Facialis – when the facial nerve is paralysed

By: Noa Rabinowitz, Speech Therapist, Reuth Rehabilitation Hospital Tel Aviv

Paralysis of the facial nerve also known as facialis, is a nerve disorder expressed by weakness or paralysis of the facial muscles. Mainly the paralysis will appear on one side of the face and in rare cases it will appear on both sides. The phenomenon is very common and appears in 1 of 5000 people. Facialis appears in men and women equally and in all ages when it is most common between the ages of 15 and 45. Furthermore, it is most common amongst diabetics, around the third trimester of pregnancy and in the spring and autumn.

The facial nerve or by its second name – the seventh nerve – is responsible for innervations of the facial muscles. It is responsible, inter alia, for the facial expressions movements, such as smiling, lifting eyebrows, closing and opening the eyes and control of the facial muscles that participate in speech, eating and drinking. The facial nerve also innervates the salivary glands and tears and is responsible for the sense of taste.

What happens when there is damage to the facial nerve?

 Damage to the facial nerve could cause several defects:

• Distortion of the face due to paralysis or weakness on one side.
• Difficulty in making facial expressions.
• Difficulty in controlling the mouth, possibly drooling.
• Difficulty with chewing and swallowing.
• Unclear speech.
• Changes to the quantity of tears and saliva.
• Damage to the sense of taste.
• Pain, numbness and a tingling sensation in certain areas of the body.

Those suffering from this paralysis have to cope with functional defects and also with feelings of discomfort, embarrassment and unpleasantness due to the fact that their face is not symmetrical and this constitutes an aesthetic disorder.

Types of paralysis of the facial nerve

 There are two types of facialis: peripheral paralysis – when the damage is directly to the facial nerve. As a result of this type of paralysis all the expression muscles on the side of the face that is damaged are paralysed, including the area of the eyes and eyebrows. Central paralysis – when the damage to the nerve is in the inter-cranial area, of the central nervous system. In such a case the paralysis is only in the lower area of the face (the mouth and cheek) on the opposite side of the place in which the cerebral damage has been caused.

The reasons for the facial paralysis

The most common reasons causing facialis (in decreasing prevalence) are:

1. The most prevalent reason (about half of the cases) is due to Bell’s Palsy. The reason for this paralysis is unknown.
2. Trauma: trauma could take place as a result of an accident including harm to the cranium through which the nerve passes, as a result of harm to the nerve during surgery or during birth.
3. Various infections: a very common infection causing facialis is herpes zoster.
4. Tumours proximate to the seventh nerve which put pressure on to it.
5. Neurological reasons which cause facialis such as: CVA or autoimmune disease such as Guillan Barre, multiple sclerosis and myasthenia gravis.

How is paralysis of the facial nerve diagnosed and how can it be treated?

The diagnosis is made pursuant to clinical indications characteristic of the disease. In order to diagnose the reason for the disease an examination is required by an ENT specialist and a neurologist. Due to the fact that there could be complications that involve the eyes and the vision it is also important to be examined by an ophthalmologist.

In most of the cases in which the reason for the appearance of the paralysis is unknown (Ball’s Palsy) the paralysis is temporary and complete and spontaneous recovery is anticipated within one to six months. In a small number of cases the damage will remain which will be expressed mainly by drooping to the angle of the mouth.
Also in cases of facial paralysis as a result of brain damage (CVA or brain damage) treatment to reduce the defect is possible. The closer the treatment to the incident, the faster the results, moreover it is possible to see a functional improvement throughout the rehabilitation process.

There are various types of treatments for facialis pursuant to the type of facialis and the reason for its appearance. If necessary facialis can be treated with various types of medication and surgery. Furthermore facialis can be treated by means of physiotherapy and by complementary medicine. Treatment by a speech therapist will focus on improvement of the facial expressions by exercises designed to activate the facial muscles and by massaging the facial muscles. Furthermore the treatment will focus on improvement of abilities to chew, swallow and speak which were harmed due to the facialis.

The information presented in this article is general. It does not constitute medical advice or replace consultation with a physician. It should not be regarded as a recommendation or an alternative for medical treatment.

(image is for demonstration purposes unsplash)