Facial Nerve Palsy
FACIAL NERVE PALSY
Some people may develop facial nerve palsy during his/ her life, be it due to Bell’s palsy, brain tumour or surgery or viral infection. Many left with distorted asymmetrical face, droopy brow and eyelid, inability to close the eyes and lower eyelid everting out (ectropion), difficulty in speech and water drooling out from the corner of the mouth. Facial nerve affect main muscle which close the eyes and mouth. After recovery, some may develop abnormal facial movement or twitching of face secondary to aberrant regeneration of nerve.
Causes of Facial nerve palsy
a) Idiopathic : Bell's palsy. Lower motor neuron. Please note that NOT all facial nerve palsy is Bell's palsy. It is important when a patient develop this condition to see ophthalmologist as there may be other cause of Facial nerve palsy such as tumor.
b) Ear problems
c) Upper motor neuron Facial nerve palsy: forehead is symmetrical compared to lower motor neuron
Patient with right facial nerve palsy. Note right brow drooping, right lower eyelid ectropion (everting out) and marked facial asymmetry.
Left facial nerve palsy secondary to brain tumor. Patient is not able to close left eye.
Depending on the cause of facial paralysis, the treatment varies.
For treatment of facial nerve palsy, the top priority is to protect the eye. The inability to close the eye will make the eye dry and susceptible to ulcer and infection. The options range from the use of lubricants or artificial tears, nocturnal taping, botulinum toxin to drop the upper eyelid to cover the eyes to surgery such as tarsorrhaphy, upper eyelid loading with platinum weight, lower eyelid lifting, ectropion correction and brow lift. The aim is to protect the eyes, treat watery eyes and reduce facial asymmetry and thus increase social acceptance.
For those who develop symptoms of aberrant regeneration after 7th nerve palsy such as abnormal twitching of face and crocodile tears (watery eye while eating or salivating), botulinum toxin can be used to treat this condition.
Please consult an oculoplastic surgeon for further management if one develop facial paralysis. Remember , it is not just affecting the appearance , but affecting the eye sight too.
Pre Op: This patient has brain tumor and subsequently has it removed. She developed inability to close her left eye. Due to lack of lubrication, her left eye develop scarring and not able to see well. She has to tape her eye close every night.
Post Op: Patient has platinum plate inserted. Platinum plate is compact and hence is not that visible externally. She said she is able to sleep well now.
Pre Op: This patient has right facial nerve palsy. The brow in the right eye is dropping. The lower eyelid also evert out causing water to come out. The face look asymmetrical.
Post Op: One week post op with remarkably reduced left swelling.
Pre Op: This man has brain tumor removed leaving him unable to close left eye.
Post Op: immediately post op, left eye is able to close now.
Pre Op: Right lagophthalmos (inability to close right eye).
Post Op: improved right lagophthalmos
Pre Op: Right persistent corneal ulcer despite multiple treatment. Please look at the sagging right lower eyelid.
Post Op: Healed right corneal ulcer. Raised right lower eyelid post modified right lower eyelid retraction surgery.