Facial paralysis

Facial paralysis or facial palsy is defined as decreased or absent movement of half of the face. When it happens abruptly, the priority is to rule out a stroke. Usually, when the forehead and eyebrows are affected (decreased movement) as well, a stroke is unlikely. Patients are usually evaluated by a family doctor or in the Emergency Department before being referred to Otolaryngology.

Evaluation by an Otolaryngologist is essential for patients with facial paralysis. When they appear abruptly, the majority of facial paralyses are due to a viral infection (Bell’s palsy or Ramsay-Hunt syndrome). Certain more rare cases can be due to inflammatory or infectious diseases of the ear or salivary glands, or tumors of the facial nerve at its exit from the brainstem. When facial palsy is due to Bell’s palsy or Ramsay-Hunt syndrome, the treatment is oral steroids and oral antivirals, as well as eye protection. When the eye does not close completely, this predisposes the patient to keratitis and irreversible vision loss. We suggest eye ointment at night and eye drops during the day.

Once the acute paralysis is over, patients end up in one of two categories : flaccid facial palsy or hyperkinetic/synkinetic facial palsy.

Flaccid facial palsy is defined by complete loss of tone in the face. The treatment is to reverse the cause if known (if it is a tumor it must be treated) and then to proceed with facial reanimation. Our Otolaryngology specialists perform the extent of facial reanimation procedures, including brow-lifting, gold weight insertion, and smile reanimation.

The second category of facial palsy is called hyperkinetic or synkinetic facial paralysis. After acute facial paralysis, the facial nerve can regrow in a disorganized fashion in the face resulting in unwanted movement in an area of the face. Sometimes, the eye can close during eating or speech, or the mouth will move when blinking the eye. Two proven treatments are recommended for this condition. Neuromuscular therapy, performed by a facial rehabilitation specialist (a speech pathologist in our case) will help teach the patient how to improve facial motor control. Treatment with botulinum toxin will weaken themuscles that move uncontrolably and soothe the patient’s symptoms.

The treatment of facial palsy involves the development of a long-term relationship with an ENT specialist that specializes in facial rehabilitation.