OVERVIEW
This is a sudden onset of weakness of the whole of one side of the face. The life-time incidence is about one in sixty. There is also an increased incidence during pregnancy, if you have diabetes, a recent upper respiratory tract infection, and it can run in families. The recurrence rate is bout 10% and usually occurs on the opposite side. Red flags for another diagnosis would be gradual onset with twitching of the face going on for more than seventy-two hours.
CAUSE AND PATHOPHYSIOLOGY
This is probably a viral reactivation of the herpes simplex group and effects the facial nerve in the inner ear bony canal. There is swelling of the nerve resulting in decreased blood supply and decrease function.
CLINICALLY
There is a rapid decrease in function with a complete paralysis in about 70% of the cases. Other symptoms that may occur are epiphora (tearing of the eyes), a painful ear, decreased taste, drooling and an increase sensitivity to sound.
PROGNOSIS
70% will have normal or near-normal function in three to six months. 30% will have partial recovery with or without synkinesis (this is an abnormal movement e.g. blinking when smiling).
TREATMENT
General eye care as the Cornea is exposed as blinking does not happen. Steroids and anti-virals can be given especially if diagnosed early. Anti-virals are usually given if there is complete paralysis or in high-risk patients such as the elderly and diabetics. Speech therapy can help with exercises to improve the end result. Other forms of treatment include Botox. Surgery such as decompression is not often done these days and has to be done via the cranial or brain approach.