What conditions are associated with facial paralysis?
CVA (brainstem) Bell's Palsy Tumor-Acoustic Nueroma Herpes Simplex Virus Type 1 Trauma Post-surgical complication
How can you tell if the facial paralysis is due to a stroke?
- Can lift eyebrow because frontalis is bilaterally innervated
- Possible sensory loss to face
- Rapid Onset
How can you tell if the facial paralysis is due to bell’s Palsy?
- Cannot lift eyebrow on lesion side…ipsilateral CN VII innervation
- No sensory loss to face…Trigeminal is sensory to face
- Rapid Onset
How can you tell if the facial paralysis is due to a Tumor?
- Tumor compresses nerve
- Might have a mild hearing loss due to the proximity of CN VIII
- Balance may also be impacted due to CN VIII compression
- Slow growing tumor so pts compensate very well. Most times, facial paralysis is the first sign of a tumor
What muscle is important to test for facial paralysis?
Frontalis muscle (test for symmetry and weakness)
What is Bell’s Palsy?
facial muscle weakness due to a lesion or damage to CN VII
What are the signs and symptoms of Bell’s Palsy?
- Weakness of facial muscles
- Inability to lubricate the eye
- Change in taste
- Biting the inside of the mouth
- Drooling
- Poor food management
What should you look for when doing a facial muscle examination?
- weakness
- tightness
- synkinesis
Facial expressions
- raise both eyebrows
- close both eyes tightly
- smile
- puff cheeks
- purse lips
- show upper and lower teeth
What is the prognosis for Bell’s Palsy?
- about 70% of pts with facial paralysis will recover fully
- roughly 18% will have significant dysfunction such as contractures, synkinesis, weakness, or asymmetry
What is synkinesis?
When contracting one muscle voluntary causes other muscles around the area to involuntarily contract
True or False: Facial paralysis, no matter if it is reoccurring, will usually resolve fully in 70% of patients
False, is there is recurrence (5-7% of cases) then there is a poorer prognosis for full recovery
What are the two subscales of the facial disability index? How are they scored?
Physical Function (0-5 scale)
- usually did with
- no difficulty (5)….much difficulty (2) - Usually did not eat because:
- health (1)….of other reasons (0)
Social/Well-being (1-6 scale)
-all of the time (1)….none of the time (6)
Which questions are asked for the Physical Function section of the facial disability index (FDI)?
- How much difficulty did you have keeping food in your mouth, moving food around your mouth, or getting food stuck in your cheek while eating?
- How much difficulty did you have drinking from a cup?
- How much difficulty did you have saying specifci sounds while speaking
- How much difficulty did you have with your eye tearing excessively or becoming dry?
- How much difficulty did you have with brushing your teeth or rinsing your mouth?
What questions are asked for Social Function section of the FDI?
- How much of the time have you felt calm and peaceful?
- How much of the time did you isolate yourself from people around you?
- How much of the time did you get irritable toward those around you?
- How much often did you wake up early or wake up several times during your nighttime sleep?
- How often has your facial function kept you from going out to eat, shop, or participate in family or social activities?
How is the House-Brackmann Classification of Facial Function scale scored?
From Normal (1) to Total Paralysis (6) using both Gross and Motion characteristics
What are the Gross and Motion characteristics for a Normal (1) grade on the House-Brackmann Classification of Facial Function scale?
Gross
- obvious but not disfiguring difference between the two sides
- noticeable but not severe synkinesis, contracture, or hemifacial spasm
- at rest, normal symmetry and tone
Motion
- Forehead-slight to moderate movement
- Eye-complete closure with effort
- Mouth-slightly weak with max effort
What are the Gross and Motion characteristics for a Mild Dysfunction (2) grade on the House-Brackmann Classification of Facial Function scale?
Gross
- slight weakness noticeable on close inspection
- may have slight synkinesis
- rest rest, nomral symmetry and tone
Motion
-forehead moderate to good function
eye complete closure with minimal effort
mouth has slight asymmetry
What are the Gross and Motion characteristics for a Severe Dysfunction (5) grade on the House-Brackmann Classification of Facial Function scale?
Gross
- only barely perceptible motion
- at rest, symmetry
Motion
-forehead none
-eye incomplete closure
mouth slight movement
What are the Gross and Motion characteristics for a Moderately Severe Dysfunction (4) grade on the House-Brackmann Classification of Facial Function scale?
Gross
- obvious weakness and.or disfiguring asymmetry
- at rest, normal symmetry and tone
Motion
- no forehead movement
- incomplete closure of eye
- asymmetric mouth movements with max effort
What are the Gross and Motion characteristics for a total Paralysis (6) grade on the House-Brackmann Classification of Facial Function scale?
Gross
-no movement
Motion
-No movement
What is the Sunnybrook Facial Grading Scale (FGS)?
What is examined?
What are the Pros of this test?
How is it scored?
Performance based measure of facial impairment
Resting posture, voluntary movement in 5 regions, synkinesis
Good inter and intra-rater reliability, convenient and easy to use clinically, sensitive to change over time
0-100 (0=most impairment; 100=normal)
What drugs are mainly used for pharmacological intervention of facial paralysis?
Corticosteroids (most effective) and antivirals (possibly effective)
True or False: E-stim is a proven method for treating facial paralysis which results in faster recovery and less synkinesis
False, E-stim does not work and has actually been observed to possibly cause synkinesis
True or False: Having patients practice general facial expressions does not work to improve facial paralysis
True
