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Facial palsy

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.

The causes

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 treatment

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.

Surgery

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. The patient shown at the right illustrates quite a consequences of this debilitating disease. Her right eyebrow is drooping, which is made more obvious by her lifting the left one. The right lower eyelid is drooping, causing ectropion and associated watering. The eye may also be uncomfortable, since it cannot close. The midfacial area is droopy too, as shown by a more droopy right cheek. Finally the mouth has ‘fallen’ on the right side.

Eyebrow droop can be corrected in several ways, the eyelid can be made to close in several ways, the lower eyelid can be tightened. The watering may be inconvenient, requiring correction. Droopyness 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 !

This lady requested a few operative corrections, but did not wish too much surgery. Move your mouse over the image to see the difference. Some asymmetry is still visible, but of no concern to the patient. She did not request “all that could be done”.

More information on care after the operation.

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