Facial Palsy

What is Facial palsy?

Facial palsy occurs when the facial nerve becomes injured and stops working. This results in the inability to move the muscles that are responsible for creating facial expressions (happy, sad, surprised, angry…). There are a variety of causes including:

Common

· Bell’s palsy

· Ramsay Hunt Syndrome (Herpes Zoster)

· Trauma (including head and neck surgery)

Less Common

· Tumour impacting the peripheral nerve

· Otitis Media, mastoiditis and cholesteatoma

· Other infections such as Lyme disease, HIV

· Autoimmune and inflammatory conditions such as Guillain-Barré, Sarcoidosis and Sjögrens syndrome

In the majority of cases, only one side of the face is affected. Onset is typically quick – occurring within a few hours, and people often wake up to a complete or partial palsy. People may notice difficulty or an inability to close their eye, their face may feel heavy and droopy, and they may have difficulty managing food and liquids. In addition, people may experience a dry eye and mouth, altered taste, and may have sensitive hearing on the affected side. This is because the facial nerve plays a role in creating tears and saliva, interpreting taste, and in dampening sound.

Please note: the following information relates to Bell’s palsy. Recovery rates and research on the effectiveness of treatments do not necessarily relate to the other causes of facial palsy. The therapeutic approach I take with clients, however, essentially remains the same – providing education, teaching management techniques, and addressing complications as they arise.

What is Bell’s palsy

Bell’s palsy is the most common form of facial palsy, and the good news is that the vast majority of people diagnosed with Bell’s palsy have complete spontaneous recovery. Approximately 70% of people will recover without any complication, even with no intervention – this number increases up to 85% when treated with glucocorticoids. Unfortunately, 15% to 30% of people diagnosed with facial palsy do not have full recovery, and complications of hypertonia (stiff muscles) and synkinesis (uncoordinated and aberrant movement) often occur in this population.

So why see a facial therapist if there is a strong chance of full recovery?

In my experience, clients who suddenly have a loss of the movement to half their face feel scared, worried, and anxious. You may have a number of questions about your condition and what recovery will look like. In addition, your recovery may start to occur after a few weeks, but may take several months – in the meantime, learning to contend with complications like an eye that won’t close and feels dry, loss of ability to manage food and liquids or facial heaviness can be challenging.

My goal is to provide you with information that will help you to manage these complications while you recover. I provide you with information about what has happened, the possible course of recovery, things to look out for, how to maintain as much facial symmetry as possible as you await recovery, and most importantly, how to manage your eye care. Together, we can come up with a plan that helps you manage the condition better through recovery. I believe that knowledge is empowering and that knowing what is expected and what to look out for makes the process more manageable. Many clients only need one appointment while some may need more support through recovery.

With or without therapy, the long term outcomes for those affected by Facial Palsy are good and most people make a full recovery. I view my role as helping to support you along that path, teach tips and tricks to make the physical challenges easier and to help identify when recovery is affected by complications.

I have been told that exercises won’t help at this stage, so why would I see a physiotherapist?

To be clear, it is absolutely true that at this phase, exercises will not help with recovery – that does not mean that a trained facial therapist cannot help. In terms of exercise, the analogy is that at this phase, the muscles of the face are like a lightbulb in a lamp that is not plugged in. Trying to turn that lightbulb on is futile, no matter how many times you try. The same applies to the face – until the nerve starts working again, the muscles are not connected to the power source, and no amount of exercise will change that. However, a trained facial therapist has much more than exercises to offer.

What can a facial therapist do for the 15% to 30% of people who do not have full recovery?

Once the face starts to recover, 15% to 30% of people who have had Bell’s palsy have long term effects such as hypertonia (stiff muscles) and synkinesis (uncoordinated or aberrant movement, potentially due to faulty re-wiring of the nerve as it re-grew). The first goal is to bring down the stiffness in the face to allow as much movement as possible – this can be done through stretching, massage and relaxation techniques specific to the muscles you are having difficulty with. My clients often report feeling comfort and relief following stretching. The goal is to decrease the overall stiffness of these muscles over the course of a few weeks to allow for more movement.

The next goal is to assess where the synkinetic or uncoordinated movement is occurring. When this happens, I work to develop a facial movement program specific to the difficulties you are having. Generic strengthening programs or modalities like NMES (electrical stimulation) are not of benefit and can cause long term complications.

Appointments are typically scheduled at 4 to 6 week intervals to begin with, in order to provide you an opportunity to succeed – progress is typically quite slow, and clients are not aware of the changes they have made until we are able to compare where they were at to where they are now.