Facial Nerve Paralysis: Pain Management and Recovery Insights

Q: Facial Nerve Paralysis: Pain Management and Recovery Insights

Hello： Your symptoms are very similar to peripheral facial nerve palsy, primarily affecting the seventh cranial nerve. <br>The clinical symptoms include occasional numbness or stiffness in the face. <br>Due to the inability to close the eyelids, tearing may also occur. <br>Someti

Facial nerve paralysis with left-sided facial pain during treatment?

Hello Doctor, I started experiencing an imbalance and paralysis in my face on August 1st.
After seeking treatment at the hospital on August 3rd, I have been undergoing a combination of Western medication and acupuncture for rehabilitation.
It has now been over a week since the treatment began.
I have completed the five-day course of steroids prescribed by the Western doctor, and a day or two after stopping the medication, I began to feel slight pressure pain in my left ear, which has gradually intensified.
Currently, I am experiencing a bruised-like pain on the left side of my face, and I still cannot move the left side of my face (such as raising the corner of my mouth or tightly closing my eyes).
The facial paralysis has significantly affected my confidence, and I have persistent pain on half of my face even without pressure.
I would like to ask the doctor: (1) Is the pain I am experiencing a normal symptom associated with facial nerve dysfunction? The pain is quite severe at the moment.
(2) Given that it has been nearly two weeks with no improvement in the paralysis on the left side of my face, does this indicate an unfavorable prognosis? I am very concerned about the possibility of long-term sequelae.
(3) Generally, how long does it take for common cases of facial nerve dysfunction to show significant improvement? Currently, my symptoms include inability to move the left side of my face, dryness in the left eye, sensitivity to loud sounds in the left ear, but I do not have drooling symptoms.
Additionally, there is pain and a vague feeling of swelling (unsure if it is edema) on the left side of my face.
I have been receiving Western medication and acupuncture treatment for a week, and the diagnosis was facial nerve dysfunction (similar to Bell's palsy).
I would appreciate your insights on these concerns.
Thank you, and I look forward to your response.

Miss Yang, 20~29 year old female. Ask Date: 2020/08/14

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms are very similar to peripheral facial nerve palsy, primarily affecting the seventh cranial nerve.
The clinical symptoms include occasional numbness or stiffness in the face.
Due to the inability to close the eyelids, tearing may also occur.
Sometimes patients may notice an increased sensitivity to sound due to a decrease in the ear's tympanic reflex, as well as a reduced sense of taste on the tip of the tongue.
Typically, the impact on facial muscles is quite extensive.
In the acute phase of facial nerve palsy, symptoms improve over time due to nerve damage.
The use of steroids in the first week is primarily to control inflammation and reduce the extent of nerve damage.
Other treatment options include medications such as vitamins and agents to improve blood circulation, as well as electrical stimulation, acupuncture, massage, low-level laser therapy, infrared exposure, shortwave therapy, and facial muscle exercises.
Aside from steroids, there is insufficient evidence to support the effectiveness of other treatment methods.
After the acute phase, there are almost no medications that are definitively helpful, and patients are advised to take B vitamins as an adjunct.
Approximately 10 to 20% of cases may not fully recover.
The most common clinical presentation is Bell's palsy, which is often of unknown origin or due to viral infections, leading to impaired blood circulation that nourishes the facial nerve, resulting in facial muscle paralysis.
However, given your age, it may be worth considering some immune-related diseases.
I recommend that you consult a neurologist for discussion and treatment.
Wishing you good health and peace.
Dr.
Jiang, Department of Neurology, Taoyuan Medical Center, cares about you.
You can refer to the related audio file here: https://www.youtube.com/watch?v=eyeMD2jNwI8&t=238s.

Reply Date: 2020/08/14

More Info

Facial nerve paralysis, particularly conditions like Bell's palsy, can be distressing and significantly impact daily life. Your symptoms, including facial asymmetry, pain, and inability to move the left side of your face, are indeed consistent with facial nerve dysfunction. Let's address your concerns systematically.

1. Pain as a Symptom: The pain you are experiencing, especially after stopping corticosteroids, can be a common symptom associated with facial nerve paralysis. This discomfort may arise from several factors, including nerve regeneration, inflammation, or even muscle spasms in the affected area. It's not unusual for patients to report pain that feels like bruising or pressure in the facial region. This pain can be exacerbated by the lack of movement in the facial muscles, leading to stiffness and discomfort. While pain is a normal part of the recovery process, if it becomes severe or unbearable, it is essential to consult your healthcare provider for further evaluation and management.

2. Concerns About Recovery: The duration of facial paralysis and the lack of improvement after nearly two weeks can understandably raise concerns about potential long-term effects. Generally, the prognosis for facial nerve paralysis varies. Most patients with Bell's palsy begin to see improvement within a few weeks, but complete recovery can take several months. It's important to note that about 10-20% of patients may experience residual effects, such as facial weakness or synkinesis (involuntary movements). If you have not seen any improvement, it may be beneficial to follow up with a neurologist or a specialist in facial nerve disorders to explore additional treatment options or diagnostic evaluations.

3. Treatment Duration and Options: The timeline for recovery from facial nerve paralysis can vary widely among individuals. While some may see significant improvement within a few weeks, others may take months. Treatment typically involves a combination of corticosteroids to reduce inflammation, physical therapy, and sometimes antiviral medications if a viral cause is suspected. Complementary therapies, such as acupuncture, may also provide relief for some patients. Regular follow-up with your healthcare provider is crucial to monitor your progress and adjust your treatment plan as necessary.

In addition to the treatments you are currently receiving, consider incorporating facial exercises into your rehabilitation. These exercises can help improve muscle tone and coordination on the affected side. Gentle massage and heat application may also alleviate discomfort and promote blood flow to the area.

If your symptoms persist or worsen, further investigations may be warranted to rule out other underlying conditions. Imaging studies, such as MRI or CT scans, can help assess the integrity of the facial nerve and surrounding structures.

In conclusion, while the journey to recovery from facial nerve paralysis can be challenging, many patients do experience significant improvement over time. It's essential to maintain open communication with your healthcare team, adhere to your treatment plan, and explore additional therapies that may enhance your recovery. Your concerns are valid, and seeking further evaluation and support can help you navigate this process more effectively.

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