Facial nerve paralysis

On 3.2.2015 a patient searched us out, let’s call her mrs. Alena, she had her right part of the face paralysed (nervus facialis). It is an illness which manifests as a partial inability to activate the face muscles and move freely. The client could not drink or eat without using a napkin. She was unhappy, because of the long waiting list for rehabilitation, but also because she was dealing with the same diagnosis already 2 times in the past (2005 and 2007), on the left side the treatment always took longer. And she was left with inability to puff her cheeks or pucker her nose.

THE CAUSE OF FORMATION

Cheek nerve is the 7th brain nerve, it goes through a narrow canal from brain through skull bones to the surface to facial muscles. The nerve can get cold in the area of the passage through the bone (for example: sitting next to an open window etc..). That leads to swelling, which consequently puts pressure on the nerve. Thanks to insufficient nutrition of the nerve, patient is struck with paralysis of the facial nerve. Paralysis can also occur during damage of the nerve itself, during plastic operation, or after injuries of the face, when the nerve is physically severed.

MANIFESTATIONS

  • Relieving the muscle tension on the disabled side
  • Drop of the eyelids and mouth corner
  • Inability to puff cheeks, pucker lips, close eyelids, wrinkle forehead, etc..

Muscles on the healthy side were more active than muscle on the other side. Long-term lasting of the problem leads to crooked facial expression, and the return to the healthy condition really matters on starting therapy as soon as possible.

TREATMENT PROCESS

The client visited us from 3. 2. 2015 to 27. 2. 2015 daily, for one hour therapy, during which we stimulated the roots of the facial nerve, with the help of Focused shock wave therapy. Stimulative values were depending on the successfulness of the localization of the facial nerve, so that it would be sufficiently stimulated for regeneration.

In the second part of the therapy, we applied manual massage of the face in combination with a foam ball, which the client got for herself, and continued in a home therapy. Consequently we continued in a stimulation of the affected muscles according to the method of nurse Kenny (Australian Elizabeth Kenny developed this method for children suffering from poliomyelitis. Today is this method used in therapy of facial nerve paralysis).

Client was already advised from the past experience with facial nerve paralysis to massage her face several times a day, stimulate it, and actively exercise the mimic muscles. For a assurance it was all explained once again, and client tried it herself with physiotherapist in front of a mirror.

After 14 days of intensive therapy there was a significant improvement, some muscles went up to 2 grades of the general muscle strength. Client felt the improvement in significantly better articulation and while drinking. Great achievement was, that she could puff both of her cheeks, and switch the air from one cheek to another, which was impossible to do at the start of the therapy. She felt an overall improvement and natural relief.

Therapy continued for another week in the rhythm of daily therapies, and her condition continued to improve. The client then left for a week long vacation, and when she returned, she came 3 more times, 9.3., 12.3., 19.23). The asymmetry in the face wasn’t visible on the first look, and there were really just “cosmetical” imperfections remaining. Therapy was ended on 19.3.

MUSCLE TEST OF THE MIMIC MUSCLES

Muscle strength is being evaluated according to muscle test by prof. Janda (to see. Chart no.1).
Tested movements are in the Chart no.2. The whole face had a significantly lowered muscle tension, especially in the area of eyes and lips. From previously suffered paralysis, the tension was lowered in the left side of the face a little more.

Rating

  • Rating was done in form of a scale from 0 to 5, which compares the movement between the healthy and disabled side.
  • Stage 0 = without the notion of activity
  • Stage 1 = contraction in a quarter of the range of the healthy side
  • Stage 2 = contraction in a half of the range of the healthy side
  • Stage 3 = slight asymmetry
  • Stage 5 = without asymmetry

From that results that the higher the value, the better.

Chart no. 1: Muscle test


Name of the muscle


Muscle strength

Date of testing

3. 2. 18. 2. 19. 3.
Forehead muscle 2 3 5
Corrugator supercilii muscle 1 2 5

Orbiculari oculi muscle

1 2 4

Procerus muscle

0 2 5

Nasalis muscle

2 2 4

Levator anguli oris muscle

2 2 4

Depressor labii inferioris muscle

1 2 5

Zygomaticus minor and major muscle

0 2 5
Risorius 1 3 5

Depressor anguli oris muscle

0 1 4

Orbicularis oris muscle

1 2 5
Mentalis 3 3 4

Buccinator muscle

0 3 5

Platysma muscle

2 3 4

Chart no. 2: Tested Movement

Frontalis Muscle

Lifting eyebrows

Corrugator supercilii muscle

Scowl

Orbiculari oculi muscle

Closing eyes

Orbicularis oculi muscle

Pulling the skin towards the root of the nose

Nasalis muscle

Clasping nostrils during abrupt inhale

Levator anguli oris muscle

Moving mouth corner upwards

Depressor labii inferioris

Pulling the lower lip downwards and to the sides

Zygomaticus minor and major muscle

Smiling, - mouth corners are pointing up

Risorius

Straight smile - mouth corners are in lateral position

Depressor anguli oris muscle

Pulling mouth corners down

Orbicularis oris muscle

Pouting lips

Mentalis

Bending lower lip - lifting chin skin upwards

Buccinator Muscle

Puffing cheeks

Platysma muscle

Stretching skin on the chin and throat



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience from private practice in physiotherapeutic field, FYZIOklinika

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