Facial paralysis can be gradual or sudden. Certainly few conditions are as disquieting as to have disfigurement from full or partial paralysis of the facial muscles on one side or, rarely, on both sides. Facial paralysis can cause or contribute to other physical problems such as the inability to close the eye, which can endanger the eye by increasing susceptibility to infection, or difficulty in tasting or chewing food and liquids, or difficulty in speaking clearly.
Patients may be referred by their physicians or may call for an appointment themselves. It is important to contact the Facial Nerve Center as soon as possible after the onset of the condition. In many cases, treatment begun in the first 24-48 hours makes considerable difference in a positive outcome.
Patients with long-standing paralysis can also be helped by today’s understanding of facial paralysis and its rehabilitation. Patients may refer themselves or be referred by a physician.
FOR APPOINTMENTS CALL 314-362-7509 or 1-800-437-5430. Please state that you have a Facial Paralysis.
J. Gail Neely, M.D.
A prompt diagnosis of facial paralysis is critical to early treatment. Click to read more on diagnosing facial paralysis.
Causes of Facial Paralysis
Facial paralysis has many causes in adults or children. These include bacterial infections (such as severe ear infections) or viral infections.
Bell’s palsy, the most common form of facial paralysis, is caused by a herpes viral infection; however, it is not synonymous with facial paralysis. Bell’s palsy is a very special type of facial paralysis and is diagnosed when other causes of paralysis are excluded.
Current experimental and clinical research suggests that viruses, especially the herpes simplex, type 1, viruses (the type that cause “fever blisters” on the lips) or the herpes zoster virus (the type that causes chicken pox and shingles), may cause facial paralysis. However, it remains unclear exactly how these common viruses cause facial nerve injury.
Experimentally, it seems that cellular immunity may play an important role in the disease.
Other causes of facial paralysis include physical injury or trauma; tumors of the head, neck or cranial nerve; as a result of tumor removal; stroke; medication side-effects; radiation treatment to the nerve; congenital conditions; metabolic disease (such as diabetes); and others.
Medically Managed or Surgically Treated Facial Paralysis
How do I get better after I have been treated?
Surgical reanimation, with nerve grafts, cross-nerve anastomoses, and muscle transfers seem to perform better if the central nervous system is trained to accommodate these new connections. Appropriate fine motor control training may improve outcomes significantly. The details of how this works and scientific support for this concept are still limited.
Fine motor control training may be helpful for patients with partially recovered acute facial paralysis with the abnormal facial movements. It can also be helpful for facial spasms, or contracture (tight muscles on the affected side), and may be helpful in improving voluntary movement.
Botulinum injection to reduce spasm and inappropriate movement may be effective. Combinations of medical, surgical, and rehabilitative techniques may improve the overall outcome in acute and chronic facial paralysis.
Washington University Advantage
The Washington University Facial Nerve Center is a unique regional resource. Only a few centers exist in the United States and none are in the Midwest. The Facial Nerve Center focuses on the diagnosis and interventional treatment of patients with acute or chronic facial paralysis, multi-specialty rehabilitation for patients, and research into the cause and care of patients with these conditions.
The team, led by J. Gail Neely, M.D., otolaryngologist-head and neck surgeon, includes audiologists, physical therapists, occupational therapists, and technicians experienced in facial motion studies. When needed, patients are also treated by specialist consultants in ophthalmology (eye, orbital nerves and related structures), neurology (EMG studies and botulinum injection), reconstructive surgery (muscle and nerve transfer or grafting), psychology (to help with the psycho-social impact of the disorder), and other fields as might be required. In addition, patients may be eligible for clinical trial using new techniques and medications.