Facial Palsy – Symptoms and Causes

Write short note on Facial Palsy.

Answer. Facial palsy refers to the paralysis of facial muscles.

Facial Palsy is of two types:
1. Upper motor neuron palsy
2. Lower motor neuron palsy or Bell’s palsy:

“Understanding facial palsy through FAQs: Symptoms and causes explained”

Upper Motor Neuron Palsy

• Upper Motor Neuron Palsy affcts mainly muscles of lower part of face and is never complete.
• Upper Motor Neuron Palsy is seldomly isolated palsy.
• The emotional movements are preserved.
• There is no muscle *contracture.
• There is no reaction of degeneration.
• Electromyography and nerve conduction is normal.

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Lower Motor Neuron Palsy Or Bell’S Palsy

Bell’s palsy is an acute apparently isolated, lower motor neuron facial palsy.

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Facial Palsy Etiology

• Cold: It usually occurs after exposure to cold.
• Trauma: Extraction of teeth or injection of local anesthetic may damage to the nerve and subsequent paralysis.
• Surgical procedure: Such as removal of parotid gland tumor in which the facial nerve is sectioned can also cause facial paralysis.
• Tumors: Tumors of the cranial base, parapharyngeal space and infratemporal fossa after cause 7th nerve palsy.
• Familial: Familial and hereditary occurrence is also reported in case of Bell’s palsy.
• Facial canal and middle ear neoplasm.
• Herpes simplex—viral infection.

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Facial Palsy Symptoms: How to Identify and Diagnose

Facial Palsy Clinical Features

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Facial Palsy Investigations

Electromyography is of prognostic importance.

• If signs of denervation are present after 10 days, i.e. axonal degeneration is present and recovery is incomplete or delayed.
• If there is incomplete denervation in less than 7 days the prognosis is good.
• Fibrillation potential after 2 weeks is suggestive of wallerian degeneration.

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Facial Palsy Management or Facial Palsy Treatment

• Local heat: Infrared or moist heat over the face or parotid region or both if there is tenderness of nerve trunk.
• Local treatment ofmuscles: The patient should massage the facial muscles with bland oil for twice a day for 5 min.
  The massaging movements should start from the chin and lower lip and are directed upwards.
  With return offunction the patient should practice movements of various muscles of face before a mirror.
• Prevention offacial sagging: Application of strips of adhesive tape is done to lift up the angle of mouth.
• Tape is attched to the temple and extends down in a V shaped fashion to upper and lower lips.

“Early warning signs of gaps in understanding facial palsy basics: Common questions”

• Protection of eye: It is done with dark glass or eye patch.
  Mild zinc boric solution is used to wash the eye to prevent conjunctivitis.
• Corticosteroids: If seen under a week of onset. Prednisolone 40mg/day for 4 days and in tapering doses for over next 6 days helps by reducing secondary edema.
• Anti–virals: Acyclovir, Valacyclovir or Famciclovir in combination with steroids, ifstarted within 3 days ofonset.
• Surgery: Decompression of facial nerve in second or third week cannot inflence favorably natural course of Bell’s palsy. Cases which fail to recover after 9 months in them anastomosis of facial nerve with accessory or preferably hypoglossal nerve is considered, or plastic surgery in cases of total paralysis with atrophy of muscle.