Facial Paralysis

Facial paralysis is a temporary or permanent dysfunction of the facial nerve that affects about 20 out of every 100,000 inhabitants in the Spanish state each year. The facial nerve is in charge of innervating the facial musculature, so its paralysis causes a loss of muscle tone at the facial level. This manifests itself on both a cosmetic and functional level, and can have a huge impact on the patient’s life.

Causes of facial paralysis

There are numerous causes of facial paralysis, although the most common is Bell’s palsy or idiopathic. Its cause is unknown and represents 50% of total facial paralysis. It is typically unilateral and in most cases resolves spontaneously within 6 months. Numerous causal agents have been proposed as responsible for this picture, including the herpes virus, although this has not been proven. However, early treatment of these paralyses with oral steroids has been shown to increase the chances of full recovery. Other pathologies that can lead to facial paralysis are certain infectious, tumour or neurological diseases. Surgery for acoustic nerve neurinoma is another relatively common cause of facial paralysis.

Consequences of facial paralysis

Ectropion-del-parpado-inferior-debido-a-la-perdida-de-tono muscular
Palpebral Ectropion caused by facial paralysis

On the one hand, the deviation of the oral commissure, which causes a difficulty in speech and swallowing, in addition to being a significant aesthetic alteration for the patient. The orbicularis muscle, responsible for closing the eyes and supporting the eyelids, loses its strength, so the affected eye does not close properly. The inability to close the eye completely is called lagophthalmos. In addition, the lower eyelid may also descend due to lack of muscle tone; this is called ectropion. This results in exposure of the eye surface and poor ocular lubrication due to ineffective blinking. An overexposed eye surface is a sure source of problems; corneal ulcers can even threaten vision in that eye.

Eye care in facial paralysis

There are different measures to ensure adequate protection of the eye surface. From day 1 of the paralysis it is necessary to establish intense lubrication patterns in the affected eye. This consists of the frequent application of eye drops and lubricating gels. The use of wet rooms at night is also useful to ensure adequate nighttime humidification of the eye. In a large percentage of cases, lubrication alone will be sufficient to protect the eye surface while waiting for the recovery of facial nerve function. In those cases where there is no recovery from the paralysis or where early corneal problems appear, surgical action is necessary to ensure good eye protection. There are a number of minimally invasive treatments and surgeries that in some cases can even be performed in the office. Which one is best for you will depend on the specifics of your case.

Corrective surgeries in facial paralysis:

  1. Lagophthalmos enhancement: This is achieved by placing a gold or platinum weight on the upper eyelid through a small incision with no visible scar. This makes the eyelid close due to the weight when the patient wants to close the eye.
  2. Eyebrow elevation: Facial paralysis causes a drooping eyebrow that is sometimes very noticeable. It can be effectively and easily corrected by a direct browlift.
  3. Ectropion correction: Eectropion can be more or less severe and require more or less surgery, but there is always a solution. The simplest is the tarsal strip technique, which can be performed simply under local anesthesia. The simplest is the tarsal strip technique, which can be performed simply under local anesthesia.
  4. Correction of buccal deviation: The least invasive dynamic surgery that offers the best results is the suspension of the orbicularis oculi muscle from the mouth to the tendon previously released from the temporal muscle. This corrects the position of the mouth and provides some mobility for example for the smile.
Inability to close the eye with facial paralysis

Facial Paralysis: Inability to close the eye

There are other more invasive techniques of facial rejuvenation that may be appropriate in some cases. They are usually treated in a hospital setting and require the coordination of different specialists, including rehabilitation specialists.

Non-surgical treatments in facial paralysis

  1. Botulinum Toxin (Botox®): Used to improve facial asymmetry. For example to balance the forehead, paralyzing the healthy side. Also to partially correct oral deviation. Other applications are to cause complete closure (temporarily) in the case of corneal ulcers, or to reduce tearing in patients who complain of excessive tearing after facial paralysis.
  2. Hyaluronic acid: It can be used to improve the oral area, treating the paralyzed area to give greater consistency to the lip and thus promote its function. Also when we cannot perform a gold weight implant or the patient does not want to. In these cases the infiltration of hyaluronic acid into the upper eyelid has a “weight” effect to improve eye closure.
Pide una cita
Últimas publicaciones
Call Now Button