What Is Facial Palsy? Causes, Symptoms and Treatment Process

The cold weather may have affected your body as well, as temperatures suddenly dropped while winter was still arriving. Especially if you go outside without protecting your face during the morning hours when the wind is also a factor, you may be at risk of developing facial palsy.

We spoke with the Ear, Nose and Throat and Head and Neck Surgery specialists at Hisar Hospital Intercontinental about the causes and treatment methods of facial palsy, which is seen more often in winter due to the cold.

What is facial palsy?

There are two nerves on each half of our face that control the movement of the muscles. After these nerves leave the brainstem, they continue inside the temporal bone of the skull and, after exiting the skull, they divide into five branches that control the movement of the muscles of the forehead, eyelid, eyebrow, nasal margin, lip margin and neck. If this nerve is damaged, the control of the muscles here decreases. Accordingly, the muscles begin to become immobile. Muscle immobility may be mild or may be complete immobility. This condition is called facial palsy. We divide facial palsy into two types: central facial palsy, which we call central, and peripheral facial palsy, which we call peripheral. Central facial palsy is facial palsy that occurs due to damage in the brain, and it is accompanied by other findings such as inability to move other parts of the body, brain damage and stroke. The second is peripheral facial palsy, which occurs due to an event affecting the nerve after it leaves the brainstem, affects only that side of the face, and does not cause any findings in other parts of the body. Ear, Nose and Throat diseases deal with peripheral facial palsy, which is more common than central facial palsy.

What are the symptoms of facial palsy?

Usually, when the patient wakes up, there is a difference on one side of the face;

Reduced movement when looking in the mirror

Pulling of the mouth to one side, inability to control saliva

Excessive tearing of the eye or dryness of the eye

Taste changes in the mouth.

Apart from these symptoms, ear pain caused by viral infections along with immobility of the face and accompanying facial palsy may be seen together. The extent of facial palsy is proportional to the amount of damage to the nerve. It can range from a slight closure defect to complete inability to close the eye, inability to move the corner of the mouth, and flattening of the forehead lines. This is complete paralysis.

What are the causes of peripheral facial palsy?

Facial palsy of unknown cause, which appears suddenly, can be seen in all age groups, shows an equal distribution between sexes, and recovers spontaneously in more than 90% of cases, is the most common type of facial palsy. Other causes may include damage to the nerve along its course through the skull base after problems such as head trauma, such as a fracture in the area the nerve passes through. While the nerve continues inside the skull, it passes through a very thin canal within the temporal bone. Swelling of the nerve in this canal, leading to nutritional disturbance, can cause damage and facial palsy. Facial palsy, which is seen less often in children, is more common in young adults and in women in the last three months of pregnancy. In addition, in metabolic diseases such as diabetes, the risk of facial palsy is 4 times higher. The risk of occurrence increases slightly in lipid (fat) disorders and thyroid hormone disorders. In particular, hypothyroidism increases the risk of facial palsy because it increases edema in the body. One of the important factors causing facial palsy is exposure of the face to strong wind or cold. Exposure to cold may cause swelling of the nerve within that bony canal. Apart from cold, metabolic diseases, traumatic causes, and especially viral infections such as cold sores, otitis media (middle ear infection), salivary gland tumors, and swelling of the nerve after some upper respiratory tract infections such as the common cold and influenza can also cause facial palsy.

How is it diagnosed?

The most valuable finding for the diagnosis of a patient presenting with facial palsy is the examination. By looking at the patient's face, we ask them to perform certain facial movements such as closing their eyes, raising their forehead and eyebrows, wrinkling their nose, whistling, and stretching their neck. With these facial movements, we determine the degree of damage on the affected side. Afterwards, we also ask about the patient's general condition, such as age and medications being used.

How is facial palsy treated?

When a patient develops facial palsy, they may feel numbness in the face, drooping, inability to keep saliva in the mouth, tearing or dryness of the eye, and this condition may worsen within 2-3 days. The recovery process varies depending on the rate of nerve damage. The greater the nerve damage, the longer the likelihood of residual problems and the longer the recovery process. In this case, it is beneficial to start treatment within 24-48 hours. First, corticosteroid treatment is applied. Of these cases, about 80% generally recover within 7-10 days; 10% recover within 3-4 weeks. The remaining 10% may continue to have movement restriction problems even after 3 weeks have passed.

If there is complete movement restriction of the facial nerve and no improvement at all, we may benefit from some neurophysiological tests. The first of these is the EMG (electromyography) test. If the degeneration level according to the test is above 95%, we may proceed with surgical decompression of the nerve. Apart from that, facial palsies caused by cold or viral infections recover spontaneously in 90-95% of cases. The average recovery period may last between 3 weeks and 1 year. Nerve fibers regenerate by at most 1-2 mm per day. Generally, nerve damage starts at the end and progresses toward the center. Recovery starts from the center and progresses toward the nerve endings.