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Advances in Facial Paralysis

by Gretchen Henkel •

For the majority of Bell’s palsy patients, symptoms resolve within a one- to three-month period. Even during this period, however, the eyes must be protected. Without the ability to close the eye, patients’ corneas become dry, putting them at risk of abrasion and ulceration. Therefore, whatever the cause or prognostic course of the paralysis, noted Dr. Hom, “we always think first of protecting the eyes.” Short-term measures include the use of eye ointments, non-preservative eye drops, transparent moisture eye patches and wraparound sunglasses during the day.

Stave Off Social Isolation

Facial paralysis can have dire psychosocial and even economic consequences for patients, said Lisa Ishii, MD, assistant professor of facial plastic and reconstructive surgery in the department of otolaryngology-head and neck surgery at Johns Hopkins University School of Medicine in Baltimore, Md.

Physicians have recognized for some time that patients with facial paralysis feel that people perceive them differently and tend to isolate themselves socially. Recent studies done by Dr. Ishii and colleagues validated the idea that observers view faces with paralysis as less attractive (Laryngoscope. 2011;121(6):1138-1143; Arch Facial Plast Surg. 2011;13(1):14-19; Laryngoscope. 2012;122(3):533-538).

Loss of attractiveness puts patients at risk for depression, said Dr. Ishii, which can, in turn, result in diminished productivity and other economic consequences. She and her coauthors advocate more awareness of patients’ psychosocial states and urge physicians to initiate discussions with patients’ family members and encourage sensitivity toward patient needs.

Some patients may benefit from initiating facial massage, said D. Bradley Welling, MD, PhD, chair and professor in the department of otolaryngology-head and neck surgery at the Wexner Medical Center at The Ohio State University in Columbus. “Massaging the face can cause the muscles to contract and retain tone while waiting for nerve regrowth,” he noted. Others have suggested biofeedback with electrical stimulation, although the evidence is not definitive on its efficacy for hastening recovery. Attention to hair styling and makeup strategies can also de-emphasize asymmetry, according to Dr. Hom. (Patient information, personal grooming ideas and other self-help tips can be accessed at facialnervepalsy.com.)

Temporary or Permanent?

The initial goal is to reinnervate the facial muscles in order to maintain muscle tone. How long clinicians should wait before initiating directed interventions is often debated, said Dr. Welling. At his institution, the approach may be to use electroneuronography (ENoG) to assess nerve function in the acute phase; at six to eight weeks post-presentation, electromyography (EMG) may help assess function. It’s best not to wait beyond one year to initiate grafting procedures, said Dr. Welling, because reinnervation may be compromised. However, he added, “The way we treat facial paralysis includes art as well as science. We need to press forward with good outcomes studies that will help us answer some of these questions about timing more definitively.”