The term facial palsy refers to a medical condition where the nerve which works the muscles of facial expression (the facial nerve) is not working correctly. This can lead to a weak or absent smile; asymmetry of the face; difficulty with eye closure and drooping of the brow.
The commonest cause is Bell’s palsy where the condition occurs spontaneously, usually affecting one side of the face. Most people with Bell’s palsy have a complete or near complete recovery, but up to 15 % of sufferers do not recover fully. Other caues of facial nerve weakness include trauma or injury; following infection and following certain surgical procedures. Some people are born with facial palsy, where this is called a congenital condition. Most people with facial paralysis have only one side of the face affected, but both sides can be involved.
The effects of facial palsy are commonly very significant, and people with the condition often have difficulties which are physical, relating to how their face works and also in terms of how their facial appearance affects their interactions with other people.
The good news is that many aspects of facial paralysis can be successfully treated and improved.
For partial or recovering facial palsy non-surgical treatments such as physiotherapy and Botox can improve symmetry and diminish abnormal facial movements. These abnormal movements are called synkinesis if one movement triggers another, commonly smiling triggering eye closure. The other similar problem is called dyskinesis where some of the facial muscles twitch involuntarily.
For people who have little or no facial movement at all with no prospect of full recovery, facial re-animation operations can be indicated. These include nerve grafting or nerve transfer procedures, where new nerve supplies can be imported to strengthen the weakened face. In some cases this is not sufficient in which case more complex operations involving free tissue transfer where a new piece of muscle is transplanted to the face might be advised. Sometimes muscle transfers can also be used to provide a smile or strengthen eye closure.
Neurectomy procedures are sometimes used to surgically reduce the effects of overactive nerves which are causing synkinesis or tightening of the face (so called post-paretic syndrome).
In cases where there is significant asymmetry of the face at rest, when the face is not moving, then other surgical procedures may be of benefit. These can include browlift operations to lift a drooped brow, which can improve the field of vision in severe cases.
For milder asymmetry, facelift operations can reduce excess skin and drooping of the features. In more severe cases of facial droop a very powerful face lifting technique called a static support can be used. This involves using tissue from the top of the thigh (fasci lata) to provide a strong support to the drooping side of the face.
If you wish to see Mr Stephen Morley to discuss treatments for facial paralysis then an appointment can be made to be seen privately by calling 0141 334 9441 or at Ross Hall Hospital on 0141 810 3151. To see Mr Morley through the NHS then please arrange for a referral via your GP to be seen at Mr Morley’s Facial Palsy Clinic.