of the patient. Consequently, such muscles turn inactive and would become non-operational.
This produces a paralytic effect on a small to a big part of the face. The patients of this disease may observe difficulty in moving their eyes, mouth, nose and other parts of their face. Additionally, they may also lose sensations on their face. The severity of facial palsy may differ for various patients. For instance, some patients may observe inactivity in only the lower part of the face, and for some, both sides of the face are impacted.
Note that every side of the face is controlled by individual face nerves. Therefore, a damage to one side of the facial nerves would not impact the other side of the face. So, in case some patients are observing facial palsy on both sides of the face, it means that their facial nerves of both sides are damaged at the same time.
The facial muscles also control the facial expressions and production of tears and saliva. Therefore, facial palsy may also result in no control over those. The facial nerve injury that causes facial palsy may be categorized as below:
- First degree, in which the facial nerves are temporarily damaged. The patient suffering from it recovers from the symptoms in around eight weeks from their occurrence.
- Second degree, in which the damage to the facial nerves is a bit more severe from that of the first degree. The recovery in such cases starts from around four months of occurrence, which is graduated at the rate of around one millimetre every day.
- Third degree, which refers to the severe damage to the facial nerves. The recovery in such cases is very much slow and may not complete even in several years or throughout the life. At times, some surgery is required to stop further damage and restore the facial functions.
Facial Palsy may affect the individuals of any age. However, elderly individuals are more likely to suffer from this disorder due to the weakening of their muscles and immune system. Around one in every 5000 individually suffer for this disorder every year.
In most of the cases, the symptoms of facial palsy are observed for the first time while waking up in the morning post the night’s sleep. The primary symptoms of this disease include losing control from the facial nerves. This, in turn, restricts you from opening, closing or blinking eyes, smiling, and producing saliva on your own in the mouth.
Additionally, your eyes may not be able to produce tears and may appear dry. The lost control of facial nerves may also impact the muscles associated with the bones of the inner ear, which restricts the patient from hearing properly. Rest than these primary symptoms, the patient may also face some or all the following symptoms:
- The feel of paralysis on the face
- Weakness on either one or both sides of the face
- Unable to close either one or both the eyelids
- Dryness in one or both the eyes developed due to inability to blink
- Reduced development of tears in one or both eyes
- Dropping of various portions of the face, like a side of the mouth
- Uncontrolled salivation from one or both sides of the mouth
- Unable to develop facial expressions
- Altered taste while eating anything
- Difficulty in hearing
- Intense sensitivity to sound in one or both the ears
- Pain near to the ears
- Mild to a severe headache along with the above symptoms
Facial palsy is generally caused due to swelling or compression of the cranial nerves of the face. This swelling or compression results in either weakening of facial nerves, which may be healed in some time, or permanent damage or paralysis, whose symptoms last throughout the life.
It is believed that such swelling or compression of facial nerves are resulted by some infection of viruses and bacteria. The following could be the various sources of bacterial or viral infections that may cause facial palsy:
- Herpes simplex causing genital herpes or cold sore
- Acquired Immune Deficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV), which weakens the immunity of the patient
- Sarcoidosis causing inflammation in various organs of the body
- Shingles and chickenpox caused by the herpes zoster virus
- Mononucleosis caused by the Epstein-Barr virus
- Lyme disease caused by the bacterial infection
- Infections caused by cytomegalovirus
- Respiratory diseases caused by the adenovirus
- Measles caused by rubella
- Mumps caused by the mumps virus
- Influenza B
- Hand, foot and mouth disease caused by coxsackievirus
- Ramsay Hunt disorder
- Surgery for removing the facial nerve tumour or acoustic neuroma
- Surgery for operating the parotid gland
- Neurological disorders like Guillain-Barre or Neurofibromatosis 2
- Trauma causing injuries like a fracture in the skull, or other injuries of the brain or face
- Trauma caused during the birth of a baby in rare cases like with facial presentation delivery
- Inborn disorders such as an irregular development of facial nerves and muscles, which may be adopted by the foetus in the womb due to multiple reasons
- Genetic disorders like CHARGE syndrome or Moebius
You may take some prevention measures to minimize the probability of developing facial palsy. Some of those are mentioned below:
- Maintain a healthy diet rich in vitamins, minerals, protein and fibre.
- Avoid food items containing stimulants like caffeine.
- Minimize the consumption of alcohol.
- Quit smoking, as it produces stress, which may trigger the chances of occurring facial palsy in many individuals.
- Avoid the food to which you are allergic.
- Avoid the food containing refined ingredients.
- Exercise on regular basis.
- Get your blood pressure checked on a regular basis.
- Include fresh vegetables and fruits in your diet every day.
- Get full body health check-ups done at least once every year.
Facial palsy is an indication of a serious disorder. The sooner the treatment is started, the more changes are of quicker and complete recovery. So, whenever you observe any unexpected change in the ability to move your facial muscles, you must visit your physician immediately. The doctor will first physically examine your symptoms and try to assess the strength of your facial muscles.
The patient would be asked to perform a series of tasks to the best extent requiring movement of mouth and tongue. This gives the doctor an idea of the level of disability caused due to facial palsy. The doctor may also ask the patient to read and repeat some words and sentences. Rest than those, the muscles of the patient’s neck, head, and ears are also checked to identify if those are also impacted along with the facial muscles.
A post examining the symptoms, the recent medical history of the patient is also gone through for understanding if facial palsy is occurred due to some infection. The case may further be diagnosed by an otolaryngologist or the specialist of the ear, nose and throat (ENT) disorders. Furthermore, one of the following investigations may be prescribed by the doctor to identify the root cause of facial palsy like Lyme disease, stroke, and more:
- Electromyography (EMG), in which some electrodes are attached to the face of the patient. Those are further attached to a device that monitors the activity of the facial muscles through the transferred electrical signals. The test aims at identifying the extent of damage to the facial nerves. It also precisely determines the portion of the face, which is impacted by facial palsy.
- Magnetic Resonance Imaging (MRI) scan in which radiological pictures are captured of the face and brain to identify if the symptoms are occurring due to stroke, tumour or facial palsy.
- CT scan of the face and brain, in which multiple X-ray pictures are captured in some stipulated time. The CT scan report identifies the abnormalities or inactiveness of the facial muscles of the patient.
- Digital X-ray may be prescribed to the patient to understand if the symptoms are occurring due to some skull fracture.
The patients of first and second-degree facial palsy are recovered from the symptoms within one to six months depending on the intensity of the symptoms. The root treatment of this disease is based on a steroid known as prednisolone. In case the disease is identified and consulted with the doctor within 72 hours, prednisolone may provide an effective and speedy recovery.
It reduces inflammation in the facial muscles of the patient caused due to facial palsy. Alongside, it accelerates the recovery of the impacted facial nerves. The drug also prevents the body from releasing the chemicals, like prostaglandins and leukotrienes, which may cause inflammation in the facial muscles.
The patient is prescribed to consume two or more tablets of this medicine with food for the first few weeks. Depending on the progress, the physician may revise the dosage. Note that the patients may face lots of side effects while consuming prednisolone. Those, however, disappear within few days from stopping consumption of this medicine. Some of those side effects may include:
- Pain in multiple parts of the body
- Stomach Bloating
- Abnormal sleep
- Dryness of skin
- Mild to an intense headache
- Dizziness while getting up from the bed in the morning
- Reduced or increased appetite
- Excessive sweating
- Indigestion problems
- Mood swings
- Poor wound healing
- The sensation on the skin
- Constant lethargy
- Difficulty in breathing
- Swelling on the face
Other than prednisolone, your doctor may also prescribe you other anti-inflammatory medicines, like Advil and ibuprofen, to help relieve you from the symptoms. Rest than that, several treatment methodologies are followed to treat the symptoms locally. For instance:
- Patients are prescribed some medicine drops or ointment to put in the eyes for lubrication. Since the patients of facial palsy are unable to blink eyes and the capability of producing tears is also reduced, the excessive dryness may damage their eyes. Such drops may produce artificial tears in the eyes of the patients when they are awake.
- Some patients who could not close their eyelids while sleeping may use surgical tapes to shut those.
- You may be prescribed specific exercises for strengthening the muscles of jaws, tongue and mouth for quicker recovery. These exercises provide flexibility to the facial muscles and you would be able to tighten or relax those for performing various facial tasks.
- Because of no sensation in some or whole part of the mouth, patients may face problems in eating and swallowing food. They are prescribed to eat very slowly and include soft foods in their diet like yoghurt and juices till the time the symptoms persist.
- If your speech is also affected, you may be prescribed ways to improve it. For instance, you may practice speaking a bit slowly or to give pause in between sentences to have control over your speech.
The first and second-degree facial palsy could be treated over a period and their symptoms are also completely recoverable. But in the case of the third-degree facial palsy, the symptoms could not be recovered. Some of the complications associated with facial palsy are mentioned below:
- The eyes of the patient may be damaged due to the excessive dryness that causes partial to complete blindness.
- The nerve tissues may observe abnormal regrowth. This would prevent the patient from using several facial muscles correctly. Like while smiling, the eyes of the patient may get closed.
- The pain persists forever in case of third degree. This may require the patient to consume painkillers and anti-inflammatory medicines throughout the life, which cause lots of side effects.
Myth #1: Facial palsy always cause permanent disability of the facial muscles
Most of the cases of facial palsy are of degree one and two, which are recoverable. In some little cases, recovery is not possible.
Myth #2: There is no effective treatment of facial palsy.
The symptoms of facial palsy in most cases could easily be treated by medicines and other therapies.
Myth #3: The only cause of facial palsy is a stroke
Facial palsy is different from a stroke. The symptoms caused by a stroke attack may be similar to those of facial palsy. However, their cause is different. Stroke does not cause any direct damage to the facial nerves. It causes damage to some part of the brain, which in turn prevents the facial nerves to function normally.
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