Treatment of Facial Paralysis
The goals of treatment are to improve the nervous system's ability to send signals to the facial muscles and restore facial functionality. Patients must be fully informed about the expectations for improvement and any possible remaining sequelae, as these depend on the type of injury and its prognosis. When there is an injury to the facial nerve, no treatment method can fully restore its functionality.
Drug treatment
Corticosteroids. These are anti-inflammatory medications that are most effective when taken within a few days of the onset of symptoms.
Antivirals. Currently, isolated antiviral therapy is not recommended, except in patients with Ramsay-Hunt syndrome or lesions caused by herpes.
Other additional treatments: vitamins B1, B2, B6, B12 isolated or in combination with steroids.
Rehabilitation treatment
Neuromuscular re-education. This is personalised treatment aimed at improving motor control, movement and facial functionality. The patient must remember that improvement depends on the type of injury and its prognosis, so the patient may not recover full functionality of the facial nerve.
The rehabilitation programme consists of facial neuromuscular re-education. Rehabilitation consists of several sessions at the hospital, including facial movement, stretching and mirror exercises. This treatment uses sensory proprioceptive information to improve learning (Biofeedback). That is, it provides real-time information about how the body is functioning to be able to learn to control it better. For example, when patients use a biofeedback device to improve their smile, they monitor the electrical activity of the facial muscles which shows how these muscles are responding in real time when they try to smile. Using this information, the patient learns to activate the muscles more effectively to achieve a more symmetrical and natural smile.
The patient also has to carry out home treatment for at least 30 minutes a day.
During follow-up, the treatment is changed according to the patient's progress.
Botulinum toxin. This drug is obtained from the bacteria clostridium botulinum. Treatment involves injecting botulinum toxin with an insulin needle or intramuscularly in small amounts into the affected facial muscles to decrease muscle tension and reduce pain. The effects usually occur 24-72 hours after infiltration and usually last 3-6 months.
Surgery
Surgical treatment for paralysis is uncommon, as the first line of treatment is rehabilitation.
This treatment is indicated when the affected nerve can be repaired or a new electrical impulse can be provided to the damaged nerve from other nerves in the craniofacial region.
Additionally, surgery can be used to improve the position and movement of some facial muscles. Tension threads or gold weight implants are also used to raise the eyelid or eyebrow of an affected eye.
Surgery can also improve poor eye closure when there is corneal damage, which in turn also helps decrease facial asymmetry.
Since there are numerous surgical techniques, recovery depends on the treatment given.
Postoperative pain is controlled with painkillers and the inflammation tends to subside 2–3 weeks after the operation.
Substantiated information by:
Published: 11 June 2024
Updated: 11 June 2024
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