What is facial paralysis?
Facial paralysis is a condition that develops as a result of the facial nerve that we call “facial nerve” being affected by various reasons. This nerve is a nerve that provides the muscles that enable speech, eating, drinking, laughing, and mimic movements to work, as well as the tear gland, some salivary glands, and the sensation of part of the tongue.
Are there types of facial paralysis?
Yes, there are 2 types of facial paralysis. These are called peripheral facial palsy and central facial palsy. In fact, the type commonly known in the society and referred to when “facial paralysis” is called is peripheral facial paralysis. The facial nerve that comes to the face has a nucleus in the area we call the brain stem. The condition that occurs in the effects on this nucleus is central facial paralysis, the condition that develops due to the effects along with the core and the quadrant nerve trace to the face is peripheral facial paralysis. Both their causes and clinical findings are quite different. Central facial paralysis is mostly seen in vascular occlusions in the brain, cerebral hemorrhage, infections, and tumors in the brain. Peripheral facial paralysis is different.
What are the symptoms of peripheral facial paralysis?
Due to the weakness of the muscles on one side of the face, the inability to lift the eyebrow on that side, the inability to close the eye, the sliding and asymmetrical appearance in the mouth towards the unharmed side, sagging at the edge of the mouth, impairment in facial expression and mimic movements occur. In addition, dryness in one eye and mouth due to tear age and impaired saliva secretion, impaired taste sensation, and rarely, excessive hearing (hyperacusis) may occur in some patients.
Symptoms can occur within hours. In the beginning, there may be complaints of pain, especially spreading to the back of the ear.
What are the causes of peripheral facial paralysis?
The most common type is “Bell’s palsy”, which we call “idiopathic peripheral facial palsy”. Usually, the cause cannot be determined, but we know that these are often caused by viral infections. It is possible for the nerve to be affected at every level starting from the brainstem area where the facial nerve nucleus is.
Apart from Bell’s palsy, other less common causes are infections (such as Herpes zoster, Lyme disease, chronic otitis media, and mastoiditis), nerve injury due to trauma and accidents, multiple sclerosis (MS), vascular occlusion, especially neurological diseases affecting the brainstem. Tumors of the region, autoimmune diseases (such as sarcoidosis, systemic lupus), some types of Guillain-Barré syndrome, diabetes may occur due to many reasons such as diabetes.
Who is at risk, who is more common? Is there a difference between men and women?
First of all, we can say that there is no significant difference between men and women. It is seen in similar proportions. Pregnant women have a 3-fold higher risk of developing facial paralysis, especially in the early postpartum period and in the third trimester compared to the normal population. Apart from this, those with diabetes and hypothyroidism have a higher risk of development than other people. It rarely occurs in patients with hereditary compression-sensitive neuropathy.
What is Bell's palsy?
It is a peripheral type of facial paralysis that occurs acutely and causes all findings to be evident within a few days, usually causing only one side of the face to be affected. Its frequency is 20-30 per 100,000. Clinical findings are in the form of weakness on the affected side of the face, tear and salivary gland affected, and taste disturbance in some patients. It is generally accepted to occur due to viral causes, especially Herpes Simplex virus. In addition, Epstein-Barr, mumps, cytomegalovirus, influenza, and HIV can also cause Bell’s palsy. It improves within a few weeks or months.
If we look at the normal course of the disease, more than half of them improve within the first month. If the signs of improvement are delayed for more than 3 months, sequelae may remain in them. However, this rate does not exceed 10-15% of patients. These are sequelae in the form of incomplete recovery of weakness, inability to fully close the eye or the simultaneous movement of some muscles that we call “synkinesis” or the presence of secretions. For example, pulling on the edge of the mouth while the patient closes his eye or vice versa, or tears falling while eating.
How is peripheral facial paralysis diagnosed?
The diagnosis is based mainly on clinical examination and findings. Examination findings are very typical. In peripheral facial paralysis, the inability of the patient to close his eye and raise his eyebrow is very important in distinguishing it from central facial paralysis.
Apart from clinical evaluation, EMG (Electromyography) examination should be performed, which objectively shows the severity of the nerve damage or whether it is affected. In fact, the same test provides very valuable information in monitoring the disease and determining the level of recovery in the nerve.
In order to find out if there is another reason, it may be necessary to examine it with blood tests and imaging tests such as MRI or tomography.
What is the treatment for peripheral facial paralysis?
First of all, if an underlying cause is detected, it is necessary to treat it. If the cause has not been identified and is accepted as Bell’s palsy, the aim of treatment is to provide rapid return and prevent complications. Therefore, it is necessary to start treatment as early as possible. The sooner the patient consults a doctor, the higher the chances of recovery.
Corticosteroids initiated early in medical treatment are very effective. Although there are studies showing that corticosteroid treatment initiated in the first 7 days is effective, the results are more satisfactory, especially in patients who started treatment in the first 3 days. However, antiviral drugs are added to the treatment.
Eye protection is very important in patients whose eyes cannot be fully closed with medication. The problems that may arise due to the drying of the cornea and especially the opening of the eyelid while sleeping at night are important. It is very important to take measures such as keeping the eye moist (using artificial tears), closing the eyelid at night, etc. In addition, patients are recommended to repeat mimic movements and electrical stimulations directed at the nerve.
Decompression surgery can be considered as an option in cases with severe prognosis without any improvement and electrophysiological changes during follow-up. However, there are different opinions about the effects of this as well, and there is no definite algorithm.
Approximately 90% of patients experience nearly complete improvement.
Physiotherapy treatment for peripheral facial paralysis
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