Facial paralysis 02/06/2013

Facial paralysis is a temporary or permanent dysfunction of the facial nerve that affects around 20 in every 10,000 inhabitants in Spain each year. The facial nerve is responsible for innervating the muscles so its paralysis leads to a loss of muscle tone in the face.

This dysfunction can be seen both aesthetically and functionally and can have huge repercussions for the patient's life.

Causes of facial paralysis

There are numerous types of facial paralysis, the most frequent being Bell's palsy or idiopathic paralysis, whose cause is unknown but which accounts for 50 % of all cases. It is typically one-sided and, in most cases, resolves itself spontaneously within six months.

Several causes for this disorder have been proposed including the herpes virus, although this has not been proven.

However, it has been demonstrated that early treatment of such paralysis with oral corticosteroids increases the chances of a complete recovery.

Other pathologies that can give rise to facial paralysis are certain infectious, tumorous or neurological diseases. In these cases it's essential to treat the underlying cause.

What's the role of the oculoplastic surgeon in facial paralysis?

When the face's muscles lose their normal tone, the orbicularis oculi muscle of the upper eyelid loses its ability to contract and therefore close the eye properly. The lower eyelid can also slump due to the lack of muscle tone; this is called ectropion. The inability to close the eye completely is called lagophthalmos and leads to the problem of the eye's surface being exposed. An exposed cornea is a certain source of problems; corneal ulcers can even endanger the sight of the eye in question.

There are different measures to ensure the surface of the eye is suitably protected. Intense lubrication procedures need to be implemented for the affected eye from day one of the paralysis, consisting of the frequent application of collyria and lubricating gels. It's important to consult an oculoplastic surgeon who can follow the evolution of your paralysis and assess your capacity to close the eye in question and to what extent the eye's surface is affected. In a large percentage of cases, merely lubricating the eye's surface will be enough to protect it while waiting for facial nerve function to recover. However, in some cases it's not enough and surgery must be carried out to prevent or solve corneal problems that endanger the patient's sight. To this end, there's a range of minimally invasive surgical techniques which, in some cases, can be carried out during consultation; the best option for you will depend on the particular features of your case. It's also important to know that all these surgical techniques are reversible and will therefore not have any impact on your facial expression should you recover from the paralysis.

Unfortunately, in some cases facial paralysis is permanent. In such cases we must look for permanent solutions that ensure the eyelids close properly and also to improve the patient's aesthetic appearance. Today, a drooping eyebrow or deviation in the corner of the mouth can be improved significantly with minimally invasive surgery.