Facial Nerve Palsy
Facial nerve palsy is the disease of the face muscles, which is caused by the inability or insufficientness of the facial nerve (cranial nerve VII) to provide muscles on one side or both sides of the face with the necessary activity. The facial nerve consists of the motor and sensory parts. It serves muscles of expression of the face, conveys taste in the anterior 2/3 of the tongue, and contains parasympathetic fibers to the lacrimal and salivary glands. In case this nerve is destroyed, the affected patients experience facial asymmetry, inability to move their faces, and functional and psychological issues. The most widespread form is Bell palsy that is an idiopathic, lower motor neuron lesion.
Causes of Facial Nerve Palsy
- Idiopathic cause
- Viral infections include herpes simplex virus and herpes zoster (Ramsay Hunt syndrome).
- Otitis media and mastoiditis Middle ear infections.
- HIT injuries to the head or temporal bone fractures.
- Injury in surgery of the ear or parotid glands.
- Tumors which affect the facial nerve by compression include tumors of the acoustic nerve or tumors of the parotid gland.
- Tissues of the facial nerve.
- Metabolic diseases like diabetes mellitus. During pregnancy, and more so during the third trimester.
- Systemic infections such as meningitis.
- Exposure to cold air or wind.
- Congenital facial nerve palsy.
Symptoms and Clinical Features of Facial Nerve Palsy
Sudden onset weakness or paralysis of facial muscles on one side of the face.
Loss of facial symmetry at rest and during facial expressions.
Flattening of the forehead with inability to wrinkle the forehead on the affected side.
Drooping of the eyebrow on the affected side.
Inability or difficulty in closing the eye (lagophthalmos).
Upward rolling of the eyeball during attempted eye closure (Bell’s phenomenon).
Reduced or absent blinking of the affected eye.
Dryness of the eye or excessive tearing (watering of eye).
Flattening of the nasolabial fold.
Drooping of the angle of the mouth on the affected side.
Physiotherapy Management – Acute Phase
The acute phase normally takes place during the onset to 2-3 weeks.
The primary objectives are to decrease inflammation, inhibit muscle atrophy, eye protection, and muscle extensibility. During the acute stage, the eye care takes priority.
The patient would be informed to apply artificial tears in the day time and the use of the eye ointment at night.
Corneal damage can be prevented by the use of eye patching or taping. Muscles on the face must be relaxed. Massage of the face with light stroking and kneading strokes is beneficial to circle the blood and decrease the edema.
Massage will be done in the middle of the face to the surrounding and the affected side to the normal side.
Interrupted galvanic or low-frequency currents of electrical stimulation can be applied in the instances of complete lower motor neuron paralysis to inhibit muscle atrophy, however, only under the guidance of specialists.
Passive movements of facial muscles are promoted in a gentle manner to ensure that the soft tissues are mobile.
The patient should also not strain too much or make hard movements on his or her face, as it will put him or her at risk of synkinesis in the future.
Education to patients is required. As a patient he/she should be advised against exposing him/herself to cold air, covering the face, good oral hygiene.
Physiotherapy Management – Chronic Phase
Chronic stage develops after 3-4 weeks or at the time of beginning of voluntary muscle activity.
The primary objectives will be increased muscle strength, coordination, facial symmetry, and avoiding abnormal movement patterns.
The basis of chronic phase management is facial exercises. These are exercises in which the eyebrows are raised, the eyes are also closed narrowly and gently, smiling, frowning, puffing cheeks, whistling, and blowing. The exercises are to be done in a slow manner with the presence of a mirror to give visual feedback and ensure a symmetrical movement. The movement patterns are re-trained using the neuromuscular re-education methods to limit synkinesis.
This is not mass contractions, but rather isolated movements which are controlled. Mirror biofeedback or EMG biofeedback can assist patients in feeling the actions of the muscles and learn to control them. Stretching of tight muscles on the affected side and relaxation of overactive muscles on the unaffected side should be done in a gentle manner in order to restore facial balance.
The chronic stage of massage is used to loosen stiffness and enhance blood circulation. Slow stroking and long stretching, which are some of the inhibitory techniques, are useful in case of synkinesis.
Emphasis is made on functional training which entails facial expressions when speaking, eating and emotional expression.
Also necessary is psychological support as facial disfigurement can be the source of anxiety and low self esteem.