Facial Paralysis (7 th Nerve palsy)

Facial palsy may be due to an upper or lower motor neuron lesions
  • The causes of an upper motor neuron s may be hemorrhage, thrombosis or a tumor in the brain
  • The lower motor neurons - the nucleus or it's fibers within the pond can be affected in acute poliomyelitis, hemorrhage or tumors but the commonest presentation however is bells palsy which is idiopathic. The patients report to the department after exposure to cold with facial palsy, thought to be due to compression at the stylomastoid foramen. The peripheral fibers, after they have left the pond, may be injured or compressed either in the bony canal, or after they have emerged on the face, due to otitis media, accidental severance at operations on the ear, wounds or fractures of the skull. Upper motor neuron palsy usually recovers due to the bilateral innervation of the facial nerve, so the majority of patients with residual facial muscle weakness are in fact LMN palsy victims. The symptoms are:-
  • Eye can be opened but cannot be closed due to weakness of orbicularis oculi. 
  • Blinking is lost resulting in excessive tears
  • Eye is not efficiently protected from dust and injurious substances. 
  • Bells phenomenon:- the eye tends to rotate upwards and outward when closing
  • The corner of the mouth droops. 
  • Patient cannot raise the corner of mouth on affected side while smiling
  • The face is asymmetrical
  • Food collects between teeth and cheek and the person finds a difference in taste. 
  • The patient cannot whistle or frown
  • Facial expressions are affected. 
  • Articulation of the lips affected resulting in dysarthria. Pronunciation of labial/consonants is affected. 
  • There is loss of secretion in the anterior part of the tongue, or in some cause hypersensitivity to certain sounds is present. 
Physical treatment
Electrical treatment:- Muscle stimulation should only be by interrupted galvanism and nerve stimulation by faradism
Massage:- Stroking, effleurage, small circular fingering, kneading can be given all over the affected side of the face
Tapotement:- this is a form of massage by tapping quickly and lightly with the finger tips on the affected area
Vibration is preformed with the tips of one or two fingers. 

Exercises
  • Widen the eyes, then frown
  • Close tightly eyes, and then open wide. 
  • Smile, grin, say O and try to whistle. 
  • Pronounce the vowels or their combination aa ee ou
  • Hold straw in mouth - suck and blow out air. Show as if blowing a balloon
  • The patient should practice these exercises in front of a mirror twice a day with about five repetitions. 
Precautions:--
  • Patient is always advised to wear spectacle and avoid seeing bright light
  • To splash lukewarm water frequently to remove dust. 
  • To wear cotton plugs in ear to avoid exposure to cold. 

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