Facial paralysis

What Does Facial Paralysis Mean?
We enable us to make facial movements (lips, cheeks, eyebrows, around the eyes) through the facial nerve (facial nerve).
It allows us to make the movements we want by transmitting the movement orders from the brain to the facial nerve and facial muscles.
provides. If some diseases in the brain or facial nerve block this transmission, facial paralysis occurs and facial nerve
movements are partially or completely lost. Facial paralysis medically as facial paralysis
is named.

Where is the facial nerve?
The fibers that will form the facial nerve come in a mixed manner between the brain and the brain stem. This section is more
It’s about neurology. After the brain stem, the facial nerve follows a convoluted path. Passing through the inner ear canal
around the ear and reaches the facial muscles in several branches towards the back of the ear. One hundred
It passes through the salivary gland in front of the ear before reaching the muscles. Passing through the inner ear canal
coexists with the auditory nerve. It gives some branches along its path, and these branches do various tasks.
The secretion of the lacrimal gland, the secretion of the salivary glands under the chin, and the taste cells of the tongue
It also provides branches of the facial nerve.

What are the Causes of Facial Paralysis?
Facial paralysis occurs in many areas between the brain and the brain stem, or from the brain stem to the facial muscles.
may develop due to disease. The causes of facial paralysis between the brain and the brain stem are usually
bleeding and are examined in the neurology department. Central facial paralysis caused by these reasons
called paralysis. Peripheral facial paralysis is the facial paralysis that occurs in facial nerve diseases after the brain stem.
is called. There are many reasons that can cause peripheral facial paralysis:

– Bell’s Paralysis: It is the most common cause of facial paralysis. The reason is actually not certain. inner ear of facial nerve
Inflammation is thought to occur in a part of the surrounding area. Effectiveness of exposure to cold and wind
There is no finding other than the loss of nerve function. Other neurological findings
diagnosed as absent. Usually heals completely.

– Ramsay-Hunt Syndrome: It is a disease caused by viruses. In addition to findings in Bell’s palsy
There are pain and some lesions in the external ear canal. Complete recovery rate is slightly compared to Bell’s palsy.
less.

– Middle Ear Inflammations: Acute otitis media in children and chronic otitis media in adults
It can reach the facial nerve by melting the surrounding bone or reaching through the existing openings and facial paralysis.
can do.

– Systemic Diseases: Diabetes, hypertension, neuritis (nerve inflammation), vitamin deficiency, etc.
diseases affecting other regions.

– Tumoral Diseases: Tumors in the facial nerve itself or in the areas where it passes along its path
they can do a stroke. These nerves can be benign or malignant. facial nerve, ear before going to muscles
Since it passes through the salivary gland in front of it, these salivary gland tumors can also cause facial paralysis.

– Traumas: Traumas (blows) around the ear or to the face damage the facial nerve and result in facial paralysis

they can.

– Operations: During operations performed for other reasons in the head, ear or salivary gland
facial nerve may be injured.

What Kind of Symptoms Occur?

The most obvious sign of dysfunction of the facial nerve is the decrease or disappearance of facial movements. Eyebrow
movements such as lifting, closing eyes, showing teeth, laughing, puffing cheeks are impaired. Except this
decrease in tears, decrease in salivation, deterioration of the sense of taste, increased sensitivity to noise.
can be found in the findings. Additional findings may be seen depending on the main cause of facial paralysis.

What is seen in the examination?

The first thing to notice on the examination is the inability of the patient to make facial movements. Bell, the most common cause of facial paralysis
There is no other finding in his paralysis. However, there may be additional findings for other causes. Among them, external
lesions in the ear canal, signs of otitis media, and other neurological findings. middle ear infection
If there is no middle ear tumor or a middle ear tumor, the ear examination is normal.

What Kind of Tests Are Done?

For the most common Bell’s palsy, an examination is usually performed if no other disease is suspected on the examination.
not done. However, as the side effects of the drugs given in the treatment can be increased blood pressure and sugar.
blood pressure and fasting blood sugar measurements can be made. General tests that can be done are:

– Fasting blood sugar, blood pressure, cholesterol measurements
– Computed tomography or magnetic resonance imaging if intracranial or salivary gland tumors are suspected
resonance
– Hearing tests
– Testing the amount of tears (schirmer test)
– EMG
– To show nerve conduction velocity or the percentage of nerve disease, called electrophysiological tests
tests that are useful (These tests are applied especially if surgery is considered for treatment).

How is the diagnosis made?

Facial Paralysis is diagnosed by observing that the patient’s facial movements are impaired. However, the important thing is
what the reason is. To investigate this, appropriate examinations are made for the suspected condition and a disease
If found, it will be treated. If there is no finding other than facial paralysis during the first examination, blood
blood sugar and blood pressure measurements are made and treatment is started considering Bell’s palsy. Medication
In cases that do not go away with or recurring, especially such as computed tomography or magnetic resonance
research can be carried out, especially examinations.

How Is It Treated?

The treatment of facial paralysis is also done according to the cause. Treatment of Bell’s palsy is drug therapy. The patient’s other
corticosteroids and vitamin B if disease permits (blood pressure, high blood pressure or stomach problems)
drugs are given. In addition, stomach medications, artificial tears to prevent dry eyes, or
Antibiotic creams are given. Massage on the facial muscles as the conditions that the patient should pay attention to

hot applications, chewing gum to move facial muscles can be counted. Ramsay-
In Hunt syndrome, additional drugs are given against viruses. If another cause of facial paralysis is found

This disease is treated with medication or surgery. These treatments are described in the sections related to that disease.
For example, inner ear tumors or facial paralysis due to chronic middle ear infections require surgery.
While diseases, facial paralysis due to acute otitis media is treated with scratching the eardrum and antibiotics.

Is Surgery Necessary?

Some causes of facial paralysis require surgery. As mentioned above, tumor (intracranial or
in the salivary glands), chronic middle ear infections require surgery. But Bell, which is usually treated with medication
Diseases such as paralysis sometimes require surgery. It is clear when surgery is required.
is not the subject. When deciding this, the degree of response to the drug, the degree of facial paralysis, electrophysiological
The decision is made taking into account the results of the tests and the time elapsed since the beginning. This decision is your doctor.
will be appropriately received.

What Kind of Surgeries Are Performed?

Different surgeries are performed according to the cause of facial paralysis. By opening the skull bones in inner ear tumors
or the tumor is tried to be removed by entering behind the ear. Facial paralysis in some inner ear tumors
Although it is not developed, it may occur after surgery. If there is a tumor originating from the facial nerve, together with the tumor
part of the nerve is removed. The remaining nerve part is tried to be repaired, but sometimes other
It may be necessary to combine the nerves with the facial nerves.

In facial paralysis due to chronic middle ear infections, the inflammation in the middle ear is cleared and the sheath surrounding the facial nerve is removed.
It is opened and the inflammation is cleared. With salivary gland in facial paralysis due to salivary gland tumors
The part of the nerve that is affected by the tumor is also removed. The face in Bell’s palsy or Ramsay-Hunt syndrome
According to the result of drug treatment in paralysis, if surgery is required, the procedure is usually done behind the ear.
It is to reach the nerve by entering and open the sheath around it.

When it is seen that the facial nerve cannot be treated with medication or surgery, some auxiliary surgeries are performed.
These include the transfer of muscles moving with other nerves to the face, transfer of other nerves to the facial nerve.
combination, placing a gold weight on the eyelids and ensuring the closure of the eyes.
surgeries can be done.

Is Physical Therapy Necessary?

The application of physical therapy methods to the facial muscles restores function to the facial nerve.
are not methods. However, especially in long-lasting facial paralysis, facial muscles become weak from inactivity.
and later, even if the facial nerve works, there may be facial asymmetry and loss of strength. Therefore, the patient’s
It is recommended to apply physical therapy other than self-massage and gum chewing.

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