facial palsy physical therapy

 Introduction:

Facial paralysis or bells palsy is also called 7th cranial nerve ( facial nerve) is caused by injury. In this the face becomes crooked, the eyes doesn't close completely, mouth doesn't open completely, the cheeks do not enlarge, Dribbling of saliva on one side, slurred speech. All these symptoms are seen in facial palsy.

It is estimated that around 30,000 to 40,000  Americans suffer from facial palsy every year, with the age between 20 to 40 years. 

 

How does the facial nerves work? 

  There are 12 pairs of cranial nerves in our head, each side of the face has its own facial nerve. So damaging the right facing nerve will only affect right side of the face and vice versa. Each nerve starts at the brain and enters the face to the front of the ear where it then divides into five separate branches. These branches supply the muscles which are used for facial expression. Tears, saliva production and taste are also controlled by the facial nerve in many different ways. 

 Causes:

1. Hypertension or simply called high BP is one of the main reasons of bells palsy.

2. Diabetes

3. Brain infection like Meningitis, Encephalitis, Brain Tumor, haemorrage, can also cause paralysis.

4. If dengue or bone fever increases, facial paralysis may occur.

Classification of facial nerve injuries

There are three different kinds of facial nerve injury: 

1. Mild- when the facial nerve is just concussed or bruised and recovers within 6 to 8 weeks

2. Moderate- in this the patient nerve is more severely damaged but still retains its outer layer. The nerve begins to show the first science of recovery at about 12 weeks as it slowly repairs itself at the rate of around 1 mm per day.

3. Severe- in this the facial nerve is more severely damaged and recovery is much slower and always incomplete. sometimes in the nerve is completely severed and surgical repair is needed to restore facial function.

Related article - how do you know when you need physical therapy ?

Physical therapy Examination:

• Ask the patient to open and close both eyes 
• Smile with showing all teeth
• To blow the cheeks
• Raise both the eyebrows
• Ask to open and close the mouth
• Lost facial expression
• Forehead wrinkling                                                                                                                                                                       Treatment:

Use pills to control blood pressure and diabetes but Physical therapy 

 is the best treatment for Facial Palsy. A Physical therapist examine

 and evaluates the condition and treats accordingly with

 facial stimulation ( Electrotherapy ) and some Facial Exercises

 for Bell's palsy condition. Within no time, the puffiness of the face

 gets completely cured, regular Physical therapy session gives 100%

 result. Later on Exercises are taught by therapists by

 which Paralysis doesn't repeat anymore.

Gentle massage of the facial muscles can also be performed and taught by physical therapist to the patient, so that he/she can repeat and perform the exercises at home several times a day. The aim of facial massage is to reduce muscle spasm and increase flexibility to regain normal muscle tone of facial muscles.

Related article - myofascial-pain-release

Performing home exercises in front of a mirror provides a visual feedback for the person to do it correctly and can see the progression day by day. 

Is Facial Physical Therapy Safe ? 

Yes physical therapy is a safer option for facial palsy treatment, there are no side effects of this treatment and it is a better option as compared to any other form of treatment. Facial paralysis patient recovery differs from each other regarding time taken for recovery, but Sooner or later every patient gains 100% recovery from bells palsy. 

➤ Home exercise such as blowing a balloon stimulates the muscles of cheeks and helps in regaining the normal muscle tone

 ➤ Also chewing a gum constantly provide movement at the temporal mandibular ( jaw )  joint which influences surrounding muscles. 

 ➤ Taping the eyes closed at night ensure the prevention of corneal ulceration.

      Complications of bells palsy

Usually it is seen that a mild case of bells palsy typically disappears within a month also but recovery from a more sewer case in which the face was completely paralyzed can very according to time. Some complications may include: 

•  Irreversible damaged to facial nerve.

•  Irregular regrowth of nerve fibers which result in involuntary contraction of certain muscles when your trying to move other muscles. For example, when you laugh or smile the eye on the affected side may close.

•  Partial or complete blindness of the eye that won't close. This is caused by excessive dryness and scratching of the clear protective covering of the eye that is cornea.

    Prevention of bell's palsy

Unfortunately there is nothing you can do to prevent bell's palsy. It's linked to certain viral infections, but not everyone who has those viral infections developed Bell's palsy. 

If you have risk factors for the condition, like diabetes, obesity or high blood pressure, managing them well me help reduce your risk.                                                 

Surgery for facial paralysis

Facial nerve decompression is an option in cases of virally induced facial nerve palsy and also bell's palsy, however this has not shown significantly positive outcomes compared to conventional physical therapy treatment. 

Conclusion

In condition like facial palsy or bell's palsy physical therapy treatment should be the first line of treatment as compared to any other form of medical management. You should go first to a physical therapist for its treatment  rather than anything else.