Facial Paralysis (Peripheral Facial Paralysis)

Facial twitching, weakness or inactivity are signs of a disease involving the facial nerve. Abnormal movements or paralysis on the face may occur due to an infection, injury or tumor, and the cause must be investigated. An Ear Nose Throat Diseases Specialist is trained on facial nerve diseases and their treatment.

What is Facial Nerve (Facial Nerve)?
The facial nerve is similar to a telephone cable and contains 10,000 different nerve fibers, 7000 of which go to the muscles. Each fiber carries electrical impulses for a facial muscle. The information carried by the fibers of this nerve allows us to laugh, cry, smile or frown, and therefore It is the nerve that provides the expression of the face. If an obstruction occurs in half or more of these nerve fibers, facial weakness occurs.
However, the facial nerve; It also has functions such as tear production, saliva production, playing a role in hearing by carrying impulses to the muscle of the stirrup in the middle ear, and providing the sense of taste in the anterior part of the tongue.
Facial paralysis is divided into two.
1-      Facial paralysis due to brain damage (central)
2- Facial paralysis due to peripheral (peripheral) injuries

Peripheral Facial Paralysis: As the facial nerves leave the brain and come to the face, they pass through a narrow channel through the ear. They come out in front of the ear and disperse to the facial muscles (mimic muscles). Paralysis is most common in daily life due to the compression of the nerve in the canal due to cold and viral diseases. This type of facial paralysis is also called Bell's palsy. Brain hemorrhages and diseases, inner ear infections, especially upper jaw tooth infections, face and head traumas, some congenital diseases and nerve damage during birth, viral diseases, tumors, diabetes, hyper/hypothyroidism, pregnancy, It is caused by hypertension, toxic causes, post-surgery and prolonged exposure to cold air drafts. Facial paralysis manifests itself in many different ways depending on the person. Sometimes it is seen as very mild and facial paralysis can be understood as soon as the person smiles. Facial palsy is a rapidly progressive disease and may reach its maximum severity in a few hours or days. More patients feel a difference in that half of their face when they wake up in the morning. Sometimes, there may be ear pain before the paralysis. When the paralysis develops, the movement in the facial mimic muscles decreases or disappears completely. The eye cannot be closed because the eyelid muscles do not work on that side. The facial features on the paralyzed side are flattened. Naturally, the most common symptoms are difficulty in speaking, inability to blink, drooling from the mouth, difficulty in eating and drinking, along with the feeling of slipping in one half of the face (especially on the lip side) due to the inactivity of the facial muscles. The patient cannot move one side of the mouth. . Can't whistle. The mouth shifts towards the healthy side. This shift becomes very evident, especially when laughing. Speech is impaired. In many people, the sense of taste is also impaired. In addition, there is a constant tearing problem due to dryness of the eye on the affected side and the affected eyelid cannot fully spread the reduced tear to the eye. If the eye is constantly open and not properly closed and protected, foreign objects and dust may enter the eye. Irritation and infection occur in the eye. Since a branch of the facial nerve is also responsible for the sense of taste, some patients complain of a strange and unpleasant taste, such as a metallic taste. Findings such as decreased tear and saliva secretion, impaired taste, and increased sensitivity to noise appear as symptoms of facial nerve palsy.

What are the conditions that increase the probability of getting the disease?
Age is considered an important factor, for example, although the incidence is much lower in children, spontaneous recovery is also higher. Some metabolic diseases, for example; The risk of developing facial paralysis in diabetes is 4 times higher than in the general population. The last three months of pregnancy are considered a period to be considered for facial paralysis. Diseases that cause disorders of the immune system also constitute another risk group. The decrease in body resistance makes it easier to catch the disease. For example, infections that may occur due to a decrease in body resistance due to cold, fatigue, insomnia, malnutrition and, most importantly, stress.

Does it affect other parts of the body?
No, in facial paralysis, complaints such as paralysis, weakness or numbness do not occur in any other part of the body, and if they do, another disease should be considered and investigated.

Is the disease contagious?
No, it is not contagious. Those who have the disease can continue their work and normal activities.

How is it diagnosed?
Facial paralysis is mostly diagnosed from the patient's clinic, but laboratory or imaging tests are applied when other diseases that may cause facial paralysis are suspected.

What is the recovery rate?
The healing process is directly proportional to the destruction of the facial nerve. In mild injuries, the recovery is quite rapid and complete in only a few days, while in more severe cases this period may be longer, such as a few months.

Is it repetitive?
The recurrence probability of facial paralysis is around 5 - 15%, and it varies according to the underlying diseases and risk factors.

How is the treatment done?
The disease usually resolves spontaneously without the need for any medical or surgical treatment. 80% of patients recover in 2-3 weeks. Apart from these, 10% may take up to a year to heal, while 10% cannot heal and facial synkinesis (nerve fibers are misdirected during recovery and accordingly tearing during eating, contraction at the mouth during eye closure) develops. Treatment should be started as soon as possible after the onset of the disease. In Bell's Palsy, drug treatment is applied. Medication should be started within the first 24-48 hours. If the patient has other existing diseases, these should also be considered. In order to accelerate the treatment process, massage is recommended together with facial muscle exercises. It should not be forgotten to protect the head and neck area and to keep warm in cold weather. Since the eyes do not close completely during the illness, they should be protected from infection and physical trauma with artificial tears, antibiotics and eye patch during sleep. In more severe cases, steroids (cortisone may be beneficial by reducing edema in pinched nerves) and antiviral drugs are used. However, since there will be a change in the person's external appearance, the psychological support and information of the patient during the treatment period is the most important point of the treatment that should not be ignored. In the event that no message is detected, surgical intervention is planned.

Does physical therapy have a place in treatment?
Physical therapy also contributes to the recovery of the disease. • Local blood circulation is increased with hot applications, muscle atrophy is prevented with active exercises performed in front of the mirror and improvement in muscle functions is observed.

When is surgical treatment required?
Different surgeries are performed depending on the cause of facial paralysis. In facial paralysis due to chronic middle ear infections, the inflammation in the middle ear is cleared and the sheath surrounding the facial nerve is opened to clear the inflammation. According to the result of drug treatment in Bell's palsy or Ramsay-Hunt syndrome (viral) facial paralysis, if surgery is required, the procedure is usually to reach the nerve by entering behind the ear and open the sheath around it. When it is seen that the facial nerve cannot be treated with medication or surgery, some auxiliary surgeries are performed. Among these, operations such as transferring muscles moving with other nerves to the face, joining other nerves to the facial nerve, placing gold weights on the eyelids and ensuring the closure of the eyes can be performed.

As a result;
Facial paralysis is not uncommon and has various causes. Proper diagnosis and treatment at the earliest possible time is very important for the best possible restoration of facial nerve functions. Even patients with permanent facial nerve damage can be helped by surgical procedures developed to restore facial functions.