Facial Swelling After Facial Nerve Paralysis: What to Do Next?

Q: Facial Swelling After Facial Nerve Paralysis: What to Do Next?

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>The unilateral lower limb swelling and pain (right leg) should not be related to the facial nerve paralysis on the same side, nor should it be associated with renal dysfunction (as renal dysfunction typicall

During the recovery phase of facial nerve paralysis, swelling of the eyes and face may occur?

Hello Doctor, I experienced facial nerve paralysis on the right side of my face on August 3, 2017.
At that time, my right eye's vision, hearing, and taste were all affected.
Although I sought immediate treatment and continued with acupuncture and rehabilitation, I only began to see improvement by late October to early November (I could smile and close my eye while sleeping).
However, around mid-November, I suddenly developed some swelling in the affected area, including around my eye and face.
Initially, I thought it was edema, but it has persisted until now without subsiding.
Neither traditional Chinese medicine, acupuncture, nor hot and cold compresses have alleviated the swelling.

In late January of this year, I visited an ophthalmologist who diagnosed me with eye allergies, but after a week of using eye drops, there was still no reduction in swelling.
The facial swelling is not very noticeable, but it becomes quite apparent when I smile or move the corner of the affected side of my mouth (the facial swelling also affects my eye).
I finally managed to close my affected eye freely and smile, but the swelling still makes my smile look unattractive.

In October of last year, I experienced severe swelling and pain in my right foot, making it difficult to walk, and I had to use a wheelchair in the hospital.
Blood tests showed normal kidney function, and my family medicine doctor could not determine the cause of the swelling and pain, so they prescribed antibiotics (as the swelling was also itchy, and I was concerned about developing cellulitis from scratching).
The swelling subsided after two days, but I am unsure if this is related to the current facial edema.
I know that my kidney function was normal in October, but my facial swelling began in mid-November (without pain or itching).
Should I undergo another kidney function test? I am worried that my immune system may have been compromised due to the facial nerve paralysis, which is why I want to see a rheumatologist.
However, after researching online, I found that facial swelling can be evaluated by ophthalmology, dermatology, nephrology, cardiology, or metabolic medicine, making it difficult for me to determine which specialty I should consult!
Facial nerve paralysis should be evaluated by a neurologist, but currently, the neurologist only prescribes B vitamins for my condition, which I am not considering.
Moreover, I want to address the issue of the swelling on one side of my face.
When the facial nerve paralysis first occurred, my eye could not close and was very wide open, and I had no nasolabial folds.
However, now due to the swelling, my affected eye appears smaller, and the nasolabial folds are very prominent, leading subsequent rehabilitation specialists and traditional Chinese medicine practitioners to mistakenly believe that my normal side is the affected one.
Therefore, I do not think I need to see a neurologist for the swelling, but the swelling is precisely in the affected area.
I genuinely do not know what to do.
I cannot find similar cases online.
I hope the doctor can advise me on which specialty I should consult for examination.
I have a history of allergies, often sneezing and having nasal congestion, and my facial skin is prone to allergies.
In the past two months, I have occasionally experienced dry mouth and throat, but I believe this is due to insufficient water intake rather than Sjögren's syndrome, as my eyes still produce tears for lubrication when they feel dry.
I wonder if seeing a rheumatologist for allergy treatment would be beneficial?

MJ, 20~29 year old female. Ask Date: 2018/02/06

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
The unilateral lower limb swelling and pain (right leg) should not be related to the facial nerve paralysis on the same side, nor should it be associated with renal dysfunction (as renal dysfunction typically leads to bilateral edema).
Therefore, I believe there is no need to further monitor renal function.
2.
If the recovery from facial nerve paralysis is not satisfactory, I personally recommend consulting a neurologist.
Although they may prescribe B vitamins, they are the most experienced physicians in monitoring the recovery process of facial nerve paralysis.
Thus, I suggest you seek advice from a trusted neurologist.
Good consultation can provide reassurance and is a beneficial approach to treatment and outcomes.
3.
The rheumatology and immunology department can address allergies, so you may consider visiting a nearby rheumatology and immunology clinic.
4.
If your symptoms are not straightforward, and in addition to facial nerve paralysis, you experience intermittent joint symptoms, fever, skin rashes, or even new neurological symptoms, I would recommend seeing a rheumatologist.

The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to assist you.

Reply Date: 2018/02/06

More Info

Facial swelling following facial nerve paralysis can be a complex issue, and it’s understandable that you feel uncertain about the next steps in your treatment. Based on your description, it seems that you have been dealing with the aftermath of facial nerve paralysis since August 2017, and while you have seen some improvement, the persistent swelling is understandably concerning.

Understanding Facial Swelling Post-Paralysis
Facial nerve paralysis, such as Bell's palsy, can lead to various complications, including facial swelling. This swelling can be due to several factors:
1. Inflammation: After nerve damage, the body may respond with inflammation, which can lead to swelling in the affected areas.

2. Fluid Retention: The body may retain fluid in response to injury or inflammation, leading to a puffy appearance.

3. Muscle Imbalance: The inability to fully control facial muscles can lead to uneven tension and swelling in certain areas, especially when you attempt to smile or make facial expressions.

4. Allergic Reactions: Given your history of allergies, it’s possible that the swelling could be exacerbated by an allergic reaction, particularly if you have been exposed to allergens.

Next Steps: Which Specialist to See?
Given the complexity of your symptoms, it may be beneficial to consult with multiple specialists to address the various aspects of your condition:
1. Neurologist: While you mentioned that the neurologist primarily prescribed B vitamins, they are still essential for nerve health. If you haven't already, consider discussing your ongoing swelling and any neurological symptoms with them. They may suggest further imaging studies, such as an MRI, to rule out any underlying issues.

2. Rheumatologist/Immunologist: Since you are concerned about potential autoimmune issues affecting your facial nerve and causing swelling, a rheumatologist or immunologist could provide insights into whether there is an underlying autoimmune condition contributing to your symptoms.

3. Ophthalmologist: Since you have experienced eye-related symptoms, it’s crucial to continue monitoring your eye health. An ophthalmologist can assess whether the swelling is affecting your eyes and recommend appropriate treatments.

4. Dermatologist: If your facial swelling is related to skin allergies or conditions, a dermatologist can help identify and treat these issues.

5. Allergist: Given your history of allergies, consulting an allergist may help determine if there are specific allergens contributing to your symptoms.

Management Strategies
While you navigate through these consultations, consider the following management strategies:
- Cold Compresses: Applying cold packs to the swollen areas may help reduce inflammation and provide relief.

- Hydration: Ensure you are drinking enough fluids, as dehydration can exacerbate swelling.

- Dietary Adjustments: Reducing salt intake may help minimize fluid retention.

- Gentle Massage: If tolerated, gentle massage around the swollen areas may help improve circulation and reduce swelling.

Conclusion
It’s essential to approach your situation holistically, considering both the neurological and potential allergic components of your symptoms. While it can be overwhelming to decide which specialist to see, starting with a neurologist and then branching out to other specialists based on their recommendations may provide a structured approach to your recovery. Remember to keep a detailed record of your symptoms and any treatments you have tried, as this information will be valuable for any healthcare provider you consult. Your proactive approach to seeking help is commendable, and I wish you the best in your journey toward recovery.

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