Treatments and Surgery

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What can be done to help?

There is a wide range of treatments available for patients who have suffered a facial palsy. These treatments should always be provided and supervised by professionals trained in Facial Rehabilitation. It is important that any treatment or exercise programme is determined following a detailed assessment. This will identify the key problems and ensure that the treatment is appropriate for the stage of recovery. This is because certain exercises and therapies may be inappropriate and can be detrimental to recovery.

What to do:

Eye Care – You may be unable to close your eye and produce tears. This means that the surface of the eye (cornea) will have very little protection and is at risk of becoming dry and easily damaged. This can affect your vision and is often, but not always, painful. If the cause of your facial palsy has also affected sensation to the cornea, your eye is at greater risk of harm because you can’t feel it becoming dry and irritated.

If you haven’t been provided with eye care advice and products, it is important that you see your GP who will advise you and may refer you to an ophthalmologist or local eye hospital walk in centre. You will probably need to use eye drops during the day and eye gel at night and may be advised to tape your eye shut at night.

If you adhere to the advice you are given, you are much more likely to maintain the health of your eye. You may find it helpful to wear wraparound  glasses or sunglasses to protect your eyes, especially in bright sunshine or wind and avoid prolonged exposure to air conditioning or blow heaters.

Blink your eye manually as often as possible. This will not only keep your eye moist and healthy but also stop your eyelid stiffening up preventing future difficultiesThe link at the end of this section takes you to a series of videos, one of which focuses on eye care.

Facial Massage – Massaging your face is important. It helps to improve circulation to the facial muscles and helps to keep you ‘in touch’ with your face. Massage your face using slow, gentle, circular movements. Use firm pressure keeping your fingers still so as you can feel the facial tissues moving. Massage keeps your muscles healthy whilst your nerve recovers. Focus your massage on forehead, temples, cheeks, chin and neck. The link at the end of this section takes you to a series of videos, one of which focuses on facial massage.

Mouth – Look after your oral health – ensure you clean your teeth thoroughly on the affected side and visit a dental hygienist regularly. If you suffer from dry mouth, there are specialist products available to ease this via your GP or pharmacy.

These videos are for patient use to help explain the facial care needed during the early phase of facial palsy:

https://www.facialpalsy.org.uk/support/self-help-videos/management-of-flaccid-facial-paralysis-floppy-face/

There is a huge amount of online information available about all sorts of health conditions including facial palsy but not all of it is accurate or helpful and some of it can be harmful.

Information on the Facial Therapy Specialists International and Facial Palsy UK www.facialpalsy.org.uk websites is written and regularly reviewed by professionals who work exclusively or predominantly with patients affected by facial palsy and are sources of guidance and support based on up to date clinical evidence and experience.

What to avoid:

  • At this early stage, you should avoid doing any facial exercises until you have seen your facial rehabilitation therapist. Your facial nerve will recover in its own time and no amount or exercise will speed the recovery process.
  • Avoid exaggerating or forcing your facial movements. This will not speed your recovery; it will only make the unaffected facial muscles more dominant and your face more imbalanced.
  • It is important however, that when you do start a treatment / exercise programme, it is the correct treatment that will meet your specific needs at that time and is provided by a clinician with specialist training in facial rehabilitation.
  • Avoid using electrical stimulation on your facial muscles. Facial Therapy Specialists International do not recommend the use of electrical stimulation for all but very exceptional cases. The available evidence demonstrates it is not effective and may be detrimental to recovery after facial palsy.

What to do:

  • If your facial palsy has not resolved or is only partially recovered by 6-8 weeks after its onset, it is important that you seek specialist assessment and support. You may require further investigations and the care of a multidisciplinary team. For information on accessing specialist care see the Contact Us page.
  • Specialist therapists will be able to educate you about your condition and advise you on a variety of treatments available.

What to avoid:

  • Please avoid the temptation to exercise your face without guidance as this may produce complications. As the nerve recovers, there is the potential for your face to become tight, painful and overactive and the wrong exercise could make this worse. Doing no exercise is better than doing bad exercise!
  • Do not assume that information you find online, even if it is on medical sites, is suitable for you and it might not be written by professionals with experience in treating facial palsy. As indicated before, the information on www.facialpalsy.org.uk is written and regularly reviewed by professionals who work exclusively or predominantly with patients affected by facial palsy.

What to expect in therapy:

  • Full assessment of the history, evolution, and current presentation of your face.
  • Discussion of your goals for therapy
  • Advice and education including:
    • Advice on eye care and taping the eye closed.
    • Advice on mouth care and dry mouth management.
    • Advice on eating, drinking and speech improvement.
    • Relaxation of your facial nerve and muscles
    • Massage to keep the muscles mobile and healthy.
    • Stretches to lengthen muscles which have become short or tight.
    • Exercises to help relearn and develop balanced facial movements.
    • Exercises to reduce involuntary, unwanted movements.
    • Teaching of home exercise programmes to enable you to be independent with your recovery.Monitoring of progress.
  • Sometimes, special electrodes may be attached to your face to record how much energy your facial muscles are creating when you relax and when you try to contract them. This is called Surface Electromyography (sEMG). A muscle can only contract if the nerve to that muscle is intact and working. This is NOT the same as electrical stimulation of facial muscles as sEMG records the energy generated by your facial nerve / muscles, it does not add electrical energy to the face.
  • Reassurance and motivation
  • Monitoring of progress
  • Your therapist will ensure, where required, that other appropriate professionals are involved in your care or refer you to them.
  • Patients should allow up to 2 hours for therapy sessions and expect to return at intervals.
  • The number and frequency of treatment sessions will vary between different people as everyone’s needs are different.
  • Some people may require a course of botulinum toxin injections to help facilitate their recovery. These will be repeated approximately every 4-6 months whilst required and are carried out by doctors and specially trained therapists.
  • Some people may be referred to the eye specialists for advice and monitoring
  • Some people may undergo a course of psychological therapy including social interaction skills retraining to regain confidence.
  • Some people, in a small number of cases, may be appropriate for specialist surgeries.

Facial surgery can be an option for a small number of patients who have very little or no recovery from their facial palsy. Most patients will not require facial surgery.

Patients with eye problems e.g. difficulty with closing the eye may be suitable for various ophthalmic or plastic surgery procedures such as insertion of an upper eyelid weight to facilitate eye closure or a lift of the eyebrow/removal of excess eyelid skin (upper blepharoplasty) for those whose eyelid is limiting their visual field.

Surgical options have limited benefit in the recovery of facial palsy and other rehabilitation options tend to be more successful.

If you feel you need specialist assessment or management, please see the Contact Us page to find details of your nearest specialist centre: https://facialtherapyspecialists.com/contact-us/

What to do:

Eye Care – You may be unable to close your eye and produce tears. This means that the surface of the eye (cornea) will have very little protection and is at risk of becoming dry and easily damaged. This can affect your vision and is often, but not always, painful. If the cause of your facial palsy has also affected sensation to the cornea, your eye is at greater risk of harm because you can’t feel it becoming dry and irritated.

If you haven’t been provided with eye care advice and products, it is important that you see your GP who will advise you and may refer you to an ophthalmologist or local eye hospital walk in centre. You will probably need to use eye drops during the day and eye gel at night and may be advised to tape your eye shut at night.

If you adhere to the advice you are given, you are much more likely to maintain the health of your eye. You may find it helpful to wear wraparound  glasses or sunglasses to protect your eyes, especially in bright sunshine or wind and avoid prolonged exposure to air conditioning or blow heaters.

Blink your eye manually as often as possible. This will not only keep your eye moist and healthy but also stop your eyelid stiffening up preventing future difficultiesThe link at the end of this section takes you to a series of videos, one of which focuses on eye care.

Facial Massage – Massaging your face is important. It helps to improve circulation to the facial muscles and helps to keep you ‘in touch’ with your face. Massage your face using slow, gentle, circular movements. Use firm pressure keeping your fingers still so as you can feel the facial tissues moving. Massage keeps your muscles healthy whilst your nerve recovers. Focus your massage on forehead, temples, cheeks, chin and neck. The link at the end of this section takes you to a series of videos, one of which focuses on facial massage.

Mouth – Look after your oral health – ensure you clean your teeth thoroughly on the affected side and visit a dental hygienist regularly. If you suffer from dry mouth, there are specialist products available to ease this via your GP or pharmacy.

These videos are for patient use to help explain the facial care needed during the early phase of facial palsy:

https://www.facialpalsy.org.uk/support/self-help-videos/management-of-flaccid-facial-paralysis-floppy-face/

There is a huge amount of online information available about all sorts of health conditions including facial palsy but not all of it is accurate or helpful and some of it can be harmful.

Information on the Facial Therapy Specialists International and Facial Palsy UK www.facialpalsy.org.uk websites is written and regularly reviewed by professionals who work exclusively or predominantly with patients affected by facial palsy and are sources of guidance and support based on up to date clinical evidence and experience.

What to avoid:

  • At this early stage, you should avoid doing any facial exercises until you have seen your facial rehabilitation therapist. Your facial nerve will recover in its own time and no amount or exercise will speed the recovery process.
  • Avoid exaggerating or forcing your facial movements. This will not speed your recovery; it will only make the unaffected facial muscles more dominant and your face more imbalanced.
  • It is important, however, that when you do start a treatment / exercise programme, it is the correct treatment that will meet your specific needs at that time and is provided by a clinician with specialist training in facial rehabilitation.
  • Avoid using electrical stimulation on your facial muscles. Facial Therapy Specialists International do not recommend the use of electrical stimulation for all but very exceptional cases. The available evidence demonstrates it is not effective and may be detrimental to recovery after facial palsy.

What to do:

  • If your facial palsy has not resolved or is only partially recovered by 6-8 weeks after its onset, it is important that you seek specialist assessment and support. You may require further investigations and the care of a multidisciplinary team. For information on accessing specialist care see the Contact Us page.
  • Specialist therapists will be able to educate you about your condition and advise you on a variety of treatments available.

What to avoid:

  • Please avoid the temptation to exercise your face without guidance as this may produce complications. As the nerve recovers, there is the potential for your face to become tight, painful and overactive and the wrong exercise could make this worse. Doing no exercise is better than doing bad exercise!
  • Do not assume that information you find online, even if it is on medical sites, is suitable for you and it might not be written by professionals with experience in treating facial palsy. As indicated before, the information on www.facialpalsy.org.uk is written and regularly reviewed by professionals who work exclusively or predominantly with patients affected by facial palsy.

What to expect in therapy:

  • Full assessment of the history, evolution, and current presentation of your face.
  • Discussion of your goals for therapy
  • Advice and education including:
    • Advice on eye care and taping the eye closed.
    • Advice on mouth care and dry mouth management.
    • Advice on eating, drinking and speech improvement.
    • Relaxation of your facial nerve and muscles
    • Massage to keep the muscles mobile and healthy.
    • Stretches to lengthen muscles which have become short or tight.
    • Exercises to help relearn and develop balanced facial movements.
    • Exercises to reduce involuntary, unwanted movements.
    • Teaching of home exercise programmes to enable you to be independent with your recovery.Monitoring of progress.
  • Sometimes, special electrodes may be attached to your face to record how much energy your facial muscles are creating when you relax and when you try to contract them. This is called Surface Electromyography (sEMG). A muscle can only contract if the nerve to that muscle is intact and working. This is NOT the same as electrical stimulation of facial muscles as sEMG records the energy generated by your facial nerve / muscles, it does not add electrical energy to the face.
  • Reassurance and motivation
  • Monitoring of progress
  • Your therapist will ensure, where required, that other appropriate professionals are involved in your care or refer you to them.
  • Patients should allow up to 2 hours for therapy sessions and expect to return at intervals.
  • The number and frequency of treatment sessions will vary between different people as everyone’s needs are different.
  • Some people may require a course of botulinum toxin injections to help facilitate their recovery. These will be repeated approximately every 4-6 months whilst required and are carried out by doctors and specially trained therapists.
  • Some people may be referred to the eye specialists for advice and monitoring
  • Some people may undergo a course of psychological therapy including social interaction skills retraining to regain confidence.
  • Some people, in a small number of cases, may be appropriate for specialist surgeries.

Facial surgery can be an option for a small number of patients who have very little or no recovery from their facial palsy. Most patients will not require facial surgery.

Patients with eye problems e.g. difficulty with closing the eye may be suitable for various ophthalmic or plastic surgery procedures such as insertion of an upper eyelid weight to facilitate eye closure or a lift of the eyebrow/removal of excess eyelid skin (upper blepharoplasty) for those whose eyelid is limiting their visual field.

Surgical options have limited benefit in the recovery of facial palsy and other rehabilitation options tend to be more successful.

If you feel you need specialist assessment or management, please see the Contact Us page to find details of your nearest specialist centre: https://facialtherapyspecialists.com/contact-us/