Advanced Expertise in the Diagnosis and Treatment of Facial Paralysis

• Antivirals. When facial nerve paralysis is caused by a virus, the symptoms are usually due to inflammation and swelling which can restrict blood flow to the facial nerve. Oral antiviral medications stop the virus from multiplying and spreading, relieve the inflammation and restore normal blood flow - allowing the nerve to heal and return to normal function.
• Corticosteroids. Steroid medications may be prescribed to reduce inflammation and swelling around the facial nerve. Usually they are taken orally for 10 to 14 days although in some cases a more aggressive approach to treatment may be required. For example, if your doctor suspects that your symptoms are causes by the herpes zoster virus (shingles), a stronger dose delivered intravenously may be the first step, followed by a course of oral medication for 7 – 10 days.
• Analgesics. If there is pain associated with your facial nerve inflammation, your doctor will recommend the appropriate pain medication(s) as part of your total treatment plan.
• Eye Drops. When facial nerve dysfunction affects the ability to blink and/or fully close the eyelid, keeping the eye lubricated is an essential part of treatment. In addition to using eye drops frequently throughout the day, your doctor may recommend the use of a lubricating gel at night, with the eye taped shut.

They may be used separately or together to enhance facial movement, function and cosmetic appearance.

• Botulinum toxin or Botox^® has been used for many years to relieve facial tightness and improve facial symmetry by weakening or paralyzing certain muscles in the face. It is most commonly used to treat tightness around the eyebrow, mouth, cheek and neck or to improve facial symmetry by weakening the muscles of the non-paralyzed side of the face. The effect is temporary, lasting approximately 3 – 6 months but can be repeated every 4 – 6 months if the results are beneficial to the patient.
• Facial fillers are used to add volume and restore symmetry to areas of the face affected by muscle atrophy. They can also be used to treat certain functional problems – for example, injecting filler around the lip can help resolve recurrent lip biting or drooling and improve certain speech problems. Facial filler treatments are typically done in the doctor’s office with local anesthesia and may last up to 18 months or more.

At University Hospitals, our team of physical, occupational and speech therapists carefully evaluates each patient and develops a personalized plan of care based on their diagnosis, prognosis and the severity of their condition. The goals of therapy are to:

• Stimulate, strengthen and retrain the facial nerve and supporting muscles to improve facial coordination
• Improve facial symmetry
• Regain or refine facial movements for specific functions such as speaking, eating and closing the eye
• Restore the ability to smile, frown and other facial expressions
• Correct abnormal patterns of facial movement

These goals are achieved through a series of special exercises designed to retrain the brain to coordinate the facial muscles more effectively. Our therapists take the time to teach each patient how to do the exercises properly and how often to do them for the best possible outcome.

Although often considered cosmetic, these surgical procedures have been shown to help relieve symptoms and improve function in certain patients with facial paralysis. These procedures include:

• Facelift
• Forehead/brow lift
• Eyelid surgery (blepharoplasty)
• Rhinoplasty