What is Facial Paralysis?

The facial nerve (the seventh cranial nerve) controls muscles of facial expression, eyelid movement, and muscles of the forehead and neck. Therefore, the facial nerve controls smiling, laughing, blinking, winking, closing the eyes, raising the eyebrows, and frowning, just to name a few of its functions. Facial paralysis can occur suddenly or progressively with weakening or complete loss of facial movement and drooping of the facial muscles. Most commonly, facial paralysis only involves one side of the face.

What causes facial paralysis?

Loss of facial nerve function can occur for several reasons such as; infection, inflammation, head trauma, head and neck tumors, stroke, or diabetes. However, in many cases no apparent cause of facial paralysis is found. If Sudden facial paralysis occurs in the absence of a specific cause, the diagnosis is Bell’s Palsy.

Bell’s Palsy

Bell’s palsy is the most common form of facial paralysis in the United States. Approximately 40,000 Americans each year experience sudden facial paralysis due to Bell’s palsy. The cause of Bell’s Palsy is unknown, but may be related to a viral infection of the facial nerve. Luckily, most people with Bell’s palsy recover completely within six months.

What are symptoms of facial paralysis?

Facial paralysis has a major impact on quality of life and can cause: difficulty talking, inability to express emotion, difficulty eating and drinking, drooling, muscle twitching, tearing of the eye, dryness of the eye and mouth, facial pain, headaches, dizziness, earaches, ringing in the ear, and sensitivity to sound.

Those with loss of facial function who are unable to close the eye need to take extra care to help prevent permanent eye damage. When the facial nerve does not recover function, the surface of the eye can be compromised since the eyelids do not close. In severe cases, the eye will dry out and an infection or ulcer can occur. This can have serious consequences potentially leading to blindness. In addition, the tone of the eyelid muscles is weakened which may cause the lower eyelid to sag and droop, further causing redness, tearing and greater exposure of the eye.

How is facial paralysis treated?

Treatment of facial paralysis varies depending on the cause and severity of facial nerve loss. In Bell’s Palsy, oral steroids and antiviral medications can help increase chances of complete recovery. Physical therapy can also help strengthen the facial muscles and prevent permanent damage. For those who do not fully recover, surgery can improve facial drooping or an asymmetric smile, or eyelids that won’t close or are sagging.

How is the eye treated in facial paralysis?

Facial paralysis causes drooping of the lower eyelid and inability to blink and close the eye. Initially, aggressive lubrication with artificial tears and ophthalmic ointments is necessary to prevent the eye from drying out. In severe cases, the eyelids may need to be patched or taped shut during sleep. If conservative treatment is not adequately protecting the eye, or the facial paralysis does not improve with time, then eyelid surgery may be indicated.
There are several ways to improve the function and cosmetic appearance of the eyelids in cases of facial paralysis. In some cases, surgery is performed to help with eyelid closure, such as placing a gold weight within the upper eyelid or lowering the upper eyelid height. Others require surgical repair of the drooping lower eyelid, eyebrow and face. An in-depth consultation with Dr. Lissauer will determine a customized treatment plan.

If you would like to schedule a consultation regarding facial paralysis please contact our New York office at: 212-717-2150 for an appointment.