KU

Facial nerve palsy causes paralysis of one half of the face. There are many causes for facial nerve palsy, including Bell’s palsy, facial tumours, tumours of the brain, parotid gland or ear area, along with infections and stroke.

Facial nerve palsies can be divided into pre-stapedial or post-stapedial depending on the location of damage to the facial nerve. People with a pre-stapedial facial nerve palsy may experience worse dry eyes, because the nerve innervating the tear gland (lacrimal gland) can also be affected.

People with facial nerve palsy may have varying signs and symptoms, ranging from having no movement of one side of the face at all, to facial movements being just slightly weaker. The eyebrow may be more droopy (brow ptosis), and often the blink is much worse or even absent when compared to the healthy eye. The upper eyelid may be retracted (sit higher) compared to the other side, and the lower eyelid may be weakened or even falling away from the eye itself (ectropion). The smile on the facial palsy side is often weak or absent.

Depending on the cause of the facial nerve palsy, some acute facial nerve palsies can partially or completely recover. Once a facial palsy becomes chronic, people may develop tightness or abnormal movements (synkinesis) of the affected side. The consultation of a facial palsy therapist may be useful in both the acute and chronic stages: Exercises may help with regaining function and stretching and massage techniques can help with the tight feeling. There are many resources and videos online.

Some people develop synkinesis (abnormal movement) as a result of a facial nerve palsy and this may affect the eyelids, forehead, cheek and tear gland. People may experience winking of the eyelids or excessive tearing when eating or speaking or they may develop a tendency to bite the inside of the cheek. Botulinum toxin injections can help in some people to both improve symmetry of the face and treat synkinesis. These injections need to be repeated every few months as their effectiveness wears off with time.

Most people with facial palsy will require supplementation of artificial tears / dry eye drops. Often affected people may need surgery on both the upper and lower eyelids to improve their blink and appearance.