Facial Palsy refers to facial paralysis caused by trauma to, or dysfunction of the facial nerve. This nerve controls the muscles of facial expression and affected patients lose the ability to raise their eyebrow, close their eye fully, or form a smile.

The cause of this may be congenital or acquired. One of the most common acquired causes is Bell’s palsy, but many other causes (such as infections, autoimmune conditions and tumours) must be excluded before this diagnosis can be safely made.

The first step in the management of this condition is to establish a diagnosis and treat the cause- if required. Management of the paralysis itself is a team effort, as it is multimodal from facial therapy and Botox to improve facial symmetry, to surgical options to improve symmetry and re-create a smile.

Surgical Options include managing the eye with upper eyelid weights to help the eye close, and tendon slings to help support the lower eyelid.

With regards to dynamic options to help re-create a smile, this includes nerve and muscle transfers.

Patients with the sequelae of some types of facial palsy (called a post-paralytic facial palsy syndrome) have recovered some movement and tone, but develop synkinesis (where involuntary movement of one muscle occurs during the voluntary movement of another muscle- such as winking when smiling or eating, amongst others), as well as tightness of some muscles which cause restriction of other movements (such as a restricted smile), and lastly weakness of select muscles. This imbalance is treated with facial therapy in the first instance, with the addition of Botox to weaken tight muscles and balance the face, and the addition of surgical options such as neurectomy (where certain nerve branches to overly stimulated muscles are divided), and even division of select  tight muscles (which are restricting the movement of the rest of the face).

You would need to be seen in clinic to determine which options are available to you, along with the advantages and disadvantages of each.

For further information please visit the BAPRAS website ,and the FacialPalsyUK website.

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