Facial paralysis

What is it?

The facial muscles have the facial nerves in it, the 'nervus facialis'. This nerve runs from the brain stem, through the middle ear, through the cranial wall and then through the large salivary gland (at the corners of the jaw) before reaching the facial muscles. If there is a problem with the course of this nerve, a facial paralysis can occur.

In addition to being the nerve in the face, this nerve is also responsible for tasting and muffling loud noises. Therefore, a patient who has facial paralysis may experience reduced taste in one half of the tongue and an oversensitivity to sounds.

Causes

Usually, the cause of facial paralysis cannot be clearly identified, though it is probably due to a viral infection of the facial nerve. This is called a Bell's pearl. Of these patients, 70% are expected to experience complete facial nerve recovery.

Others causes include:

• fractured skull with trauma of the facial nerve
• middle ear diseases
• disorders of the salivary glands
• brain disorders
• Lyme disease
• congenital
• ...

Treatment

During the visit, the physician will rule out that the problem is not happening in the brain (e.g. infarction, cerebral haemorrhage, etcetera). Facial motor abilities are examined and a hearing test is performed. Sometimes, imaging and a blood test are also carried out.

Given that, in case of severe facial paralysis, the patient can no longer close the eye properly, it is very important to protect the eye from dehydration. Eye drops, eye ointments and, if necessary, eye bandages are prescribed. Often, facial paralysis can spontaneously (partially) recover because nerve fibres begin to grow back. However, this process is very slow, since a nerve fibre grows about one millimetre a day. After weighing the pros and cons, treatment with cortisone and antiviral drugs can be started to promote patient recovery. If there is a bacterial infection, treatment with antibiotics is started. If there has also been a trauma injury, surgical reconstruction is performed.

Mimotherapy is a facial treatment with the help of a speech therapist or physiotherapist. They teach you exercises and techniques to allow the halves of the face to move as symmetrically as possible. This way, facial paralysis is less noticeable and spontaneous recovery is stimulated.

Electrostimulation of the face is not recommended. Electrostimulation will cause the nerve fibres to grow back to the wrong muscles more frequently. This can cause a patient to involuntarily activate other muscle groups, such as closing their eye when smiling or chewing.

Latest publication date: 13/12/2023
Supervising author: Dr Vermeiren Judith