Facial paralysis, or the loss of muscle tone on one half of the face, has significant functional, aesthetic, and emotional consequences. To address this, there are many treatments to improve eating, breathing, eye protection, and symmetry of the face. Improvement of the function and appearance of the face can have a profound impact on the patient’s psyche. If you have facial paralysis, Dr. Kulbersh will work hard to improve your quality of life.
Facial paralysis is a very complicated condition and should only be treated by an expert. Doctors who do not have extensive knowledge in facial paralysis can misdiagnose the cause of the paralysis, which may be detrimental to a patient. Dr. Kulbersh was trained under one of the country’s premiere facial paralysis surgeons, has a distinctive insight into facial nerve function and facial aesthetics, and has authored numerous book chapters on the subject. This knowledge provides his patients with customized facial paralysis treatment options.
Treating Synkinesis with Botox
What is Facial Paralysis?
Facial paralysis is a condition where the facial muscles become paralyzed. This occurs when the nerve controlling the facial muscles is injured or sustains other nerve damage. This can be secondary to Bell’s palsy, tumor, trauma, infections, or other disease processes. We have two facial nerves and one of them is more commonly affected. This will result in paralysis on half of the face. A patient with facial paralysis will be unable to move some or all of the muscles on the affected side of their face.
Not only does facial paralysis inflict aesthetic challenges such as an asymmetrical face, it also causes functional disabilities, making chewing, swallowing, breathing and speaking difficult.
What is Bell’s Palsy?
The most common form of facial paralysis is Bell’s Palsy, which is caused by inflammation of the facial nerve. This inflammation causes the nerve to swell and prevents the nerve from passing signals between the brain and the facial muscles. The exact cause of the inflammation is not known, but most people believe it is from a virus.
The onset of Bell’s palsy is very abrupt and reaches its peak within 48 hours. Many patients report that their face suddenly feels stiff or pulled to one side. If you think you are experiencing Bell’s Palsy symptoms, seek medical attention immediately, preferably from a facial paralysis expert!
The prognosis from Bell’s palsy is relatively good. 85% of patients suffering from Bell’s palsy will completely recover without any signs of facial asymmetry, 10% of patients will have an incomplete recovery with lingering facial weakness, and 5% of patients will have complete facial paralysis or significant synkinesis.
What is Synkinesis?
Patients who have had facial paralysis may develop synkinesis, which is the loss of the ability to control the individual muscles of the face. This results in muscles contracting in unwanted areas. For example, when a patient smiles, the muscles around the eye contract, causing the eye to narrow. Synkinesis develops during the healing phase of the damaged nerve, when the nerve regrows into the wrong areas of the face.
What Causes Facial Paralysis?
Since the facial nerve is long, there are numerous facial paralysis causes. Determining the cause of a patient’s paralysis is vital so that Dr. Kulbersh can treat the paralysis correctly. The various causes of facial paralysis include:
- Genetic disorder
- Complication from surgery
- Bell’s palsy
- Traumatic accident
- Infection with herpes simplex or herpes zoster (shingles) virus
- Tick bite – Lyme disease
- Stroke and other central nervous system disorders
- Systemic disease
- Other infections
- Miscellaneous causes
What are the Symptoms of Facial Paralysis?
Facial paralysis usually develops very abruptly. The face will look asymmetrical because only one side is paralyzed. The side that is paralyzed will drop and will not be able to display any expressions. Other common symptoms of face paralysis are:
- Depression of brows
- Inability to close the eyelids
- Decreased tear production
- Corneal damage
- Paralysis of the lower eyelid
- Mid-face drooping
- Nasal airway obstruction
- Effacement of the nasolabial folds (laugh lines)
- Inability to smile
- Oral incompetence and drooling
- Lower lip deficit
It is important to identify facial paralysis and Bell’s palsy as soon as possible and start paralysis treatment early. The most important treatment of a recently diagnosed facial paralysis is protecting the eye. When the face becomes paralyzed, the eye can become dry and this may cause a corneal ulcer. This can ultimately lead to blindness if the eye is not kept moisturized.
How is Facial Paralysis Treated?
Treatment for facial paralysis depends on multiple factors:
- Cause of the facial paralysis
- Patient goals
- General health of the patient
- Age of the patient
Generally speaking there are non-surgical treatments and surgical treatment options for facial paralysis.
Facial paralysis treatments and surgery are very complex and must be performed by a facial paralysis expert like Dr. Kulbersh. His primary goals for paralysis treatments are the restoration and reconstruction of facial movement, improvement of facial appearance and the prevention of unwanted eye complications.
Non-Surgical Facial Paralysis Treatments
Botox and Dysport are one of the most effective treatments for patients with facial nerve synkinesis. Botox is a muscle relaxer that is used to selectively prohibit movement of certain muscles and provide improved facial symmetry. It also reduces tense pulling sensations that many patients experience on the side of the face and neck.
Fillers can be used to achieve a more symmetrical facial appearance for patients with facial paralysis. Dermal fillers, like Juvéderm and Restylane, add volume to facial folds to improve facial symmetry.
Physical Therapy is central in the treatment of patient with facial paralysis and synkinesis. Retraining the face muscles can dramatically improve the patient’s ability to function normally. It is also important to undergo physical therapy of the facial muscles after surgery for the treatment of facial paralysis.
Surgical Treatments For Facial Paralysis
Static procedures offer a great treatment option for facial paralysis patients. To address issues associated with the lower third of the face, including facial asymmetry and oral incompetence, Dr. Kulbersh utilizes static suspension, or static sling. This is a surgical facial paralysis treatment that is used to create facial symmetry and improve some of the most disabling side-effects of paralysis, like drooling and biting of the inner gums. Dr. Kulbersh may use a suture, Alloderm or tissue harvested from the patient’s thighs (tensor fascia lata) to support and create a laugh line. This improves the symmetry of the lips, corners of the mouth, laugh lines and also oral competence.
To address eye-related issues, Dr. Kulbersh can use gold weight inserts in the upper lids. This procedure will help a patient who cannot completely close their eye as a result of the paralysis. Dr. Kulbersh will make an incision in the upper eyelid crease and insert a gold weight into the muscle.
The lower lid may droop, causing functional and aesthetic concerns. While in Beverly Hills, Dr. Kulbersh mastered this new minimally invasive technique that is used to support or raise the lower lid.
Temporalis Transfer is used to improve a patient’s voluntary facial movement. The temporalis muscle is one of the muscles we use to chew our food. Transferring the temporalis muscle from the scalp to the corner of the mouth restores the patient’s ability to chew and make other natural facial movements. This surgery has a very strong track record for improving facial movement.
Temporalis transfer is generally used for patients over 55 who have had facial paralysis for a long time, but are not good candidates for more advanced facial paralysis treatments.
Hypoglossal-Facial Nerve Jump Graft uses the nerve that moves your tongue to innervate the muscles of the face. This can give patients facial movement and also prevents atrophy of the paralyzed muscles in the face. This gives tone to the face and prevents the sagging that would occur with a loss of tone.
Gracilis Free Flap Transfer is used for dynamic reanimation of the face. The gracilis muscle is located in the inner thigh and is a great muscle for facial paralysis treatments. The gracilis muscle is transplanted to the face along with the nerve, artery and vein. The nerve, artery and vein in the face are connected to the corresponding components of the gracilis muscle. When the patient smiles on the non-paralyzed side, the implanted gracilis muscle on the paralyzed side will be activated and the patient will be able to smile. This procedure takes multiple surgical procedures and typically occurs over two years.
Gracilis free flap transfer is best utilized for younger patients with long-term paralysis. Recovery from this procedure can be long and difficult, though the benefits of the results far outweigh the drawbacks of recovery.
Facial Paralysis Frequently Asked Questions
Q: What is the difference between Bell’s palsy and facial paralysis?
A: Facial paralysis is the general term given to patients who lose the ability to move one side of their face. Bell’s palsy is a specific subset of patients who have facial paralysis.
Q: How is facial paralysis diagnosed?
A: Dr. Kulbersh will perform a thorough examination of the patient to determine the cause of the facial paralysis or Bell’s palsy. He will ask you questions about your paralysis symptoms, and may also give you a physical and neurological exam to check the facial nerve functions.
Q: Who is affected by Bell’s palsy?
A: Anyone can suffer from Bell’s palsy, though it tends to be more common in pregnant women and people with a family history of Bell’s palsy.
If you or someone you know is suffering from facial paralysis, please schedule a consultation with Charlotte facial paralysis expert Dr. Kulbersh.
Read more about Bell’s Palsy at medlineplus.gov before your next appointment.
Next, learn about Botox Treatment of Bell’s Palsy.