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Facial paralysis refers to the inability to move one’s face, usually as a result of nerve damage. It may affect one or both sides of the face, resulting in facial drooping, watery eyes, incomplete eye closure, or sagging of the brow and cheek.
Facial paralysis is caused by damage to the nerves that allow for movement of the facial muscles. This damage can result from inflammation, tumors, infection, stroke, trauma, surgery, or underlying medical conditions and neurological disorders. In cases in which the exact mechanism of paralysis is unknown, the facial paralysis is referred to as a Bell’s Palsy.
Bell’s palsy is facial paralysis or weakness in which the exact mechanism is not known. The diagnosis is made as a “diagnosis of exclusion”- meaning that all major causes of paralysis have been ruled out by history, physical exam, and diagnostic testing.
Bilateral Bell’s Palsy is a term used to refer to weakness on both sides of the face. This, however, is not a true Bell’s Palsy. Bell’s Palsy exclusively refers to paralysis of the face without an indefinable caused as ruled out on all workup- referred to as an “idiopathic” palsy. Bilateral Palsy, however, more likely a result of an underlying neurological issue. The most common causes of facial paralysis on both sides of the face are infections (e.g. Lyme Disease, meningitis), autoimmune disorders (e.g. Sarcoidosis), hereditary disorders (e.g. Neurofibromatosis), or neurological disorders (e.g. Guillain-Barre Syndrome). If you suffer from paralysis of both sides of the face, it is important to rule out causative factors, before relying on the diagnosis of a Bell’s Palsy. Common workup of such disorders may include tissue biopsy, bloodwork, imaging (e.g. MRI) of the brain and spinal cord, and electrophysiological studies.
In addition to the weakness of the facial muscles, you may experience sensitivity to sound (called ‘hyperacusis’), taste disturbances, and watery eyes.
The vast majority of Bell’s Palsy related paralysis is temporary and self-resolving within 3-6 weeks. Typically you should expect to see some resolution of facial movement within the first two weeks. More severe cases of facial paralysis, or in cases of complete paralysis, nerve function may not fully return. For cases in which paralysis is worsening or fails to resolve by 6 weeks, your specialist should order specific tests to rule out other causes of paralysis.
Your doctor may be able to diagnose Bell’s palsy simply based on your history and physical exam. A hearing test may be obtained to ensure that there is no involvement of vital ear structures. Other tests may be ordered if your physician suspects other underlying causes. Such tests may include blood work and imaging studies such as CT scans and MRI brain scans.
Depending on the exact cause and duration of paralysis different treatment options are available. The goals of treatment are to restore the smile, reduce vision impediments, and reduce disfigurement related to brow and cheek droop. There are two strategies used to restore and rehabilitate patients with facial paralysis- dynamic and static reanimation techniques. Dynamic techniques attempt to restore movement of the native facial muscles. Static reanimation techniques, however, attempt to restore form and appearance without restoring actual movement. It is important to seek consultation with a specialist who is trained in a broad range of reconstructive options to better serve your needs.
“Cable” Nerve Grafting
“Cross Nerve” Grafting
“Jump Nerve” Grafting
Temporalis Muscle Transfer
Gracilis Free Flap
Lid Tightening Procedures
Sometimes injectables can help in achieving a symmetrical appearance of the face by targeting areas on the non-paralyzed areas of the face. Also, often times, patients with facial paralysis may have involuntary muscle spasms and ticks (e.g eye twitches) that can be controlled by an injectable.
Recurrence of Bell’s Palsy recurrence is exceedingly rare, but is possible. However, during the second episode of Bell’s Palsy, or a Palsy that occurs on the opposite side of the original episode, your physician should perform a more extensive workup to rule out any underlying causes of the recurrence. This would work up may include MRI and CT scans of the head and neck region, in addition to blood work. Sometimes a neurologist can perform muscle studies to help determine the cause of the paralysis.
Facial plastic and reconstructive surgeons are uniquely qualified to deliver a higher standard of care when it comes to reconstructing the face. It is important to find a surgeon that has experience in this area, as it requires highly technical and specialized skills. Dr. Mourad has extensive knowledge and training in the field of facial paralysis. He has been a leader paving the way describing new techniques. Dr. Mourad has written book chapters in textbooks that help in the training of present-day surgeons. He also has published extensively in peer-reviewed scientific journals and is well qualified to manage your facial reconstructive needs.