What is Facial Palsy?

Facial Palsy is a medical condition characterised by weakened facial muscles and facial paralysis.

The symptoms of Facial Palsy are usually connected to a damaged facial nerve, affecting the impulses sent to the facial muscles. Depending on the cause, the symptoms can be temporary or long-term.

Typically, the eyes and mouth are the most commonly affected areas. Facial Palsy can affect one or both sides of the face. It can also impact only one area in isolation.

Regardless of the cause, facial paralysis can impact confidence and independence. Many patients find their speech, sight and ability to eat are affected.

Facial Palsy treatment is highly bespoke and is based on your personal condition, symptoms and how they are affecting your life. It is essential to speak to a consultant who specialises in the treatment of Facial Palsy who can discuss the various options available and which may be most suitable for you.

What is the Facial Nerve?

Most Facial Palsy conditions are caused by issues affecting the facial nerve. This can be congenital and apparent from birth, or arise later in life, including injury. There are two facial nerves, one on each side of the face, and damage to either of these nerves will affect the corresponding side of the face.

Each nerve originates from the brain, and the central point is found at the front of the ear. From here, it divides into several branches which communicate with the facial muscles to activate movement and facial expressions. The facial nerve branches also control taste, tears and saliva production.

Our Surgeon's View

Our expert consultant surgeon, Mr. Manaf Khatib, discusses the causes of and treatments for Facial Palsy and why Plastic and Reconstructive Surgeons may suggest certain procedures.

Cadogan Clinic has brought together a team of the best Consultant Plastic Surgeons in the UK. Several of our surgeons work in Facial Palsy treatment, and have contributed to the essential research and development in this specialist field.

What Causes Facial Palsy?

There are several Facial Palsy causes, which fall into two categories – Congenital and Acquired:

• Congenital Facial Palsy is present from birth
• Acquired Facial Palsy develops later in life

Congenital Facial Palsy Causes

Non-Syndromic Facial Palsy

Non-Syndromic Facial Palsy causes are isolated and not connected to a syndrome.

• Isolated Congenital Facial Palsy – This is Facial Palsy that is apparent from birth and may be caused by the facial nerves or muscles not developing fully during pregnancy
• Asymmetric Crying Facies (ACF) – This type of Facial Palsy is isolated to the upper lip and results in the mouth being pulled downwards on one side when a baby cries. It can be caused by incomplete development of the facial nerve or abnormalities in the chromosomes. Depending on the cause, it often resolves within a few weeks or becomes less noticeable over time

Syndromic Facial Palsy

Congenital Syndromic Facial Palsy is connected to a condition or syndrome which a genetic factor has caused. Conditions may include:

• Moebius Syndrome – A rare neurological disorder which results in the inability to smile, frown, blink, or suck
• Hemifacial Microsomia – A condition affecting up to 1 in 40,000 births globally where part of one side of the face is underdeveloped, affecting the eyes, jaw, ears and definition of the face
• CHARGE Syndrome – A rare and complex condition which covers a range of birth defects which may include Facial Palsy
• Branchio-Oto-Renal Syndrome – A developmental condition which impacts the ears and neck potentially leading to varying levels of facial paralysis

Acquired Facial Palsy Causes

Idiopathic Facial Palsy

Idiopathic Facial Palsy is connected to a condition where the cause is not known

• Bell’s Palsy – The most common cause of Facial Palsy, accounting for 80% of all known cases. Inflammation around the facial nerve creates pressure, which causes facial paralysis, although it is not understood why this occurs

Stroke

A Stroke is caused by the blood supply to the brain being restricted or cut off. This can cause the facial nerves to become damaged, leading to Facial Palsy. Depending on the severity of the Stroke, this may be permanent or temporary.

Infection of the Facial Nerve

There are a number of bacterial infections which can directly affect the facial nerve, leading to Facial Palsy:

• Ramsay Hunt Syndrome
• Lyme Disease
• Meningitis
• Poliomyelitis
• Leprosy

Fortunately, many of these conditions are increasingly rare and prevented by vaccination in the UK.

Compression of the Facial Nerve

There are several conditions which can lead to the facial nerve being compressed, resulting in temporary or permanent Facial Palsy:

• Tumours
• Vascular Masses
• Swelling of surrounding tissue
• Bony Masses
• Barotrauma – Caused by pressure changes during diving or flying
• Melkersson-Rosenthal Syndrome

Muscular Dystrophy

Muscular Dystrophy leads to the breakdown of muscle mass and loss of muscle strength. In cases where the face and neck muscles are affected, this may result in Facial Paralysis.

Trauma to the Facial Nerve

Injury or trauma to the Facial Nerve may lead to facial paralysis:

• Trauma to nerve at birth
• Head injuries
• Skull fractures
• Injury during surgery

It is important to establish and understand the cause of your Facial Palsy in order to find the correct and most effective treatment.

How to Treat Facial Palsy?

Facial Palsy treatment is extremely personal to the individual and the cause of their facial paralysis. In some cases, Facial Palsy will resolve without treatment, although it is still essential to seek medical advice during this time to ensure no further damage is being caused to the facial nerves.

Any Facial Palsy treatment should be carried out by a qualified medical professional who specialises in facial paralysis.

Non-Surgical Facial Palsy Treatment

Medication

In cases where an infection or illness causes Facial Palsy, treatment may involve medication such as antibiotics, antivirals or steroids.

• The steroid, Prednisolone is often used to treat Bell’s Palsy. It reduces inflammation, but it is essential that treatment is started within 72 hours of symptoms first occurring for the best results. Treatment usually lasts for 10 days
• For patients who have Ramsay Hunt Syndrome, a combination of steroids and antivirals is usually prescribed. Again, treatment must be started promptly for maximum benefit
• Bacterial infections such as Lyme Disease can be treated with antibiotics. The dose and treatment plan will depend on the nature and severity of the patient’s condition.

Injectable Facial Palsy Treatments

In cases where muscle weakness caused by Facial Palsy results in spasms in the face, Anti-Wrinkle Injections can be used to weaken the underlying muscle and prevent unwanted movement.

• The treatment will take 1-2 weeks to take full effect
• Repeat treatments are typically required every 4-6 months

Your consultant will likely recommend a series of facial exercises to carry out after having your treatment, as relaxing the muscles may help you to change the way your facial muscles move

Eye Lubrication

For patients who aren’t able to close their eye fully due to Facial Palsy it is essential to keep the eyes lubricated. Not being able to blink means that the usual film of tears isn’t spread across the cornea (the outer layer of the eye) regularly, which can cause discomfort and eye damage.

• Preservative-free eye drops should be administered up to every 2 hours throughout the day
• Eye ointments should be used overnight as they are long-acting and create a barrier against moisture loss. They can be used during the day, but they may cause blurry vision as they are thicker

Your consultant will recommend the best type of eye drops and ointments to address your personal concerns.

Physical Therapy

Physical therapy, also known as facial rehabilitation, is a combination of non-surgical treatments designed to alleviate the symptoms of Facial Palsy. Facial rehabilitation therapy services may involve working with several different specialists and include:

• Advice on mouth and eye care
• Working to make eating and drinking easier
• Speech therapy to improve annunciation
• Massage, stretches and facial exercises
• Neuromuscular training which utilises emotional inputs to support physical movement
• Facial rehabilitation is often combined with other treatments to enhance the overall result.

Psychotherapy

Many patients experiencing Facial Palsy are impacted by the emotional distress as well as the physical symptoms. Especially for patients whose condition may have limited treatment options, talking therapies can be an important treatment option to allow them to express and process their difficulties.

Psychotherapy is often combined with physical therapies as part of Facial rehabilitation.

Surgical Facial Palsy Treatment

There is a range of surgical options available to treat Facial Palsy with several different goals:

• Improve mouth movement, allowing someone to smile
• Improve eye movement and closure

Restore facial symmetry

It is essential to have realistic expectations of what Facial Palsy surgery can achieve, and your surgeon will ensure you are well prepared ahead of your procedure. There are currently no surgical procedures which can completely restore your face to its appearance before your Facial Palsy symptoms. Facial Palsy surgery is a personal choice, and many people choose not to have surgery for many reasons.

Blepharoplasty

For patients whose Facial Palsy impacts the appearance of their eyes, a Blepharoplasty, or Eyelid Lift, can be carried out to restore the position of the skin in the eye area and address any sagging or drooping. This can address either the upper or lower eyelid, or both.

In cases where a patient has difficulties closing their eye, small gold or platinum weights can be placed in the upper eyelid to keep the eyelid closed.

Procedures to Improve Facial Symmetry

Many patients who are affected by Facial Palsy find that their skin naturally droops more which can impact facial symmetry. There are a number of surgical procedures which can address these concerns, and improve the symmetry of the face:

• Facelift – to tighten and lift the skin and muscles around the lower and mid-face improving the balance of the face
• Brow Lift – to lift the skin between the upper eyelid and the brow, enhancing the proportions of the upper face
• Fat Transfer – Excess fat can be extracted from the body, processed and transferred to the face to enhance the shape and volume of areas with muscle weakness

Facial Nerve Decompression

This procedure can be carried out in the early stages of symptoms occurring to alleviate pressure on the facial nerve, allowing it to function more effectively.

The causes of your facial paralysis and how long you have been experiencing symptoms will influence whether you are suitable for Facial Nerve Decompression.

Facial Reanimation Surgeries

Also known as Smile Surgery, Facial Reanimation Surgery aims to improve symmetry and address typical concerns caused by Facial Palsy. There are two types of Facial Reanimation Surgery:

• Static Procedures – These improve Facial Palsy concerns at rest, but do not impact movement
• Dynamic Procedures – These improve Facial Palsy concerns and also create facial movement

These surgeries may include a combination of procedures such as Facelift and Blepharoplasty, along with specialist techniques such as Nerve and Muscle Repair.

It is essential to bear in mind that what Facial Palsy surgery can achieve is based on the nature and severity of your condition, and any other treatments you have previously tried.

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