• Facial Paralysis

    14th March 2015 | donaldt
  • Bell’s Palsy is a type of facial paralysis which causes temporary weakness or paralysis of the muscles on one side of the face. Very often it gives rise to a great deal of concern to patients affected with it. Reassurance, advice and support help individuals who are afflicted by this condition. Apart from providing this element of support, physiotherapists guide and treat patients through such difficult moments maximising recovery of the muscles involved.

    To better understand facial paralysis it is important to have an idea of some basic anatomy relating to this condition. The human body possesses twelve pairs of cranial nerves. These nerves, numbered from 1 to 12, exit from each side of that part of the brain known as the brain stem. The 7th cranial nerve is called the facial nerve. It travels from the brain stem through a series of narrow passages in the skull, enters the parotid salivary gland situated on the side of the face just beneath the ear and divides into a series of branches providing the nerve supply that controls facial muscle movement. This nerve supply allows us to perform various facial expressions such as those of excitement and sadness amongst others. It also enables us to blink our eyes and articulate our mouth to generate sound and speech. Taste, saliva and tear production are also controlled by this nerve. When this nerve is compromised these facial functions fail leading to partial or total paralysis of the facial muscles. Most people who suffer this condition feel alarmed as the first impression is that one may have suffered a stroke. A visit to the family doctor is necessary to establish the exact cause of this facial paralysis. CT scans and blood tests may at times be necessary to establish a diagnosis. Once assurance is obtained that this condition is in fact Bell’s palsy physiotherapy should commence immediately.

    The exact cause of Bell’s palsy is still not clear. It is however commonly attributed to a viral infection, which is not contagious, that generates a swelling in the tiny spaces through which the facial nerve passes. This swelling generates trauma to the facial nerve resulting in impaired function of the nerves that control muscle movement giving rise to facial paralysis. Once the pressure from swelling subsides recovery starts. Recovery can happen in a short period of time. Occasionally however it may take months and even years. Age and a clean bill of health are factors which aid recovery.

    Initially patients are usually started on a short course of steroids by their family doctor. This helps decrease the swelling. Quick removal of the swelling may have a bearing on the severity of the damage caused to the nerve which may influence the length of recovery. Application of ice and other physiotherapy modalities may contribute towards swelling reduction in these very initial stages of the condition.

    A physiotherapy visit will establish the extent of damage caused through a classification scale in which the facial muscles are examined for available strength. Furthermore advice will be given on how to cope with the disability of the condition which amongst others involves problems with eating, drinking, dry eyes and loss of the blink reflex. In very severe cases where eating, drinking and speech are significantly affected referral to a speech therapist may be necessary. Patients are instructed on facial massage and stretching exercises in order to maintain the elasticity and suppleness of the affected facial muscles. Exercises are also prescribed and progressed depending on the stage of the condition. Progress is monitored periodically at review visits. The face is composed of many small muscles which control facial expression. It is important that these muscles are maintained in a prepared state for when the nerve resumes function at which point more exercises will be prescribed to further strengthen the facial muscles. Detailed attention is given to maintain facial symmetry. At times slow progress is experienced with months passing without noting any improvement. At this point frustration, apprehension and restlessness start to set in. Physiotherapists help reassure patients passing through these difficult times.

    Many people ask whether the facial muscles can be stimulated electrically. Research shows that stimulating facial muscles electrically is not considered to be the preferred treatment modality. Generally full recovery is achieved with specific exercise therapy, facial muscle massage and stretches.

    Bell’s Palsy is the most common form of facial paralysis however facial paralysis may come from other causes. The outcome and treatment recommended may vary from that described. Professional advice must always be sought.