Treatments and Surgery

What can be done to help?

There are a wide range of treatments available for patients who have suffered a facial palsy. These treatments should always be provided and supervised by therapists 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 inappropiate 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. 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. It is important that you adhere to the advice you are given if you wish to maintain the health of your eye. You may find it helpful to wear 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 difficulties.

Facial Massage – Massaging your face is important. It helps to improve circulation to the facial muscles and also 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 and chin.

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.

  • 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 of massage or exercise will speed the recovery process.
  • It is important however, that when you do start treatment/exercise programme, it is the correct treatment that will meet your needs at that time.
  • You should not try any treatments without the supervision of a specialist therapist

What to do

  • If your facial palsy is not resolving, 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!

What to expect in therapy

  • Assessment and treatments using Electromyography (EMG). Electrodes are attached to the skin and measure how much energy your muscles are creating when you relax and when you try to contract them. A muscle can only contract if the nerve to that muscle is intact and working.
  • Advice and education.
  • Monitoring of progress.
  • Reassurance and motivation.
  • Advice on eye care and taping the eye closed.
  • Advice on mouth care and dry mouth management.
  • Advice on eating, drinking and speech improvement.
  • 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.
  • Relaxation of your facial nerve and muscles.
  • Exercises to reduce involuntary, unwanted movements.
  • Teaching of home exercise programmes to enable you to be independent with your recovery.
  • Patients should allow up to 2 hours for therapy sessions and expect to return every 3 – 6 months.

By the rest of the facial palsy team

  • Some people in a small number of cases may be appropriate for specialist surgeries.
  • Some people may require a course of Botox 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 undergo a course of social interaction skills retraining to regain confidence.
  • Some people may be referred to the eye specialists for advice and monitoring.

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 eye lid  weight to facilitate eye closure or blepharoplasty for those whose eye lid 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