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You perform your functions such as transferring your expressions to the other side in the face area, closing your eyes tightly and ensuring your lip movements while speaking using some of the muscles in our face. The movements you can control on this face are generally called mimic movements. To make your gestures in the face area:
*The region in your brain that controls mimic movements
*The nerve that leads to the muscles in your face (fascial nerve) and your mimic muscles in your face
Facial paralysis occurs if any of these structures do not work correctly.
It is the type of facial paralysis that occurs in congenital or subsequent losses due to a disease in the brain. If this condition is unilateral and the other side is functioning properly, paralysis occurs in the parts of the paralyzed side under the forehead area.
It occurs when the Facial Nerve, which carries the warnings of the facial muscles, does not work correctly due to a disease inside or outside the skull after exiting the brain tissue. In peripheral type facial paralysis, if the other side is intact, half the face is completely inoperable.
*Mimic movements such as raising eyebrows, frowning, squinting of the eyelids, lip shrinking, showing teeth and smiling cannot be performed on the affected side. Forehead wrinkles and other forehead movements cannot be performed.
*The eyelid cannot be closed on the affected side. When you’re sleeping, that side of the eyelid stays open. During eyelid closure, the upward shift of the eyeball can be observed.
*The cheek area on the affected side cannot be inflated. When eating, food in the mouth can go out.
*On the affected side hangs the corner of the mouth, the smile cannot be done enough. In some cases, loss of taste, sensitivity to loud noises can be observed.
Tumors (masses) or deterioration of the bloodstream (brain infarctions) that cause damage to the relevant area of the brain – Bell’s palsy: It is a disease for which the exact cause is unknown. When the cause of the disease is investigated, a cause cannot be found. It is the cause of 80% of acute peripheral facial paralysis. One in 64 people has a risk of being seen. Pregnant women who have previously had this complaint in their family are more at risk. – Ramsey Hunt syndrome (Herpes zoster otikus) : It occurs as a result of a viral infection of the facial nerve. It is characterized by facial paralysis, ear pain, hearing loss, skin vesicles, vertigo (dizziness). – Trauma: Temporal bone fractures, blunt or incisive fascial nerve fractures, inoperative fascial nerve damage are examples of these. – Acute-chronic middle ear inflammations – Neurosarcoidosis -Moebius syndrome : It is a condition in which there are no congenital facial nerves. In addition to both sides of facial paralysis, there may also be eye movement problems and hearing problems. The exact cause is unknown. -Tumors : Facial neuroma, hemangiomas, parotis (salivary) gland tumors, acoustic neuromes and metastatic tumors are the most common facial paralysis tumors. -Other (AIDS, autoimmune, Kawasaki disease, Guillain-Barre syndrome, birth trauma…)
What is bell’s palsy treatment like?
*It is the most common type of facial paralysis.
*85% of patients make a full recovery.
*10% of patients have a partial recovery. Sinkinesis (unwanted and unexpected facial movements) and partial facial muscle weakness are observed.
*In 5% of patients, permanent facial paralysis is observed.
*If other causes of facial paralysis are ruled out, treatment should be started with Bell’s paralysis in mind. Antiviral drug therapy (Asiklovir, Famsiklovir), high dose steroid (prednison) treatment is started. If severe facial paralysis is present, EMG, CT and MRI examinations should be performed. Eye drops should be used to protect against corneal ulcers.
Surgical methods are divided into two areas as static and dynamic reanimation methods. Static methods do not restore movement in the face, rather, it is tried to correct the posions of the sagging parts due to facial paralysis, thus providing a more natural appearance at least during rest on the face. Dynamic methods are applied to restore some important transactions. Static Reanimation Methods: Static Reanimation methods, as the name suggests, cover fixed repair methods that do not provide movement. They are used to correct sagging or deformities that occur over time on the paralyzed side of the face. They are methods that can be used in patients who do not want dynamic methods or where it is not appropriate to apply dynamic methods. Placement of gold in the eyelid: Patients with fascial paralysis have trouble closing their eyes, as mentioned before. In order to ensure that the eyelid can be closed thanks to gravity, a gold weight of appropriate weight is placed inside the upper eyelid. A patient with facial paralysis can open his eyes. In cases where it does not try to open its eye, it will be able to close the eyelid due to gravity effect thanks to this placed weight. Closing the eyelid is necessary to prevent the eye from drying out and to prevent keratitis from developing. Tarsoraphy: It is a method aimed at preventing the eyelids from being opened by partially sewn together in patients with short-term fascial paralysis. Face lift surgery: Face lift surgery can be performed in order to recover skin and soft tissue sagging on the paralyzed side. In this way, at least during rest, a more symmetrical and non-disturbing appearance is tried to be obtained. Lower Eyelid Correction: Patients with facial paralysis will also have sagging and looseness in the lower eyelids over time. In order to correct these problems, hanging or shortening of the lower eyelids will correct this problem. Static Suspension Methods: It is applied to prevent the flow of liquids by correcting sagging in the corner of the mouth. It is usually the process of hanging the edge of the mouth side sideways and up from several points with the help of the patient’s own tissues.
The mimic muscles in our face continue to maintain their capacity for an average of 2 years after nerve stimulation is eliminated. If they can be stimulated by a nerve again during this time, they can regain their function. However, since this healing process will require about 1 year, it is ideal to perform the surgery for this purpose within 1 year at the latest after injury. In cases where the Facial Nerve is severed as a result of an injury or surgery, “Direct Nerve Repair” should be performed at the earliest possible period. If facial paralysis is caused by a disorder of the brain, the facial nerve will not function. In such a case or if it is not possible to repair after damage to the nerve, it is necessary to ensure that the muscles in the face continue to be stimulated by another nerve. These surgeries are called “Nerve Transfer”. Nerve transfer can be done by using another movement nerve from the paralyzed side of the face or in the form of a solid “Nerve Bridge from the Facial Nerve” on the opposite side of the face. When a nerve is used from the same side of the face, the function of the nerve used disappears. For example, if the nerve leading to a chewing muscle is used, there will be weakness in the chewing function, but despite the weakness, the chewing will not be completely disturbed, since the chewing work is done by many muscles. In order to bridge the fascial nerve on the other side of the face, a long nerve that is not related to movement (related to touch) is taken from another part of the body and a connection is created that will allow transmission from the strong nerve to the other side of the face. If this bridge is successful, movement on the paralyzed side of the face can be achieved at the same time as the movement on the solid side of the face. The advantage of providing simultaneous movement with this method is only the disadvantage of needing two surgeries and approximately twice the recovery time. Since the capacity of the mimic muscles will disappear 2 years after injury, it is necessary to use other muscles that will function in the face area instead of these muscles. “Muscle Transfer” surgeries are the names given to this method.
Muscle transfers can also be achieved by performing some chewing muscles in the head area or “Free Muscle Transfer” from the remote area. Free muscle transfer is carried out using microsurgery methods. When free muscle transfer is applied, nerve transfer surgery that will make these muscles work should also be performed at the same time or before this surgery. As you and your patients’ relatives will understand, understanding, explaining and applying dynamic methods are somewhat complicated methods. Therefore, it will be healthier to meet with your doctor face-to-face so that you can more easily find out which method will suit you and the details of the surgeries.
