Definition, Causes, Symptoms, Diagnosis, And Treatment

Facial Paralysis Definition

The term facial paralysis means in practice Palsy. A frigore paralysis, most likely viral origin, is by far the most common.

Facial paralysis is the partial or complete paralysis of facial muscles. It means in practice so-called peripheral facial paralysis. It is the result of a facial nerve after it exits the brain. The facial nerve is the seventh cranial nerve twelve in total. It supplies all the muscles involved in facial expression.

The path followed by the facial nerve is long and complex, which explains its vulnerability and the different causes of peripheral facial paralysis. During his trip, the facial nerve between successively connected with the cerebellum, the meninges, the internal auditory canal, the auditory nerve, inner ear, middle ear, mastoid, and parotid gland. So that lesions (infections, tumors, trauma) of each of these different structures may be the cause of facial nerve paralysis.

There are two types of facial paralysis depending on where the lesion is located.

1. In facial palsy, the facial nerve is reached after leaving the brain while in the central facial paralysis, nerve damage occurs in the brain. It is usually related to a cerebrovascular accident (stroke) or the presence of a tumor. With facial paralysis on the side opposite to that of the nerve injury.
2. Central facial paralysis is different from the peripheral facial paralysis: it is often associated with paralysis of half of the body (hemiplegia) and is confined to the lower face. Eyelids and forehead were spared. Moreover, the reflex movements are preserved while voluntary movements are themselves affected.

Facial paralysis (img thanks to arquivosdeorl.org.br)

Facial Paralysis Causes

The main cause of facial paralysis is the absence of cause.

Facial paralysis in which we did not find any cause is called “idiopathic” or “a frigore”. This is the most common facial paralysis. It installs quickly and heals in a few hours in most cases.

Other causes of facial paralysis are linked to abnormalities such as:

• Tumors that are located on the course of the facial nerve;
• Trauma from rock (containing bone structures of the ear);
• Ear infections;
• Infections, including herpes zoster;
• Diabetes;
• Rare diseases such as sarcoidosis or vasculitis.

How This Happening

This is the compression of the facial nerve is usually involved.

The mechanism common to most causes of facial paralysis is compressive edema. In a frigore paralysis, the most common peripheral facial paralysis, the nerve is compressed the nerve lies in a bony canal that is not expandable so that edema causes compression to stop any blood flow (ischemia).

Compression and ischemia will, initially, cause an interruption of nerve conduction, resulting in paralysis. This is the “block” or conduction neurapraxia and is reversible upon the cessation of compression, hence the importance of early treatment.

If compression and ischemia continues, there is a degeneration of nerve fibers. The process of recovery from paralysis then uses nerve regeneration, much slower (barely one millimeter per day, representing a delay of several months). The risk of sequelae is so important: it is proportional to the degree of degeneration and variable from one person to another depending on their age and vascular conditions.

Facial Paralysis Sign

The signs of facial paralysis are typical and can make the diagnosis.

At the eye and forehead, when the person is at rest, forehead wrinkles are erased from the side of paralysis, one eyebrow is lowered and the eye is tearful.

When the person with facial paralysis will make voluntary movements, it can not raise his eyebrows, wrinkle forehead or close eye. Moreover, the impossibility of closing the eye and the fact that it goes back up and outward characteristics of facial paralysis (Bell’s sign).

In addition, we also see more discrete events as a sign of Souques: when we force to close the eyelids, eyelashes appear longer on the paralyzed side.

At the bottom of the face (nose, mouth, chin, neck), there is an asymmetry in the rest of the face with a deformation of the mouth is examined and the nasolabial fold (sulcus of the nose) is deleted. The person can not whistle, blow the cheek, smile and has difficulty articulating.

Facial Paralysis Diagnosis

The balance sheet is primarily to clarify the neurological severity of the infringement.

The assessment of facial paralysis include an examination of the eardrum, a quantification of muscle by muscle paralysis (facial muscle Testing).

The result is expressed as a percentage of residual motor function compared to the healthy side (0% corresponding to the complete paralysis).

This assessment also includes electrical tests to measure the severity of nerve damage.

• Electromyography (EMG) is to record the activity of facial muscles at rest and during voluntary movements.
• The electroneuronographie (EnoG) consists of recording muscle contraction in response to strong electrical stimulation of the nerve, which assesses the percentage of residual functional nerve fibers. It is widely accepted that if he persists less than 10% of functional fibers, the risk of sequelae is important.

MRI is performed in rare cases of diagnostic uncertainty and the forms of atypical development.

Facial Paralysis Treatment

The treatment is directly related to the cause of the paralysis

The treatment of facial paralysis associated with drug therapy, physiotherapy, eye care and, in some cases, a surgical decompression of the facial nerve. It depends on the cause of facial paralysis.

For a frigore facial paralysis, treatment is based on corticosteroids to fight against edema and compression of physiotherapy which aims to keep the facial muscles in good shape and guide the patient in his recovery. We must also take care of the eyes with eye care. These are intended to avoid complications (conjunctivitis and keratitis) due to accumulated dust and lack of wetting of the eye due to paralysis of the eyelids. Surgical intervention for people with facial paralysis with complete denervation of over 90% electrical testing and no signs of recovery in electromyography. It is to decompress the nerve.

The treatment of facial paralysis due to herpes zoster is mainly based on high-dose acyclovir in venous infusion for seven days. That of Lyme disease based on injections of antibiotics in high doses for two weeks. Facial paralysis caused by an ear infection requires treatment of the latter.

The management of central facial paralysis usually requires hospitalization in the neurology department.

In cases of trauma?

The management of traumatic facial paralysis is different depending on whether it occurs immediately or remotely from the accident.

Traumatic facial paralysis are routinely screened upon admission of a traumatic brain injury in the emergency department or neurosurgery, especially if there is a bleeding ear. Thus, we can distinguish the immediate facial paralysis and facial paralysis secondary.

Immediate facial paralysis are present in the immediate aftermath of traumatic brain injury, and reveal a wound nerve loss. The wound should be repaired with surgery as soon as the person’s condition allows.

Facial paralysis condition occurs after injury and are probably caused by post-traumatic swelling. Treatment is then based on corticosteroids.

In the vast majority of cases, facial paralysis a frigore develops favorably, with full recovery or almost complete in about 85% of cases. The effects are only present in 15% of cases, only a third leads to complete paralysis sequelae, or 5% of total paralysis a frigore.

Facial Paralysis Surgical Treatment

Two surgical techniques possible.

There are two surgical techniques depending on whether one is interested in the nerves or muscles.

• The first group includes various types of nerve anastomosis, and they are to reroute a nerve so that it “replaces” the injured facial nerve, in order to reanimate the facial muscles before they are completely atrophied. This intervention is made up from 18 to 24 months after the onset of paralysis.
• The second group is based on transpositions of muscles, the incisions of weakening of muscles on the healthy side in order to improve the symmetry of the face, and different techniques to obtain the closure of the eye (springs, cartilage grafts) .

Facial Paralysis Exercises Physical Therapy

Physiotherapy exercises, practicing alone, are important for recovery.

Exercises to practice at home, for a few minutes sessions several times a day in front of a mirror are:

• Wrinkle forehead;
• Frown;
• Close your eyes;
• Fold the back of the nose;
• Lower the nostrils;
• Show the teeth;
• Whistle;
• Open-mouthed smile;
• Smile with your mouth closed;
• Dig the cheeks;
• Pull the neck skin.

We must also take all feasible precautions in the eye that is exposed due to paralysis of the eyelids. Dusts are stagnating, and the cornea dries out, causing a risk of conjunctivitis and keratitis above and corneal ulceration. We must therefore protect the eyes with artificial tears, wearing glasses, an occlusive dressing at night.

Your Consultation

To facilitate your consultation with your doctor, do not forget anything and optimize your maintenance information here as useful information to your doctor.

What documents to bring?

• Your vital card and your insurance card
• Your last order and the medications you are currently taking

The pattern and the main reasons for your consultation?

• The start date of facial paralysis? sudden or progressive character?
• A circumstance triggering: Airflow? Sun exposure? Recent respiratory infection? Influenza-like illness? Menstruation?Tooth extraction? Emotional stress?
• Signs preceding the facial palsy: a pain around the ear?Ringing in the ears? Disorders of taste?
• Signs associated with facial paralysis: Hypersensitivity to the face? Hypersensitivity to sound or conversely decrease of hearing? Dizziness? Ear discharge? Vesicles in the hollow of the ear?Loss of strength, sensitivity disorder, clumsy gestures in the lower limb?

• Do you have other diseases that may occur in the prognosis? Diabetes? Hypertension? Lipid disorders? Atherosclerosis?
• Does a pregnancy is underway which month?
• Do you have an ear infection? is it treated? ?
• Have you recently been bitten by a tick? You eras you walked in the country
• History of facial paralysis: you? in your family?

A few tips:

• Make a payment
• Be on time for your appointment