What is facial nerve palsy?
Facial Nerve palsy refers to weakness of the facial muscles controlled by the facial nerve. These muscles move the forehead, eyelids, nose, mouth, and chin. Facial nerve paralysis can affect some or all of the facial muscles to various degrees of severity.
Facial nerve palsy can be caused by a variety of factors, including Bell’s Palsy, where the exact cause is unknown.
What are the symptoms of facial nerve palsy?
The symptoms of facial palsy vary depending on the cause, but generally only affect one side of the face. Commonly reported concerns include facial asymmetry as well as functional defects, such as the inability to close the eye or smile on the affected side. Many patients experience psychological effects as well, and express anxiety or embarrassment about their condition. Anyone is susceptible to facial nerve palsy, yet the condition can feel isolating. See our Support page for information on support groups.
What are the causes of facial nerve palsy?
Idiopathic facial nerve palsy means the cause of the paralysis is unknown, most commonly referred to as Bell’s Palsy. Viral infection of the nerve including Herpes Simplex Virus, or HSV is a common cause of Bell’s Palsy. HSV is an extremely common, often asymptomatic virus that many people are unaware they have. Reactivation of the virus usually causes small blisters on the skin of the affected nerve, but in some cases it can cause facial nerve paralysis.
Anti-inflammatory drugs such as glucocorticoids are sometimes prescribed for new-onset facial nerve palsy. Anti-viral treatment is only sometimes effective, and may or may not be added.
Other infections that affect the nerve directly include Ramsay Hunt syndrome, lyme disease, meningitis or encephalitis, poliomyelitis, syphilis, and leprosy. However, if the only symptom present is facial nerve palsy, it is unlikely to be caused by a more severe infection. Regardless, it is important to book an appointment with your doctor right away if you are experiencing facial nerve palsy, to ensure treatment can be provided time.
At times, complications from surgery such as removal of a tumour in the brain or ear, can cause facial nerve palsy.
Compression of the facial nerve can occur in settings of infection, inflammation, or growths. The resulting swelling can irritate the facial nerve.
Infections of the ear or jaw, for example, may impact the health of the facial nerve. Sometimes, paralysis can occur as a result. Trauma at birth or from a head injury can result in damage to the nerve or to the important structures around the nerve.
An additional cause of nerve compression is a growth, or tumour. Masses of tissue growing into the facial nerve’s space can affect the nerve’s ability to function. These growths can be blood vessels, bone, or tumours and are an important cause to be ruled out by a physician.
A physical exam and complete history of the paralysis event may lead your doctor to send you for imaging studies. These will help guide the diagnosis and the next steps in your treatment plan.
Conditions that cause weakness of the muscles, such as muscular dystrophies, can also affect the face.
Neurological disorders, such as Guillain-Barré Syndrome (GBS), can impact the nerve signalling that controls muscles movement, which in turn can cause facial weakness or paralysis.
Autoimmune disorders occur when the body can’t recognize one if its own tissues, and treats the tissue as an intruder. Some of these disorders can attack the nerves or muscles and cause weakness or paralysis. Conditions that affect the face include sarcoidosis or myasthenia gravis.
These conditions are rare and generally will not result exclusively in facial paralysis. It is important to see your doctor as soon as possible when you are experiencing facial nerve palsy, and even more so if you have additional symptoms you are concerned about.
Facial paralysis caused by a stroke is generally accompanied by other alarming symptoms, such as slurred speech, confusion, and difficulty walking. If you are concerned about your own risk for a stroke or the risk of someone you know, ask your doctor for more information and stay informed on how to spot and respond to the symptoms of a stroke. For more information on strokes, you can visit the CDC or the Heart and Stroke Foundation.
What are the treatment options for facial palsy?
Treatment options depend on the patient, the severity and cause of the condition, how long it has been present, and a variety of other factors.
At our clinic, we focus primarily on surgical procedures. Read the descriptions below for more information.
Facial Neuromuscular Retraining
The goal of Facial Neuromuscular Retraining (FMNR) is to teach self-management strategies for improving facial symmetry/evenness, and movement after a facial palsy. This therapy includes assessment and treatment provided by specially trained therapists. The therapist teaches techniques to manage the tone of the facial muscles by showing the patient ways to retrain the muscles of facial expression once movement begins to return.
Recovery From Facial Palsy
When the facial nerve has been damaged, it can result in weakness in the muscles of the face. While it is tempting to exercise the muscles at this stage, it is not recommended, and can lead to more work later as these habits/poor movement patterns will need to be “unlearned”. The facial nerve must heal and show movement of the facial muscles before beginning an effective, customized exercise program using natural facial expressions. Think of the facial nerve being the wire cord for a lamp. If the cord is not plugged into the receptacle, the lamp will not turn on no matter how many times we try to turn the switch. It is important to patiently wait for the wire cord (facial nerve) to be working before we try turning on the lamp (facial muscles) again.
If you are experiencing a new facial palsy, which could include lack of movement on one side, an FNMR therapist ideally would see you in these early stages of the facial palsy, to provide education and information about your diagnosis, as well as provide guidance regarding what things you CAN be doing while you are waiting for movement to return.
As nerve recovery takes place, small facial movements will begin. A FNMR therapist will then work with you to promote normalized facial movements as the nerve and muscles continue to recover.
If you have had facial palsy concerns for a longer period (chronic), you might find that side of the face feels tight and has limited or poorly controlled movements. You might be experiencing symptoms of synkinesis as well. The FNMR therapist will work with you to address your facial concerns and provide an individualized home program.
Facial Movement and Synkinesis
Our facial movement is unique to us as individuals, and degrees of facial palsy can vary as well. Your FNMR therapist will provide you with a customized home program for retraining the facial muscles. It is very important the exercises you do are geared towards your facial impairments. We discourage you from practicing a “general facial exercise” program, such as ones you might find on the internet, as it could lead you to practicing incorrectly, which could interfere with your progress.