Facial Paralysis

Facial paralysis produces an inability to contract the muscles of the affected half of the face. The inability to close the eye completely brings with it the danger of corneal desiccation, keratitis or ulcers, and even infections that can permanently affect vision. Oculoplastic techniques can improve the closure of the affected eye.

WHAT ARE THE CAUSES OF FACIAL PARALYSIS?

The most frequent paralysis, Bell’s palsy, is believed to be viral in origin. In most cases, there is a complete recovery. Other causes of facial paralysis for which recovery may not occur are brain tumor surgery and trauma or blows. There are a wide variety of treatment options depending on the different cases, which range from the use of lubricating ointments and drops to corrective surgery. Lubricating ointments and drops – Gold weight implantation – Eyebrow surgery – Surgery for facial asymmetries.

LUBRICATING OINTMENTS AND DROPS

Lubricating ointments and drops are used in those patients who are expected to recover quickly from their paralysis. The eye may be occluded at night to sleep, or a so-called “moisture chamber” may be used. This is a device that maintains corneal moisture even when the eye does not close completely. Affected people who do not recover function of the facial nerve have the possibility of resorting to different procedures aimed at improving their condition. One of the most common ones is the implantation of a gold weight in the upper eyelid. This relies on the fact that the eyelid has a muscle that opens it and another one that closes it. These muscles have different nerves that govern them, and in facial paralysis only the closing but not the opening of the eyelid is affected. In the examination prior to surgery, a test weight is attached to the skin of the eyelid, to determine what weight is appropriate for each patient, so that they can open their eye normally and close it with the help of the weight. The eye does not always close completely after surgery, but the improvement obtained is highly significant for corneal health and vision. This operation is performed under local anesthesia on an outpatient basis and is usually combined with an adjustment of the lower eyelid, which sometimes has descended due to the same problem. We have published a scientific paper in the journal Archivos de Oftalmología de Buenos Aires, where we evaluated the outcome of weight implantation in 34 patients. The procedure was successful in 97 % of patients. Facial paralysis can produce a lowering of the eyebrow that sometimes hinders vision, which can be corrected through eyebrow elevation surgery. Finally, in those people who experience difficulty drinking or speaking due to the drooping of the angle of the mouth, they might benefit from suspending that angle, elevating it to a more symmetrical and comfortable position.

What happens if, after a weight is implanted, there is a recovery of the facial nerve function?

In these cases, the weight can be removed easily, with no consequences affecting eyelid function. This is why it is not advisable to wait too long after the onset of paralysis to implant the weight, since, comparing risks and benefits, it is much less risky to have to remove a weight than to face the risk of corneal lesion. Corneal lesions in patients with facial palsy have a poor prognosis, because if a scar is produced that affects vision, a corneal transplant may be required, and the prognosis of such procedure is guarded when the eye closes incompletely.

Can the weight be infected or rejected?

Like all foreign material, the weight can become infected. The risk is 3 %. To keep this risk as low as possible, antibiotics are used during and after the operation. An allergy to gold can also occur, but this is extremely rare. Platinum weights are available for such cases.

Is the weight placed on the eyelid visible?

The weights used for this purpose are specially designed to adapt to the shape of the eyelid. However a subtle elevation of the skin in the area of the weight can be seen when the eye is closed.