Facial Rehabilitation
Facial paralysis or weakness is the result of damage to the facial nerve. The facial nerve controls the muscles of the face which give us facial expression eg smile, pout, frown.
Damage to the facial nerve can be caused by virus, trauma or disease all of which can affect the muscles of facial expression.
- Virus – which attacks the facial nerve causing nerve degeneration. The most common conditions include Bells palsy or Ramsay hunt syndrome.
- Trauma – cut to the facial nerve which may partially or fully sever the nerve. Eg sharp instrument, blow
- Disease – tumours in the skull lying close to the facial nerve and which require surgical intervention eg acoustic neuroma. The facial nerve may be traumatised during such a procedure.
Each of these conditions can result in damage to the facial nerve and the corresponding muscles or tissue it supplies. Each condition will benefit from a detailed physiotherapy assessment and appropriate intervention. Response to treatment will depend on the status of the nerve, extent of nerve damage and potential for further recovery.
One of the most well known conditions is “Bells Palsy” which I will describe in more detail below.
Bells Palsy
Bells palsy is a condition, which affects the facial nerve causing paralysis of muscles on one side of the face. It is thought to be caused by a viral inflammatory reaction to the facial nerve. The viral infection identified in most cases is the herpes virus. Facial weakness can occur suddenly and can be very traumatic for a person.
Bells palsy occurs equally in both sexes and at any age although incidence increases with age. It occurs in 10-40 / 100,000 of the population. Over 80% of people with bells palsy naturally make a full recovery. However for the remaining 20% non recovery can often be devastating. Fortunately management of Bells palsy has improved considerably with Physiotherapy now playing a key role.
Symptoms of Bells Palsy
The most common symptoms associated with bells palsy include:
- paralysis of the muscles controlling facial expression (eg smile, surprise, frown, pout and eye closure),
- excessive tearing (crocodile tears),
- dryness of the eye,
- altered taste
- excessive drooling,
- abnormal sensitivity to sound
- altered sensation on the side of the face affected.
Management
Management of this condition consists of both medical intervention and rehabilitation. Oral steroids are recommended to help reduce swelling around the nerve. These should be started as soon as possible preferably within 48hours to be most effective.
Physiotherapy
Physiotherapy begins immediately post palsy to facilitate muscle activity and optimise recovery. A Physiotherapy assessment identifies the degree of injury to the facial nerve, the areas of the face most likely to respond to treatment and facilitates an appropriate treatment strategy. Our intervention will often combine an array of skills from tissue techniques, exercise rehabilitation, taping, oral and eye care to electrical stimulation and will vary depending on the severity of symptoms and speed of recovery. Objective markers are always used to measure change.
Whilst most Bells palsies recover completely unfortunately in some cases weakness can persist. If weakness persist, then there is the possibility of developing synkinesis. This is described as a mass movement or involuntary movement of the facial muscles. For example when attempting to smile the eye may narrow or when closing the eye the mouth pulls up. It usually becomes apparent around the six month post palsy but can occur much earlier. It will develop where there is ongoing facial weakness and can vary from being subtle to quite marked interfering with appropriate facial expression. Physiotherapy intervention can address this symptom.
At the Dublin Physiotherapy Clinic we run a facial rehabilitation clinic providing assessment, treatment and monitoring a person’s recovery from acute onset through the various stages of recovery. We use surface electromyography/ biofeedback to facilitate muscle activity and recovery.
