What is Facial Paralysis and How is it Treated?
The facial nerve is the nerve that operates the facial muscles. After leaving the brain, it travels along with the auditory and balance nerves, enters the ear bone and travels in the region called the inner ear canal. In pathologies in this region, facial paralysis may be accompanied by hearing and balance complaints due to the coexistence of the facial nerve with the hearing and balance nerves. As the facial nerve progresses through the canal in the ear bone, it gives off branches that stimulate the muscle of one of the ossicles in the middle ear, stimulate the lacrimal gland, sense taste in the tongue, and activate some salivary glands. After the nerve leaves the ear bone, it extends forward and passes through the large salivary gland in front of the ear (parotid gland), giving off branches that stimulate the facial facial muscles. Due to this course of the nerve, the level at which the disease occurs can be determined by looking at the decrease in tear secretion that accompanies facial paralysis, the decrease in the sense of taste of the tongue, and the function of the stapes ossicle muscle.
The most common cause of facial paralysis is usually unknown and self-limiting. It is a disease called Bell's Palsy. In addition, pathologies such as inflammations that damage the ear bone or tumors that may occur in the area along the course of the nerve can also cause facial paralysis.
Since the treatment of diseases in this area falls within the field of ENTmedicine, patients suffering from facial paralysis It must be evaluated by an ENT specialist.
Treatment
Treatment varies depending on the disease causing facial paralysis. Purpose; It is the return of the functions of the muscles in the facial area to normal with voluntary movement.
Bell's Paralysis:Sudden onset facial paralysis without a specific cause such as trauma, tumor or infection is called Bell's Paralysis. The reason is not clear. It is accepted that it occurs due to a viral infection and an immune mechanism. It is the most common type of facial paralysis. Paralysis completely recovers in 80-90%of patients.
In the treatment of Bell's palsy, cortisone treatment is applied to patients who apply within the first 3 days, if there is no obstacle. If the causative agent is thought to be a virus, antiviral medication is added. No thinning of facial muscles during the recovery period Heat application, facial exercises and massage are recommended for healing. Drying of the eye may occur due to being kept open and unwanted eye-related discomfort may occur, so additional treatments are started against drying of the eye.
If there is improvement after three weeks of follow-up of the patient, supportive treatment is continued. For patients who do not improve, an electrical muscle stimulation test (EMG) is performed. If there is evidence of improvement in EMG, monitoring continues. If there is no sign of improvement, further examinations are performed and surgical treatment can be planned in suitable patients. As the duration of paralysis increases, the chance of recovery decreases, so if necessary, surgical intervention should be performed as soon as possible.
Trauma:Trauma is the second most common cause of facial paralysis. Ear bone fractures or surgical trauma (damage that may occur during surgery) may occur.
Facial paralysis occurring immediately after trauma is considered to be an incision or injury to the nerve. In this case, surgery should be performed as soon as possible and, depending on the condition of the pathology, the pressure on the nerve should be removed and repaired, if necessary, with the appropriate surgical technique. Paralysis that begins some time after the trauma may occur due to swelling or bleeding in the nerve canal. In this case, the treatment is like Bell's palsy. Surgery is considered in cases that do not respond to treatment.
Acute and chronic otitis media:Facial paralysis may also occur during acute otitis media. In the treatment, antibiotics should be started and the inflammation accumulated in the middle ear should be drained by making a hole in the eardrum. Additionally, cortisone treatment may be applied.
In paralysis accompanied by chronic otitis media, an inflammatory mass called cholesteatoma may be present, which grows by dissolving the bone. Facial paralysis may occur due to the cholesteatoma's pressure on the nerve or inflammation in that area. In these cases, urgent surgical intervention is required. .
Herpes Zoster Oticus:(Ramsey Hunt Syndrome)It occurs due to the virus called Varicella Zoster. It is usually accompanied by herpes-like blistering lesions on the auricle, scalp, face or lips. Anti-viral medication specific to this virus should be used in treatment. �. The other treatment protocol is the same as in Bell's palsy.
Pathologies outside the ear bone: It usually occurs due to trauma or tumors originating from the parotid gland. . Different surgical methods are used in treatment depending on the cause.
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