Facial Paralysis

Updated: Jan 5

Symptoms of Facial Paralysis & Bell's Palsy are almost same. Bell’s palsy is a type of facial paralysis happen due to dysfunction of 7th Cranial nerve. It is named after Sir Charles Bell [1774 to 1842], who was a Scottish surgeon, neurologist and anatomist. He is renowned for noting difference between motor and sensory nerves in the spinal cord.

Facial Nerve & its distribution
Facial Nerve (7th Cranial Nerve)


What is the difference between Upper Motor Neurone and Lower Motor Neurone facial palsy?

If the forehead is not affected (i.e. the patient is able to raise fully the eyebrow on the affected side) then the facial palsy is likely to be an upper motor neuron (UMN) lesion. Paralysis which includes the forehead, such that the patient is unable to raise the affected eyebrow, is a lower motor neuron (LMN) lesion.


The facial nucleus is divided into two halves. The upper half of the nucleus receives innervation from not only the contralateral motor cortex but also from the ipsilateral motor cortex. But the lower half of the nucleus receives innervation only from the contralateral motor cortex.

Now, upper part of the face is supplied by upper part of the nucleus and lower part of the face is supplied by lower part of the nucleus.

So, in UMN facial play, contralateral paralysis of lower facial muscles is seen. This is because of the ipsilateral innervation. In this case, patient is unable to smile, unable to whistle, but can raise eyebrow.

In LMN facial palsy, there is ipsilateral paralysis of both upper and lower facial muscles. Clinical features are drooping of corner of mouth, loss of labial fold but typical features are inability to raise the eyebrows and close the eyelids properly.



Clinical presentation

  • Inability to close the eyes

  • Inability to move the lips for smile or to eat

  • Eyelid may droop or face may appear droop

  • Difficulty in eating & drinking

  • Speech disturbance happens in some of the individuals, slurred speech

  • Drooling

  • Pain in or behind the ear

  • Dry eye

  • Altered taste sensation

  • Facial expressions, such as smiling, squinting, blinking compromised

  • Headache in some patients

  • Hypersensitivity to sound

Probable causes
  • Diabetes

  • Hypertension

  • Injury

  • GB syndrome

  • Myasthenia gravis

  • Infection

  • Tumour

  • Stroke

  • Middle ear infection


Risk factor
  • Diabetes

  • Pregnancy

  • Upper respiratory tract infection: which is very common during cold environment or at the time of transition from hot weather to cold weather, typically October to February in India. This is the time we get more patients of Bell’s Palsy and Facial paralysis.

Diagnostic test
  • EMG

  • CT Scan of brain (if doctor feel that it may be due to stroke)

  • MRI

  • X – Ray if tumors or fracture suspected in facial bones

Visit your private practitioner for steroids or anti-viral treatment, but it is advisable to start your Physiotherapy session from day 1 to reduce the nerve damage. You can also visit ENT doctor to differential diagnose Ramsay Hunt Syndrome.

Prognosis of Facial Paralysis is good if treatment start early, not only the medical management but also the therapeutic intervention.

Physiotherapy includes:

  • Facial Muscle Stimulation

  • Facial PNF

  • Cranial Osteopathy

  • Biofeedback

  • Mime therapy

  • Facial Massage

  • Kabat Rehabilitation

References:


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