Treatment of Facial Paralysis
What is facial paralysis
Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face because of nerve damage. Your facial muscles droops or become weak.
This condition typically caused by:
- infection or inflammation of the facial nerve
- head trauma
- head or neck tumor
Facial paralysis can come on suddenly (in the case of Bell’s palsy, for example) or can happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last a short or extended period of time.
Facial palsy is condition in which there is lesion of the facial nerve and the resultant paralysis in the muscles that it supplies.
This is a common acute, isolated facial nerve palsy believed to be due to viral infection (most probably herpes simplex) that causes swelling of the nerve within the petrous temporal bone. Facial palsy can be upper and lower motor neuron, while Bell's palsy is typically acute lower motor neuron paralysis, uni or bilateral. Usually idiopathic, but also can be associated with intermittent HSV reactivation. It is usually mononeuropathy compared to facial palsy may be associated with multiple cranial nerve involvement depending upon lesion.
There will be following features on the side of lesion:
Loss of facial expression.
Drooping of the face- Low eyelid, eyebrow and corner of mouth sag.Closing the eye is difficult.
Eating is difficult because food collects in the side of the cheek and fluid seeps out of the corner of mouth.
Speaking, whistling and drinking are impaired.
Non-verbal communication is lost as the patient
cannot register the pleasure, laughter, surprise, interest and worry.
The patient tends to sit with the hand over the side of face.
Spontaneous recovery occurs toward the end of
second week. Thereafter, continuing recovery occur. Fifty percent recover
within three months. Continuing recovery may take 12 months to become complete.
About 15 percent of patients are left with a severe unsightly residual
Steroids (prednisolone 60mg daily reducing to nil
over 10 days).
Acyclovir for viral infection.
If there is severe residual paralysis, cosmetic surgery and/or reinnervation (nerve anastomosis of the lingual to the facial) are some times performed after a year has been elapsed.
During the paralysis:
The selection of the suitable physical agent
depends upon the experience or the choice of an experienced physiotherapist.
Physiotherapist may choose from a number of physical agents available.
Ultrasound (Ultrasound therapy)is given
over the nerve trunk in front of the tragus of ear and in area between mastoid
process and mandible. There is no fear of applying ultrasound while doing the
treatment of patient with Bell's palsy. The ultrasound is always applied on the
side of lesion in front of the tragus of ear & in area between the mastoid
process and mandible where the maximum tenderness of the facial nerve is
determined by palpation. It is applied in slow circular motion with a starting
dosage of 1 watt per square centimeter for 10 minutes. The dosage may be
increased on the subsequent sessions if no remarkable improvement is noted. Let
me explain that ultrasound waves cannot traverse the bone. That means
ultrasound has zero penetration in the bone. Infact, ultrasound waves are
reflected away from the bone. So there is no fear in applying the ultrasound on
face. (This is only for LMN lesion type)
Low level laser therapy (infrared 808 nanometer wavelength 400 mill watt power for 5 minutes continuous)