Our grateful thanks to Catriona Neville from Facial Therapy Specialists International and Dr Simon Lowe from Facial Palsy UK (links to both charities can be found on our links page) for their contribution to our radio and podcast feature, which you can hear again at the bottom of this page. The information below is provided courtesy of Facial Palsy UK.
What is Facial Palsy ? The term facial palsy generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve.
When a facial nerve is either non-functioning or missing, the muscles in the face do not receive the necessary signals in order to function properly. This results in paralysis of the affected part of the face, which can affect movement of the eye(s) and/or the mouth, as well as other areas.
There are different degrees of facial paralysis: sometimes only the lower half of the face is affected, sometimes one whole side of the face is affected and in some cases both sides of the face are affected.
How do the facial nerves work? Each side of the face has its own facial nerve, so damaging the left facial nerve will only affect the left 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 different ways.
What causes facial palsy? Although the most commonly known cause of facial paralysis is Bell’s palsy, there are actually many different causes of facial palsy, and treatment and prognosis vary greatly depending on the cause. Some of the main causes of facial palsy include:
Classification of facial nerve injuries. There are three different kinds of facial nerve injury:
What functions do the facial muscles perform?
What are the symptoms of facial palsy? Facial palsy normally affects only one side of the face although in rare cases it may affect both sides. It does not cause weakness in your arms or legs. If you experience weakness in your arms or legs as well as weakness on one side of your face, you should seek immediate medical attention. These symptoms grouped together may indicate a stroke.
A complete facial palsy on one side of the face affects the brow, eye, cheek and mouth. This means the facial nerve signals that control movement in these muscles are not working. The face may appear flattened and movement may be lost.
Symptoms may improve or worsen over time depending on the type and degree of facial nerve damage and the cause of your facial palsy.
Some types of facial palsy will affect sensation including pain, as well as facial movement. This may mean that the nerve which is responsible for sensation (trigeminal nerve) has been damaged as well as the facial nerve. The facial nerve controls movement, tear production, saliva production and taste. Loss of sensation may mean you cannot feel your face when you touch it. Inability to blink or close the eye is a common symptom and needs prompt attention from your GP.
If a person develops symptoms of facial palsy slowly (over weeks or months) then they should immediately be referred for further investigations.
Spasms. When the facial nerve is injured, hemifacial spasm can occur. This type of spasm causes muscles on one side of the face to contract; the first symptoms are typically a nerve twitching in the face which gradually increases throughout the muscles in the lower face.
Synkinesis. People with facial palsy may experience synkinesis during the later stages of recovery. It is a medical term that means ‘unwanted movement’, where different parts of the face move together in unexpected ways. For example, an attempt to smile may result in an eye closing at the same time. Affected muscles have to be re-taught when to move and when to stay relaxed, and various facial exercises have to be practised over and over again.
Emotional Issues
Self Esteem. People with facial palsy often experience a reduction in self-esteem. This can be a consequence both of how you feel about yourself, but also how other people react to you. People can experience a sense of loss, especially since appearance and speech are often a large part of peoples’ identity. People often find themselves making comparisons with the appearance of not only other people, but also their own appearance, or what their appearance should have been, prior to the onset of facial palsy. Such comparisons can have a negative impact on our mood.
Building confidence levels and encouraging self-acceptance is important for anyone with facial palsy, empowering them to make friends, strive for the career they want and meet new partners.
Anxiety and depression. People with facial palsy often suffer some level of anxiety or depression, which does not necessarily relate to the degree of facial paralysis. One way that people cope with feeling anxious is to become socially withdrawn. In the short term this can help them to feel less anxious, but in the longer term this can lead to them feeling isolated. Feeling unable to relax and laugh without being stared at makes a huge impact on people’s lives. People with a facial difference have to work hard to maintain confidence levels often having a fear of new situations and meeting new people. Different psychotherapies such as cognitive behavioural therapy can help.
Stigma. As children grow older, feelings of difference can be more challenging and as their peers become more aware of difference (normally around the age of 6-8 years of age), children with facial palsy may experience more stigmatising behaviour. Adults may experience stigmatising behaviours, such as unkind comments at work, or exclusion from certain situations. Children should never feel like they need to cope on their own. It is important to educate others about facial palsy and to ensure children and adults receive relevant support, so they learn to express themselves confidently and openly.
Connecting with Others. Smiling is key to how people communicate and build relationships and can be a universal greeting that people recognise all over the world, no matter where you come from, or what language you speak.
Living with facial palsy can impact our social interactions in a number of ways. In certain cases, for example where facial paralysis affects both sides of the face, such as Moebius syndrome, it is not possible to demonstrate emotions through facial expression. Difficulties with showing emotion can make it more challenging to form new relationships.
A facial difference is something very public and can leave people permanently on their guard when it comes to showing emotion, whether it be smiling, laughing or crying. If people feel self-conscious of their facial palsy they sometimes change the way they socialise, trying to hide their smile, reduce eye contact or avoid drawing attention to their face by angling their body away. However these can have an impact on the quality of our social interaction and the ease in which conversations occur. It can make a person appear unfriendly or uninterested in the conversation and this in turn, makes it harder to make new friends.
However many people with facial paralysis learn to communicate in alternative ways, such as through direct eye contact, through speech and by being more demonstrative (e.g. through gestures and non-verbal communication). Once family or friends know the person well, they will still be able to pick up on their emotional cues.
Today’s world of social media places even more pressure on people with a facial difference; photographs have become a large part of our lives, particularly for the younger generation. A night out with friends might be spoilt by the worry of the photos that may appear later on the internet. Trying to find the right balance between looking like you are having fun, and at the same time trying to hide your facial palsy, means that people often do not fully relax in social situations.
Listen to this weeks radio report
All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.
