Facial Nerve Palsy
Facial Nerve Palsy/Facial Nerve Paralysis
The facial nerve controls movements of the face. There is a right facial nerve for the right side of the face and a left facial nerve for the left side of the face. Peripheral facial nerve palsy causes a facial droop on the affected side. This manifests as a drooping eyebrow, inability to close the eye, and sagging of the lower face with inability to smile. Due to the lower facial weakness, patients may also drool and have difficulty controlling food within the mouth on the affected side.
Causes of facial nerve palsy include infection (Herpes Zoster), stroke, trauma, tumors, neurological disease (demyelinating disease), inflammatory disease (sarcoidosis, orofacial granulomatosis), and idiopathic or an unknown cause which is referred to as Bell's palsy.
A drooping eyebrow may impair peripheral vision. Weakness of the eyelid closing muscles results in impaired ability to close the eye. In many cases the lower eyelid either rests too low (lower eyelid retraction) or is turned away from the eye (paralytic ectropion). These conditions can cause dryness, a gritty sensation, tearing, and blurry vision. Ocular lubrication with artificial tears and ointments typically helps with these symptoms. For patients with corneal exposure that does not respond to medical treatment, Dr. Mettu offers temporizing treatments that can be performed if improvement in facial nerve function is expected. These treatments include a tarsorrhaphy in which the eyelids are either partially or completely closed to protect the eye. A tarsorrhaphy can be performed with either sutures or with Botulinum.
For patients in which further recovery is not anticipated, Dr. Mettu offers more definitive facial reanimation procedures. These surgeries include brow lift, mid facelift, ectropion repair, lower lid retraction repair, and gold weight placement (or platinum chain placement) in the upper eyelid which improves blinking ability.
Aberrant Regeneration of the Facial Nerve
Aberrant regeneration of the facial nerve is a miswiring of the nerve as it recovers after facial nerve palsy from various causes including Bell's palsy. Patients who have aberrant regeneration of the facial nerve may have unwanted movements of the face. For example, with a blink, the lower face on the same side may move. Another example is a patient who has tearing when eating (gustatory tearing also known as crocodile tears). Botulinum injections can be given to decrease tone in affected muscles. Additionally, Botulinum can be injected directly into the lacrimal gland for patients with gustatory tearing.
