Facial nerve palsy

By Lee Sung-hun

According to a recent report from Health Insurance Review and Assessment Service, the number of facial nerve palsy patients, whose facial muscles twitch or paralyze unconsciously, has increased by 24.2 percent over the past five years. The number of diagnosed facial nerve palsy patients was 57,000 in 2008 and 70,000 in 2012, showing an average of 5.6 percent increase per year.

Quite recently, an office worker in her 20s visited my clinic. Her face twisted to one side making her lips unnaturally skewed and she could not completely shut one of her eyes. She also complained of pain in her ears and surely enough there were blisters in her ears a couple of days later. Band-shaped blisters are usually indicators of varicella zoster virus (chickenpox virus responsible for shingles) having infected the facial nerves, and due to high likelihood of lasting aftereffects the patient and I myself are very keenly monitoring the progress of the treatment.

Facial nerve palsy generally refers to the partial facial paralysis which often results in twisted face, dry eyes and drooling of food while eating. When the facial nerve, the seventh cranial nerve that controls the muscles of facial expression, is affected, it hinders facial muscles’ normal functions.

The first step in treating facial nerve palsy is to distinguish between a central facial palsy that can result from a stroke, and a peripheral facial palsy that can be rather easily treated, such as the Bell’s palsy. With central types, patients can frown their forehead and close their eyes at will, whereas peripheral facial palsy patients cannot. Also the paralysis of facial muscles seem the most severe on the day of occurrence with central types while with peripheral types, day 3 would show the most sever paralysis. Another distinction is that with central types, patients often display other symptoms in other part of the body such as paralysis in one arm and one leg, difficulty of speech and other behavioral disorders. If you suspect central facial palsy, immediate medical attention should be sought out to take further diagnosis such as CT and MRI scans.

Most common of the peripheral facial nerve palsies is Bell’s palsy. Although its exact cause is unknown, momentary exposure to cold, stress and infection in the facial nerve are known to be associated with it. Recent studies are showing that viral infection is also highly related. One other common peripheral facial nerve palsy is the Ramsay Hunt syndrome where the cause is from the shingles virus like the previously mentioned patient. Ramsay Hunt syndrome is more likely to cause aftereffects.

Oriental medicine considers that peripheral facial nerve palsies are caused by wind-cold, qi deficiency and blood deficiency. Wind-cold is the most frequently occurring cause. Facial nerve palsy caused by sleeping while exposed to the cold wind, or with fan or air-conditioner on, or driving in an open convertible car are all such cases. Qi deficiency and blood deficiency are caused by overwork that causes chronic gastrointestinal disorder or other diseases that damages qi and blood.

Generally speaking, about 60 to 70 percent of the peripheral facial nerve palsy patients recover on their own. With mild symptoms, it may last between seven to 10 days from initial occurrence before showing signs of recovery, and a full recovery that does not show any symptoms takes about six weeks. However, with more severe symptoms, a full recovery may take months and some even won’t reach that state. Such difference is dependent upon where the initial inflammation occurred on the nerves, and prognosis can be made after monitoring the initial symptoms.

With milder cases, patients display sensory issues, decline in motor skills, and increase in tear secretion on the affected side, and often they also complain of loss of taste and heightened sensitivity to sounds. However, if the symptoms are accompanied by lack of lachrymal gland activity and disorders in hearing and balance, the prognosis can be bad.

Therefore, it is crucial to implement appropriate treatment along with proper rest and monitoring of daily activities from the very initial occurrence. In oriental medicine, treatments include oriental herbal medicine to mitigate the symptoms during the initial acute phase, and to boost the body’s natural recuperative powers during the recovery phase, and acupuncture to promote circulation of qi and blood in the affected areas and to assist the recovering of body’s strength.

Patient should avoid stress and take plenty of rest while being mindful not to come in contact with cold on the face. Massaging the affected muscles whose movements are limited can help. Pronouncing the vowels can also stimulate the facial muscles. If the eyelids cannot be completely shut, as cornea can dry out and become susceptible to damages, wearing a protective eye patch can be beneficial.

If the symptoms are not fully treated and aftereffects last for an extended period of time, one side of the face may droop and the facial muscles become hardened, resulting in an unbalanced face. Oriental non-surgical cosmetic treatments can restore elasticity to the skin and muscles in such cases.

If you or someone you know are suffering from facial nerve palsy or from its aftereffects, visit a nearby Oriental clinic and seek professional consult from the doctor.

The writer practices Korean Oriental medicine at the UN Oriental Medical Clinic in Hannam-dong, Seoul. He can be reached at sung_hun@naver.com.