Facial Nerve Paralysis: Common Aftereffects and Treatment Options

Q: Facial Nerve Paralysis: Common Aftereffects and Treatment Options

Hello Mr. <br>Lin： You mentioned the issue of "facial nerve paralysis." Is the inability to close the left eye and the pulling of the mouth corner a common sequela? This usually occurs in patients with more severe inflammation, such as when the eye cannot close during the episode

Facial nerve paralysis sequelae?

Hello, Dr.
Jiang.
Current symptoms: 1.
When closing my left eye, the muscles below the left corner of my mouth are also pulled.
2.
There is no facial twitching at the corners of my mouth during normal activities; it only occurs when I close my eyes.
Personal medical history: 1.
Approximately two and a half years ago, I experienced sudden facial nerve paralysis, which rendered the entire left side of my face immobile.
I consulted a neurologist and was treated with corticosteroids and acupuncture.
After several months, I improved significantly, and most movements returned to normal.
However, I still have the issue of the muscles below the left corner of my mouth being pulled when I close my left eye.
2.
On May 20 of this year, I experienced facial nerve paralysis again, this time on the right side of my face.
After treatment, I am slowly recovering.
However, the previous issue of twitching at the left corner of my mouth when closing my left eye has not resolved.
My main concerns are: Given that I have experienced facial nerve paralysis twice over the years and have one lingering sequela, I would like to ask the doctor: 1.
Is the pulling of the muscles at the left corner of my mouth when closing my left eye a common sequela? 2.
Is this sequela treatable or improvable? 3.
Should I undergo further brain examinations to rule out other possible causes?

Lin Dashu, 30~39 year old female. Ask Date: 2024/06/18

Dr. Jiang Junyi reply Neurology

Hello Mr.
Lin: You mentioned the issue of "facial nerve paralysis." Is the inability to close the left eye and the pulling of the mouth corner a common sequela? This usually occurs in patients with more severe inflammation, such as when the eye cannot close during the episode.
This is primarily due to miswiring during the nerve repair process after facial nerve damage.
Because this causes muscles to tighten intermittently, muscle relaxants can be used for treatment, and in more severe cases, botulinum toxin injections may be administered to alleviate symptoms.

Should further brain examinations be considered to rule out other potential causes? Autoimmune diseases and other issues may need to be taken into account.
I recommend consulting a neurologist to discuss supplementing with vitamin B and hydration, ensuring adequate rest to enhance self-healing.
Thank you for your inquiry! Feel free to discuss further! Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Department of Neurology, Hualien Medical Center/Taoyuan Medical Center, cares for you.

Reply Date: 2024/06/18

More Info

Facial nerve paralysis, commonly known as Bell's palsy when idiopathic, can lead to a range of symptoms and aftereffects that can significantly impact a person's quality of life. Your situation, involving recurrent episodes of facial nerve paralysis and persistent symptoms, raises important questions about the nature of these aftereffects and the potential for treatment.

1. Is the muscle pulling at the corner of the mouth when closing the left eye a common aftereffect?
Yes, the phenomenon you describe, where the muscle at the corner of the mouth pulls when you close your eye, is known as "synkinesis." This is a common aftereffect of facial nerve paralysis. Synkinesis occurs when the regenerating facial nerve fibers misconnect with the wrong muscles during the healing process. As a result, movements intended for one muscle group can inadvertently trigger movements in another. This can be particularly frustrating and may lead to involuntary facial movements that are not under your control.

2. Can this aftereffect be treated or improved?
While synkinesis can be challenging to treat, there are several approaches that may help improve your symptoms. Physical therapy and facial exercises are often recommended to retrain the facial muscles and improve coordination. Techniques such as biofeedback can also be beneficial, as they help you gain awareness of your facial movements and learn to control them better. In some cases, medications such as botulinum toxin (Botox) injections may be used to temporarily paralyze the overactive muscles, providing relief from involuntary movements. Additionally, acupuncture and other complementary therapies may offer some benefits, although clinical evidence supporting their efficacy varies.

3. Should further brain imaging be considered to rule out other potential causes?
Given your history of recurrent facial nerve paralysis and the persistence of symptoms, it may be prudent to consult with a neurologist for a comprehensive evaluation. While the symptoms you describe are consistent with synkinesis, further imaging studies, such as an MRI of the brain, could help rule out other neurological conditions that might contribute to your symptoms. This is particularly important if you experience any new or worsening symptoms, such as headaches, changes in vision, or other neurological deficits.

In summary, while the aftereffects of facial nerve paralysis, such as synkinesis, can be distressing, there are treatment options available that may help improve your condition. Engaging in a multidisciplinary approach that includes neurologists, physical therapists, and possibly other specialists can provide you with a comprehensive management plan tailored to your needs. It's essential to maintain open communication with your healthcare providers to monitor your progress and adjust your treatment as necessary. With time and appropriate intervention, many individuals experience significant improvements in their symptoms and overall quality of life.

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