What is Facial Paralysis?
Facial paralysis is a temporary or permanent dysfunction of the facial nerve that affects approximately 20 out of every 100,000 people in Spain each year. The facial nerve innervates the facial muscles, so its paralysis causes a loss of facial muscle tone. This manifests itself both cosmetically and functionally , and can have a significant 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 it accounts for 50% of all facial paralysis cases. It is typically unilateral and in most cases resolves spontaneously within 6 months. Numerous causative agents have been proposed as responsible for this condition, including the herpes virus, although this has not been proven. However, it has been shown that early treatment of these paralyses with oral corticosteroids increases the chances of a full recovery. Other conditions that can lead to facial paralysis include certain infectious, tumor, or neurological diseases. Surgery for acoustic nerve neurinoma is another relatively common cause of facial paralysis.
FAQS Parálisis Facial
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On the one hand, the deviation of the corner of the mouth, which causes difficulty speaking and swallowing, in addition to representing a significant aesthetic alteration for the patient. The orbicularis oculi 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 . Furthermore, the lower eyelid may also droop due to lack of muscle tone; this is called ectropion . All of this results in an exposed ocular surface and poor ocular lubrication due to ineffective blinking. An overly exposed ocular surface is a guaranteed source of problems; corneal ulcers can even threaten vision in that eye.
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There are various measures to ensure adequate protection of the ocular surface. From day one of paralysis, it is necessary to establish intensive lubrication regimens in the affected eye. This consists of the frequent application of eye drops and lubricating gels. The use of humid chambers 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 ocular surface while waiting for the facial nerve to recover. In cases where paralysis does not recover or where early corneal problems appear, surgical intervention is necessary to ensure adequate ocular protection. There are a number of minimally invasive treatments and surgeries available for this purpose, which in some cases can even be performed in the office. The best option for you will depend on the specifics of your case.
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- Improvement of lagophthalmos : This is achieved by placing a gold or platinum weight on the upper eyelid through a small incision with no visible scar. This causes the eyelid to close due to the weight when the patient attempts to close their eye.
- Brow lift : Facial paralysis causes a drooping of the eyebrow, which is sometimes very noticeable. It can be effectively and easily corrected with a direct brow lift.
- Ectropion correction : Ectropion can be more or less severe and require major or minor surgery, but it can always be resolved. The simplest is the tarsal strip technique, which can be performed with local anesthesia. More complex cases require a midface lift via the conjunctival route along with an auricular cartilage graft to support the eyelid.
- Correction of oral deviation : The least invasive dynamic surgery that offers the best results is suspension of the orbicularis oris muscle to the previously released tendon of the temporalis muscle. This corrects oral position and provides some mobility, for example, when smiling.
There are other, more invasive facial renervation techniques that may be appropriate in some cases. They are usually treated in a hospital setting and require coordination with various specialists, including rehabilitation specialists.
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- Botulinum toxin (Botox®): Used to improve facial asymmetry. For example, to balance the forehead by paralyzing the healthy side. It is also used to partially correct a deviation in the mouth. Other uses include temporarily closing the cornea in cases of corneal ulcers or reducing tearing in patients who complain of excessive tearing after facial paralysis.
- Hyaluronic acid : It can be used to improve the oral area, treating the paralyzed area to give the lip more firmness and thus improve its function. It can also be used when a gold-weighted implant is not possible or the patient does not want it. In these cases, hyaluronic acid injections into the upper eyelid have a “weighting” effect to improve eye closure.
