Care and Treatment of Chronic Facial Paralysis
Facial paralysis is a rare disorder, but it has significant effects on an individual, both physical and emotional. While most patients fully recover from acute facial paralysis, a small population is left with chronic lingering symptoms. These patients might experience difficulty with eye closure, asymmetric smile, nasal breathing dysfunction, eyebrow droop or trouble eating. They might also experience loss of confidence, depression and other quality-of-life issues from the disfigurement. Specialized, multi-disciplinary care — including surgery and/or rehabilitation — will help improve these conditions in most cases.
How common is facial paralysis?
In the majority of acute facial paralysis cases, after a physician completes a history and physical examination and can find no underlying cause for paralysis, the term Bell’s palsy is applied. The disorder is rare — the annual incidence of Bell’s palsy is 20 to 30 patients per 100,000. That means between 1,150 and 1,700 patients in Wisconsin will receive a Bell’s palsy diagnosis each year. While 80% to 90% of Bell’s patients have complete recovery, that leaves up to 350 new patients with residual deficits across the state annually. 1
This figure does not include those patients who suffer from facial paralysis as a side effect of cancer treatment of the parotid (salivary) gland, or tumor of the inner ear and skull base. These patients are given reconstructive procedures much earlier but still may be affected with disfiguring side effects of facial paralysis.
When is specialized care necessary?
Being a rare disorder with good prognosis, most patients with ongoing facial paresis (weakness) after Bell’s palsy simply do not know that care exists and treatments are available, nor do many physicians. By three months after a patient’s initial symptoms, Bell’s palsy should display signs of recovery. If a patient displays signs of facial paresis and paralysis lasting more than three months, a referral to a specialized care clinic is recommended. There, a team of otologists, otolaryngologists, facial plastic surgeons, oculoplastics, health psychologists, and facial nerve therapy experts will evaluate the face and develop an individualized diagnostic and treatment plan.
At any point during facial paralysis recovery, the facial muscles may behave incorrectly, resulting in facial tightness, spasm or unwanted muscle movement, called synkinesis. This condition also warrants referral to a specialized care clinic. The collaborative treatment for these patients may involve a specific type of non-surgical therapy called facial neuromuscular retraining.
What are the surgical options?
Because most patients will have full recovery in the first three months, no procedures or therapy are advised during that time. However, prophylactic eye care should be used in all patients with incomplete eye closure. In patients with significant difficulty, one procedure can be considered early -– surgical placement of a weight within the upper eyelid to help with eye closure. Preserving the eye is crucial when recovering from any type of facial paralysis and placement of an eyelid weight, even if temporary, can greatly help to prevent damage or injury to the eye.
In cases of complete paralysis with no muscle recovery, between one and two years into facial paralysis the affected muscles begin to break down and restoration of function becomes less likely. Therefore, intervention before muscle break-down results in a better chance to restore or preserve natural muscle function. Thankfully, this is very rare for Bell’s palsy and more common after trauma or cancer surgery treatment.
For patients with persistent muscle paresis (weakness), several options exist to lift sagging/drooping parts of the face or improve eyelid positioning. These treatments will restore not only a patient’s facial features, but also a patient’s emotional health.
Both the static and dynamic procedures described can be performed at any time for facial paresis that did not recover, even many years later.
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For More Information
The UW Facial Nerve Clinic provides a multidisciplinary approach to diagnosing and treating long-standing, chronic facial paralysis in children and adults. Our team includes otologists, otolaryngologists, facial plastic surgeons, oculoplastics, health psychologists, and facial nerve therapy experts, working side-by-side to offer individualized treatment plans. For more information, please visit our patient and provider Facial Nerve Clinic website.
1 Source: Cummings Textbook, Chapter 167, Clinical Disorders of the Facial Nerve