A Family Doctor’s Tale – FACIAL PALSY

DOC I HAVE FACIAL PALSY

In all my years of practice, I only come across 3 cases of Facial Palsy all due to Bell’s Palsy. All 3 cases recovered within 3 weeks completely with steroid treatment and physiotherapy. There were no residual Complications. It is important for the patient to prevent foreign bodies entering their eyes and strengthening the muscles of the face during treatment.

Facial Palsy is the paralysis of the facial nerve from its origin in the brain right to the branches of the nerve in the face.
It is usually temporary.


Facial Palsy occur as a result of reduced blood supply to or pressure on the facial nerve at 2 areas:


Supra nuclear(within the Brain)
1.Cerebral vascular lesions
2.Cerebral tumors


Infra nuclear(outside the brain)
1.Bell’s palsy – most common with unknown cause, most likely due to viral infection of the facial nerve after the stylomastoid foramen.
2.Trauma- Birth injury,fractured temporal bone, surgery of the ear
3.Tumors- Acoustic neurofibroma, parotid tumors, malignant disease of the ear, sarcoidosis
4.Infections- from acute otitis media or chronic otitis media, herpes zoster of the ear, HIV, Lyme’s disease
5.Autoimmune disease- Gullian-Barr Syndrome, sarcoidosis,
6.Multiple sclerosis


The onset of facial palsy is usually very sudden.


The most important part of the diagnosis is to distinguish between the supra nuclear and infra nuclear causes of facial palsy.


Supra nuclear symptoms and signs:
1. The movements of the upper part of the face is unaffected because the forehead muscles have bilateral cortical representations


2.Depressed taste     ( lesion above chorda tympani)


3.hyperacusis -loudness of hearing ( lesion above nerve to stapedius)




Infra nuclear symptoms and signs:
1.pain and discomfort at the mastoid region(behind the ear) or in the ear.


2.weakness of facial muscle on 1 side, with sagging eyelids, difficulty in closing the eye, drooping of the mouth on 1 side.


3.dribbling of saliva


4.difficulty in speaking


5.loss of taste at the front of the tongue


6.dryness or watering of the affected eye


7.eyeball rolled up and inward on attempted closure of affected eye


8.ectropion or turned out lower eyelid


9.sharp hearing on the affected side


10.Voluntary twitches (called synkinesis) such as the corner of the mouth turning up in a smile when blinking or tears in the eye while eating.


1.Physical examination
test muscle movement of the forehead
test closing of the eye
ask patient to smile


2.investigations:
Blood for infections, HIV, Lyme’s disease
MRI of brain to exclude tumors
Electromyogram and nerve conduction studies may give a better  indication of the severity of damage to the nerve and the subsequent prognosis


Treatment involve the following:
1.Start on a course of steroids like prednisolone(about 40-60mg at first , then tapering off) to hasten rapid recovery.
The steroid usually reduce swelling of the nerve.


2.antiviral drugs such as acyclovir can help recovery especially when the cause is herpes virus


3. Protection of the affected eye which cannot be closed properly by wearing glasses or an eye pad.
Use artificial eye drops during the day to keep the eye moist.
Tape the eye at night to keep it closed.


4.Physiotherapy of the facial muscles – using facial massage,exercises, and acupuncture may help restore the facial muscle tone.


5.Surgery
Tarsorrhaphy, which narrows the space between the upper and lower eyelids, may improve eye closure.


Plastic surgery may improve permanent facial drooping


80-90% of patient with facial palsy recover spontaneously and completely within three weeks.


The remainder usually takes up to six months to recover.

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Tagged with: facial palsy

Filed under: Medical case Studies

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