About facial palsy

Facial palsy can be caused by a variety of factors that affect the facial nerve or the brain regions that transmit signals to the facial nerve. Some of the common causes include:

1. Bell's Palsy

• This is the most common cause of sudden facial weakness or paralysis.  It is thought to account for around 60-75% of cases of facial palsy.  Bell’s palsy is believed to be linked to viral infections, such as the herpes simplex virus (which causes cold sores). The exact cause of Bell's palsy is unknown, but it is thought to involve inflammation of the facial nerve.

2. Stroke

• A stroke occurs when there is a disruption of blood flow to the brain, leading to brain cell damage. If a stroke affects the part of the brain responsible for controlling facial muscles (usually in the brainstem), it can cause weakness or paralysis on one side of the face.

3. Trauma or Injury

• Physical injury or trauma to the face or head, such as fractures to the skull or damage during surgery, can directly injure the facial nerve, leading to facial palsy.

4. Infections

• Several infections can affect the facial nerve:
  
  • Ramsay Hunt Syndrome: This is caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox and shingles), this condition results in a painful rash along with facial paralysis.  When the immune system is depressed, the risk of the virus reactivation is increased.  Medications that suppress the immune system and stress may be factors that lead to Ramsey Hunt Syndrome.
  • Otitis Media: An ear infection that can lead to facial nerve inflammation and paralysis.
  • Lyme Disease: A bacterial infection transmitted by ticks, which can lead to facial palsy, especially if untreated.

5. Tumours

• Tumours, either benign or malignant, that press on the facial nerve can lead to facial paralysis. This may include tumours in the brain or near the facial nerve, like schwannomas (nerve sheath tumours) or acoustic neuromas (tumours on the auditory nerve).  The surgery to remove these tumours can also damage the facial nerve.

6. Guillain-Barré Syndrome

• This is a rare autoimmune disorder in which the body's immune system mistakenly attacks the peripheral nervous system, leading to muscle weakness, including facial paralysis.

9. Congenital Causes

• Some babies are born with facial palsy due to birth trauma (e.g., during a difficult delivery) or congenital conditions that affect the facial nerve development.

Facial palsy can have an enormous impact on an individual’s day-to-day life.  Not only does it cause a number of significant changes in the person’s physical appearance, it can also have a dramatic impact on their mental health, self-esteem and ability to work and socialise.

Physical effects:

• Loss of facial symmetry: One of the most noticeable effects is that the face appears uneven or drooping on one side. This may affect the symmetry of facial features, such as the eyes, eyebrows, and mouth, leading to noticeable changes in appearance.  In some people, the drooping phase is then replaced by excessive tightness on the affected side.  This is referred to as synkinesis.
• Difficulty with Facial Expressions: Since the facial muscles are weakened or paralyzed, people with facial palsy may have trouble showing emotions or expressions, such as smiling, frowning, or raising their eyebrows. This can make it harder to communicate emotions or engage in social interactions.
• Eye Issues: People with facial palsy often have difficulty closing their eyelids completely on the affected side, which can lead to a watery eye, dryness, irritation, and a higher risk of eye infections. In some cases, the affected eyelid may need to be manually closed to protect the eye.  Individual’s often report that the eye is very sensitive to light and wind.
• Speech and Eating Difficulties: The inability to fully move the facial muscles can make it difficult to chew, swallow, or speak clearly. Drooling may also occur if the person has difficulty controlling their mouth muscles.
• Pain and Discomfort: Some individuals experience pain or a sensation of numbness in the face or behind the ear, which can be associated with Bell's palsy or other nerve-related conditions.

Emotional and Psychological Impact:

• Self-esteem and Body Image: Facial palsy can lead to changes in how a person views their appearance. For many, visible changes to their face, especially if they are sudden or severe, can cause anxiety, embarrassment, or low self-esteem.
• Social Withdrawal: Difficulty expressing emotions or communicating effectively can result in people with facial palsy withdrawing from social situations. They might feel self-conscious, misunderstood, or anxious about how others perceive them.
• Depression and Anxiety: The emotional toll of dealing with a change in appearance, along with the physical limitations it causes, can contribute to feelings of sadness, frustration, and in some cases, depression. Anxiety about how the condition may affect personal or professional relationships is also common.

Functional Impairment:

• Daily Life Activities: Facial palsy can make it more challenging to perform simple tasks, such as eating, drinking, or brushing teeth. It can also affect speech clarity, leading to difficulty in communication, especially in environments where clear verbal expression is necessary.
• Work and Professional Life: For those in professions where appearance, communication, or facial expressions are important (e.g., actors, public speakers, or customer service roles), facial palsy can pose additional challenges. The psychological impact can also affect work performance, especially if the individual experiences self-consciousness or anxiety.

Impact on Relationships:

• Interpersonal Relationships: Because facial expressions are a primary means of communicating emotions, the inability to fully express oneself can affect how relationships are formed and maintained. Friends, family, or partners might misinterpret emotions or intentions, which can cause tension or misunderstandings.
• Intimate Relationships: For some individuals, facial palsy may cause concerns about their attractiveness or physical appearance in intimate settings, leading to discomfort or difficulty in relationships.