What is facial paralysis?

We can make our facial movements (lips, cheeks, eyebrows, eyes) by means of facial nerve.  Facial nerve transmits movement order coming from the brain to the facial muscles and enables us to make the movement we want to make.  When certain diseases in the brain or in the facial nerve prevents this message, facial paralysis occurs and facial movements are lost partially or completely.

Where is the facial nerve?

Fibers between the brain and brain stem and constituting the facial nerve come in a mixed way.

This section is mainly related with neurology.  Facial nerve follows a curly way after the brain stem.  It passes from internal ear passage, travels round the middle ear and reaches to facial muscles behind the ear in the form of several branches.  Before it reaches to facial muscles it passes from inside the salivary gland in front of the ear.  It is found together with the auditory nerve while passing from the internal ear passage.  During its route, it gives certain branches, and these branches have various duties.  Branches of facial nerve provide secretion of tear gland, secretion of salivary glands under the chin and enables functioning of taste cells of tongue. 

What are the reasons of facial paralysis?

Facial paralysis may develop because of a great deal of diseases in the section between the brain and brain stem or from the brain stem till the facial muscles.  Reasons of facial paralyses between brain and brain stem are mostly associated with cerebral bleeding, and they are investigated in the neurology department.  Facial paralyses occurring because of these reasons are called central facial paralyses.  Facial paralyses occurring because of diseases of facial nerve after the brain stem are called peripheral facial paralyses.

How to diagnose?

If paralysis occurs because of peripheral nerve system, one of the eyes is continuously open and it does not close completely, and one side of the mouth is always drooping.  In order to understand state of the patient accurately; patient is asked to show his/her teeth completely, to purse and move the mouth forward, to move the nose to right and left, dog-earing the forehead, to close the eyes and tasting tests are made.  For tasting test taste of food in four basic groups is tested: sweet, salty, sour and spicy.

The reason of facial paralysis, whether or not because of virus, bacteria or another reason, is revealed by tests to be performed by consultants.

How is it treated?

Treatment of facial paralyses is realized again according to the reason.  Treatment of Bell’s Palsy is medication.  If other diseases of the patient do not pose danger (tension, diabetes or stomach problems) corticosteroids and B-vitamin are given.  Additionally, drugs for stomach, artificial tear or crèmes containing antibiotics to prevent eye dryness are given.  Massaging facial muscles, hot applications, chewing gum to move the facial muscles are the factors patient should regard.  For Ramsay-Hunt syndrome, additionally drugs against viruses are given.  If another reason is found for the facial paralyses, this disease is treated by drugs or surgery.  These treatments are described in the related sections.  For example, facial paralyses arising from internal ear tumors or chronic otitis media necessitate surgery; while facial paralysis arising from acute otitis media is treated by making an incision on the tympanic membrane and by antibiotics.

Is Surgery Necessary?

Some causes of facial paralysis necessitate surgery.  As it is mentioned above, tumor (inside the head or in the salivary glands), chronic otitis media require operation.  On the other hand, certain diseases such as Bell’s paralysis that are mostly treated with drugs sometimes involve surgery.  It is not certain when the surgery is needed.  Patient’s response to the drugs, degree of facial paralysis, results of electrophysiological tests and time period that passed from the start of the disease are all considered to make a decision.  This decision shall be taken by your physician adequately.

What kind of surgeries is made?

Different operations are performed according to the cause of the facial paralysis.  Tumor is removed in internal ear tumors by opening the head bones or by entering from behind the ear.  Facial paralysis may not be observed in some of the internal ear tumors, however paralysis may develop after the operation.  If the tumor originates from facial nerve, part of the nerve is removed together with the tumor.  Remaining nerve part is repaired, however it may be necessary to connect other nerves with the facial nerves.  In facial paralysis arising from chronic otitis media, inflammation in the middle ear is cleaned and sheath covering the facial nerve is opened and inflammation is removed.  For the facial paralysis arising from salivary gland tumors, part of the nerve held by the tumor is also removed together with the salivary gland.  When surgery is needed for Bell paralysis or Ramsay-Hunt syndrome according to the results of drug treatment, the operation to be made is generally to reach to the nerve by entering from back of the ear and to open the sheath covering it.

When it is understood that facial paralysis can not be treated by drugs or operation, certain alternative surgeries may be realized.  Transfer of muscles moved by other nerves to the face, connection of other nerves to the facial nerve, to place weight under the eyelids and thus to enable closure, etc. are among these alternative surgeries.

Is Physical Therapy Necessary?

Functioning of facial nerve can not be saved by physical therapy methods applied to facial muscles.  However, facial muscles become weak because of immobility especially in long-lasting facial paralysis, and asymmetry on the face and power loss may be seen even though facial nerve functions.  In this case, physical therapy is recommended besides chewing gum and massage patient shall apply by himself/herself.