Facial Nerve Palsy & Bell’s Palsy
Treatment
The treatment of facial nerve paresis involves 3 steps:
1. Ensure correct diagnosis
2. Supportive treatment whilst awaiting self resolution.
3. Facial rehabilitation for longstanding changes.
Ensure correct diagnosis
This is to rule out a more sinister cause other than Bell’s palsy causing the facial nerve palsy. This will involve careful examination, history taking and sometimes specialised scans of the brain. Because most Bell’s palsy show signs of resolution within 6-8 weeks, any facial nerve palsy which does not show any signs of improvement usually warrants either CT or MRI scans of the brain. Some clinicians feel that the diagnosis of Bell's palsy (where there is no apparent cause) can only be made after all other causes are ruled out first.
Supportive treatment whilst awaiting self resolution
Because most facial nerve palsies are Bell’s palsies, i.e. there is not an obvious cause and self resolution is norm, most patients do not require anything other than supportive treatment only, whilst awaiting for improvement. There are some researchers who believe that Bell’s palsy may be due to viral infection and that some of the long term complications are thought to secondary inflammation from this viral infection. It is because of this that some clinicians may prescribe antiviral medication e.g. acyclovir (Zovirax) and steroid anti-inflammatory tablets (e.g. prednisolone).
It is very important that any patient with a facial nerve palsy be reviewed by an ophthalmologist (preferably with an oculoplastic interest) to assess the risk of development eye surface problems due to the weakness of the blink reflex.
Low Risk Facial Nerve Palsy: Many patients complain of a sore watering eye due to dryness of the cornea from improper wetting. This is either because of failure of the eye to close (lagophthalmos) or a reduction of the normal blink reflex on the affected side. Therefore eye drops and ointments are often helpful and give symptomatic relief.
Moderate Risk Facial Nerve Palsy: in some patients the lagophthalmos (inability to close the eye) may be particularly severe. In these patients, the cornea (clear window of the front of the eye), is at risk of drying out, ulcerating with possible perforation of the eye itself. For patients with these high risk eyes, their doctors may also recommend that in addition to the use of sticky ointments and drops to help lubricate the eye; other techniques may also be required e.g. taping the upper eyelid down to the cheek, sticking a small external lid weight on to the skin of the eyelid to aid closure, wearing cling film to cover the eye at night, wearing moisture goggles at night, botulinum toxin injections to the eyelid (to cause it to droop).
High Risk Facial Nerve Palsy In the small proportion of patients where the facial nerve dysfunction is particularly severe and the eye is starting to suffer despite maximal conservative measures, urgent surgery may be necessary to protect the eye whilst awaiting self improvement.
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