Acute facial palsy Information for patients Ear Nose and Throat
What is facial nerve palsy? Facial nerve palsy occurs due to inflammation or injury to the facial nerve which controls the muscles of facial expression. This usually involves an entire half of your face, leaving you with difficulty smiling and closing / blinking your eyes. The majority of people with facial weakness recover with medical treatment. Some cases however will require specific ongoing medical or surgical treatment. What can I expect from facial weakness? At first you may experience the following: a strange metallic or salty taste discomfort to noise on the affected side difficulty closing your eye a dry eye difficulty pronouncing words clearly escape of food and liquid from the mouth on the affected side trapping of food along your gum line on the affected side As the nerve recovers, you may experience: tingling in the face twitching of the face blinking causing your mouth to move or vice versa (this is called 'synkinesis' which means 'unwanted facial movement') your eyes watering on eating altered hearing or pressure in your ear on smiling (rare) page 2 of 8
How is this condition treated? Once facial palsy has been diagnosed, treatment usually consists of oral steroids (unless there is a reason not to use this treatment) and anti-viral treatment. If a specific cause for the weakness is found then that will be treated accordingly. You may require CT or MRI scans of your head and neck with ongoing medical and surgical treatment. Is there anything I need to be aware of whilst waiting for recovery? Eye care is of the utmost importance whilst waiting for recovery or on-going treatment. You may not be able to blink or close your eye properly, depending on the severity of the weakness, and your eye may be drier on the affected side. This puts the cornea (clear tissue in front of the coloured portion of the eye) at risk of damage. If this damage is severe it can affect your vision, causing blindness. If you are unable to close your eye then you will be provided with eye drops and ointment to protect your eye. You will also be provided with details on how to tape your eye shut (see below). An appointment may also be arranged to see the eye specialist, as well as a physiotherapist who specialises in weakness of the face. What are the key points to consider when looking after my affected eye? An assisted blink is helpful. You can do this by looking downwards and lifting your lower eyelid upwards and gently rolling it over the eye for a few seconds. If you go outside it is worth wearing wrap around sports glasses if you do not have spectacles. Avoid smoke filled rooms and air conditioning if possible as these irritate and dry eyes. page 3 of 8
Wearing swimming goggles can help to keep shampoo out of your eyes. Never screw your face up tight to try and close your eye; this can cause complications with your cheek muscles and lead to exaggerated asymmetry (unevenness) of your face. Eye care is continued until your eye closes and blinks effectively. Use preservative-free eye drops if using more than 4 times a day. If your eyes become painful or turn red, please seek urgent medical attention. What can I do, besides taking any prescribed medication, to aid recovery? Facial massage The muscles of your face can often become stiff. By massaging regularly, a couple of times a day, it will help maintain flexibility and promote a good blood supply. Using any massage oil, gently, using the pads of your fingertips, massage the facial muscles in a circular motion. This needs to be around your affected eye and mouth area. Eating and drinking Attempt to use both sides of your mouth when chewing and drinking. Food may become trapped inside the cheek on the affected side; where appropriate use your tongue or your finger to clear this. Saliva may also escape your mouth initially. Carry a tissue or a handkerchief and drink and eat more slowly. page 4 of 8
Eyelid stretching Your facial muscles may become stiff so exercising and stretching your eyelids will help improve your eye closure. Please follow the simple steps below. Step 1 Step 2 Step 3 Look down Use the outside of your finger to gently bring your eyelid down. Repeat this 5 times, three times a day. Raise your eyebrow and use the outside of your finger to gently bring your eyelid down. Repeat this 5 times, three times a day. Eye taping Both upper and lower lid taping can be done at any time if your eye feels tired, if you wish to keep the eye shut, as in sleeping, and/or to keep medication such as lubricants on your eye for longer periods of time. Taping of the lower lid can be done to keep the lid in a neutral position whilst waiting for healing. This should be encouraged in order to stop the lid drooping as a result of gravity. It can be done during the day and page 5 of 8
at night when sleeping combined with the upper lid taping. There is no set period for the length of taping. Taping of the upper lid is usually used for rest periods and sleep. The eye should be kept shut whilst sleeping to prevent it drying out and damage occurring. Transpore, micropore or omnipore tape should be used for taping. They can be obtained from any pharmacy. Use a piece slightly longer than the width of the eyebrow. (Taping should be done after eyelid stretching.) Taping the lower lid Taping the upper lid (for sleeping) Look into the mirror and place the tape firmly down at the inner corner of the lower eyelid. Use your finger to lift the eyelid up and place the other end of the tape on or above the cheek bone. Look into the mirror and close your eye with your finger. Place the tape firmly down at the inner corner. Ensure half the tape covers the upper lid and half the lower lid. In a horizontal direction, apply the tape to the outer corner, ensuring the whole eye is covered. page 6 of 8
Who do I contact if I have any concerns? If you have any concerns during working hours (8.00am to 5.00pm), please contact the ENT Department through the hospital switchboard on 0114 271 1900. If you have any concerns outside of these hours then please: contact NHS 111, call your emergency GP, go to your local urgent walk-in centre, or go to your local A&E. Where can I find further information? For more information please visit: www.facialpalsy.org.uk http://fts-uk.org/ page 7 of 8
Leaflet designed by Mr Anthony Bashyam, Dr Patrick King and Mr Glen Watson for Sheffield ENT Department. Thanks also to Miss Z Currie, Occuloplastic Surgeon and Mr P Barrass, Senior Physiotherapist with interest in facial weakness. Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD8890-PIL3785 v1 Issue Date: October 2016. Review Date: October 2018