Facial paralysis;
In the past, this condition was known among the public as “possession of a demon” and witches were consulted. Later, with the development of the health system and the awareness that the condition was organic, more and more facial paralysis cases were referred to neurologists and physical therapists. The outcome of the treatment in peripheral facial paralysis is not definite and is not known in advance. However, successful results are achieved with appropriate treatment. It is seen in 23/100,000. The female-male ratio is approximately equal. However, the rate increases in women in the third half of pregnancy and the postpartum period. It is especially common between the ages of 20-40.
Etiology:
The facial nerve can become diseased for various reasons.
- Traumatic: Petrological fractures, mastoidectomy, parotid and cranial surgeries.
- Tumoral: Pons or pontocerebellar angle tumors, fallopian tube or carotid tumors.
- Inflammatory: Otitis media, mastoiditis, herpes zoster, leprosy, etc. Viral infection is accepted as the cause of inflammation. (Herpes Simplex virus)
Other diseases that facial paralysis can occur with include hypertension, diabetes and multiple sclerosis. Despite all these listed causes, the etiology of facial paralysis is often undetermined. The most common form is peripheral facial paralysis. The nerve is usually compressed due to inflammation and edema in the stylomastoid foramen, which is the exit point of the nerve, due to cold.
Clinical Features:
It is characterized by the inability to close the eyelid on one side and to wrinkle the forehead, and the mouth deviating towards the healthy side. In addition, there is pain behind the ear, increased tearing and stinging in the eye that cannot be closed. A decrease in the sense of taste in the anterior 2/3 of the tongue and dryness in the mouth may also be seen.
80% of cases recover within 3-6 weeks. Recovery may be delayed in diabetics and the elderly, and sequelae may persist.
Treatment:
- Drug Treatment: Acetyl salicylic acid and non-steroidal anti-inflammatory drugs are used to reduce pain and inflammation. Steroids are given at 60-80 mg/day for the first ten days. Vitamin B and ophthalmic ointment are recommended to protect the eyes.
- Physical Therapy and Rehabilitation:
- Protecting the patient from cold
- Massaging the facial muscles in a direction against gravity
- Chewing exercises
- Mirror and awareness training with face tapping exercises
- EMG Biofeedback (on the parolitic side, training of additional muscle groups)
- Surgical Treatment: In cases where no improvement is seen within 4-6 months, nerve decompression and nerve anastomoses in the facial canal may be considered.