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The facial nerve controls the muscles of facial expression, including the frontalis muscle (raises the eyebrows), the orbicularis oculi muscle (closes the eyes), the zygomaticus muscles (raises the angle of the mouth), and the orbicularis oris muscle (closes the mouth). With paralysis or palsy of the nerve, the function of these muscles are weakened.
One may be born with a facial palsy, or it may develop later. Acquired causes include infection (Bell’s Palsy), blood vessel problems, tumors or injuries. Eye problems include eyebrow drooping, elevation of the upper eyelid, ptosis and ectropion of the lower eyelid, excessive watering, inability to close the eye drying of the cornea.
The aims of treatment are to protect the eye, improving cosmesis, and if present treat any watering. Many patients can be managed medically with topical lubrication drops and ointment, moisture chambers, and taping the eyelids closed at bedtime to protect the eye. In severe cases or longstanding ones, it may be possible or mandatory to treat some problems with operations.
If the eye sight is threatened, it may be necessary to do surgery to help protect the eye. A variety of procedures is available, and which one is most suitable, must be individualised and depends on the stage of recovery and the amount of facial palsy at the time.
If the palsy does not heal properly, several options are open for rehabilitation: both function of the eye, as well as cosmesis need to be considered. It is quite clear that seventh nerve palsy can cause significant cosmetic deformities, that can often be addressed very satisfactorily. Nobody though can make the abnormalities disappear completely.
The surgical possibilities in patients with facial palsy are many.
Her is an example of this debilitating disease. The right of left eyebrow may droop, which is made more obvious when lifting the corresponding eyebrow.
This may cause drooping eyelids resulting in ectropion and associated watering. The eye may also be uncomfortable, since it cannot close. The mid-facial area may droop as well causing the mouth to fall on one side.
Eyebrow drooping can be corrected in several ways. The eyelid can be made to close by tightening the lower eyelid. The watering may be inconvenient, requiring correction. Droopiness of the cheek may be amenable to treatment.
Sometimes patients experience “synkinetic movements”, which are due to abnormal regrowth of the nerve. This may be treated with operations, but often non operative options are advisable and work very well.
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