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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.
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.
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.
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.
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.
Dr. Nieto is a reference in oculoplastic surgery. He combines his activity in reconstructive surgery in public medicine with his private reconstructive and cosmetic activity at the Clínica Corachán in Barcelonaand the Instituto Oftalmólogico Gabriel Simón in Madrid.
Clínica Corachán 2, bajos. Plaza Manuel Corachán 4, Despacho 8 Barcelona 08017
Instituto Oftalmológico Gabriel Simón Fuencarral, 7 28004-Madrid
