Facial Paralysis

"In cases of facial paresis or complete paralysis it is necessary to resort to surgery to recover facial movement, this requires an experienced team of microsurgeons and a specific microscope to achieve repair and rehabilitation of the facial nerve".

DR. BERNARDO HONTANILLA CALATAYUD
SCIENTIFIC DIRECTOR. RESTORATIVE AND PLASTIC SURGERY DEPARTMENT

Facial paralysis is the total or partial loss of voluntary muscle movement on one side of the face. It is produced by a failure in the facial nerve, which does not carry the nerve commands to the main muscles of the face.

It is clinically manifested by the inability to raise the eyebrow, close the eye, inability to smile, alterations in speech, etc.

Central facial paralysis is that which is produced by an injury at the cerebral level (not at the nerve level). In this case, the paralysis will affect only the lower half of the face (there will be no difficulty in closing the eye or raising the eyebrow).

Central facial paralysis can be the result of a stroke, a brain tumor or a cerebral vascular malformation, among other causes. The management and prognosis of central facial paralysis is different, so if there are diagnostic doubts, the evaluation by a specialist in Neurology is essential.

Peripheral facial paralysis is relatively frequent and, in general, has a good prognosis with conservative treatment. However, the final result of a paralysis can be, in some cases, a facial paresis or a complete paralysis, depending on the causes.

The Department of Plastic, Reconstructive and Aesthetic Surgery, made up of plastic surgeons, works together with neurologists, otolaryngologists, neurosurgeons, neurophysiologists and physiotherapists from the Clinic, to correct its sequelae.

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What are the symptoms of facial paralysis?

The symptoms most frequently associated with peripheral facial paralysis are diverse. Prior to the paralysis, there may be a common cold and more or less intense pain in the retroauricular region.

The paralysis sets in within a few hours and can sometimes worsen for another 24 or maximum 48 hours.

The lack of mobility on one side of the face produces an evident asymmetry at rest and when making gestures. It also leads to the impossibility of smiling and difficulty in closing the eyelids, with alterations in tearing and sometimes also in the sense of taste.

It is also quite common to have difficulty raising the eyebrow, a smooth forehead, alterations in nasal breathing, biting of the mouth mucosa, accumulation of food in the back of the mouth and dropping of saliva.

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Learn what facial paralysis is and how it is treated (only in spanish)

Do you have any of these symptoms?

You may suffer from facial paralysis

What are the causes of facial paralysis?

There are multiple causes that can provoke an alteration of the facial nerve along its path causing facial paralysis. The most frequent cause (in 80%) is idiopathic facial paralysis, also known as Bell's palsy. Although the exact cause is unknown, it is thought that it may be due to an inflammation of the nerve produced by viruses of the herpes simplex family.

Other less frequent causes of peripheral facial paralysis are inflammation of the nerve by the varicella zoster virus, or lesions in the path of the nerve by tumors at the level of the pontocerebellar angle (acoustic neurinoma), middle ear tumors or parotid tumors.

Similarly, peripheral facial paralysis can be caused by head injuries with fracture of the temporal bone, certain toxic agents and autoimmune diseases, or yatrogeny (surgical accident).

Finally, facial paralysis can occur congenitally (Moebius Syndrome).

What is your prognosis?

Idiopathic (Bell's) facial paralysis has a benign prognosis. In a percentage of cases, full recovery of nerve function is achieved. The average time is usually between 4-6 weeks, reaching up to 6 months for full recovery.

The most frequent sequel is a slight degree of paralysis of the muscles that were affected.

The factors that worse prognosis present are:

  • Presence of a complete paralysis.
  • Hyperacusis.
  • Pain.
  • Age over 55 years.
  • Arterial hypertension.

How is facial paralysis diagnosed?

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The diagnosis of facial paralysis is mainly made by the examination of the specialist. On occasion, it is necessary to carry out a series of tests to evaluate the degree of affectation:

  • Schirmer's test, to measure the amount of tears produced by both eyes.
  • Salivation test.
  • Hearing test.
  • Tests to evaluate the affectation of the nerve.

In addition, the doctor can perform a brain imaging radiological study, by means of a CT or a magnetic resonance imaging (MRI).

How is facial paralysis treated?

The initial treatment of facial paralysis will depend on the cause of the paralysis.

In the case of idiopathic facial paralysis, the initial treatment generally consists of the administration of antivirals and corticoids.

If the paralysis is due to trauma, steroid treatment may be administered. Later, it can be corrected with surgery.

On the other hand, since the eyelid does not close, eye protection is necessary. This is done using sunglasses, artificial tears, epithelial ointments and closing with a patch during sleep, or the placement of a weight on the upper eyelid.

When conservative treatment has not been successful and the nerve has not recovered, reconstruction techniques can be performed to improve the sequelae. The Department of Plastic, Reconstructive and Aesthetic Surgery, formed by plastic surgeons, works together with neurologists, otolaryngologists, neurosurgeons, neurophysiologists and physiotherapists of the Clinic, to correct the sequelae.

There are two types of reconstruction techniques:

Static. They pursue the most natural suspension of the face, closure of the eyelid or elevation of the eyebrow, among others. They improve the physical appearance. Patients with facial paralysis can open the eye, but not close it. A gold weight is implanted in the eyelid to close it by gravity. Regarding the suspension of tissues, with the patient's tendons, the hanging parts are elevated to make them as similar as possible to those on the healthy side.
Dynamics: oriented to the patient to get to move the face and smile again. Depending on the patient's circumstances (cause of the nerve injury, age, associated diseases, etc.), the most convenient surgical technique is determined.
Facial nerve transfers and muscle transplants

To recover the smile, nerve transfer can be used if the paralysis has not passed more than 2 years or muscle transplants if more than 2 years have passed. In the transplants a muscle is extracted from the leg, with vessels and nerves.

This is the gracilis muscle, a muscle that extends from the lower branch of the pubis and the ischium branch to the tibia. The graft is attached to the zygomatic arch - a part of the human skull, more specifically the face - and the orbicularis muscle to pull the corner of the mouth.

The nerve of the grafted muscle is attached to a cross-facial nerve transplant or to the nerve of the masseter muscle and is connected to a vein and an artery in the neck.

After surgery, thanks to the learning capacity, the brain will assimilate the new function of the grafted muscle, which will then be in charge of the movement of the smile. To achieve this, the patient must do rehabilitation.

After the surgical treatment of facial paralysis by means of muscle transplant and nerve transposition (connection of the facial muscle to another nerve other than the injured facial nerve), the woman's brain readapts better, recovers its spontaneous smile and has a longer period of time available to repair the paralysis than that of the man.

Patients with complete facial paralysis, between 3.5 and 5 years of evolution, achieve mobility and an acceptable symmetry of the mouth when resting and smiling. In the long term, the postoperative evaluation shows good functional and aesthetic results.

A facial paralysis can recover spontaneously in some cases, especially when they are idiopathic facial paralyses (Bell's palsy). A prudential waiting time (6 months) is necessary to determine the recovery of facial movement.

Spontaneous recovery of movement after facial paralysis frequently leads to the appearance of aberrant movements (synkinesias), which should be treated by means of physiotherapy, botulinum toxin or surgery, depending on the case.

Where do we treat it?

IN NAVARRA AND MADRID

The Department of Neurology
of the Clínica Universidad de Navarra

The Neurology Department has extensive experience in the diagnosis and multidisciplinary treatment of neurological diseases.

We offer a diagnosis in less than 72 hours, along with a proposal for personalized treatment and post-consultation follow-up of the patient by our specialized nursing team.

We have the most advanced technology for an accurate diagnosis with cutting-edge equipment such as HIFU, deep brain stimulation devices, video EEG, PET and epilepsy surgery, among others.

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