Peripheral facial paralysis

Abstract

Peripheral facial paralysis causes asymmetry of the face affecting the upper and lower territories. Its management requires the completion of an initial clinical assessment in order to specify the topography, the severity of the involvement, the etiological nature and the possible complications. The knowledge and the mastery of the anatomo-physio-pathological bases makes it possible to understand the different clinical pictures. The rehabilitation must be started as early as possible, to accompany the various stages of sensitivo-motor recovery. It must be performed by a multidisciplinary team consisting of a physical and rehabilitation doctor, a neurologist, an otolaryngologist, a plastic surgeon, a physiotherapist, a speech therapist and a psychologist whose role is to to help the patient to accept the self-image, to recover confi dence and self-esteem and to encourage the resumption of socio-cultural-professional activities.

Rehabilitation of unilateral peripheral facial paralysis in Guillain-Barré: a case study

“…The facial musculature was assessed with the Chevalier protocol 13 , verifying null or decreased contraction in the following: occipitofrontal (0), eyebrow corrugator (0), procerus/pyramidalis nasi (0), orbicularis oculi (1), palpebral portion of the orbicular oculi (1), levator labii superioris alaeque nasi (0), levator labii superioris (0), zygomaticus minor (0), zygomaticus major (0), buccinator (2), risorius (0), depressor labii inferioris (0), mentalis (0), depressor anguli oris (0), orbicularis oris (0), platysma (2).…”

“…Facial palsy can be defined as a change in the mimetic muscles caused by a lesion in the facial nerve at any point of its trajectory (from the pons nucleus to the neuromuscular junction) 1,2 . In peripheral facial palsy (PFP), the muscles in one or both hemifaces are totally or partially involved (depending on its etiology), usually affecting equally the three thirds of the face 2 .…”

“…The musculoskeletal structure of the face evidently influences the functions of the stomatognathic system -hence, speech, mastication, and swallowing disorders are expected to occur 2,3,7,8 . Compensatory movements, not only to perform these functions but also in the guided exercises, may worsen the structural imbalances 2 and cause facial pain, particularly in the temporomandibular joint (TMJ). Facial palsies have an important impact on the person's quality of life, with functional and psychosocial consequences 9,10 .…”

Facial nerve paralysis

“…Ocular complications can be represented by lagophthalmia, keratitis, conjunctivitis, eversion of the lower eyelid with tears running down the cheeks (epiphora) 44,45 . They occur during the evolution of a facial paralysis and require proper supervision and treatment (artificial tears).…”

“…Hemifacial spasm, also called post-paralytic spasm, must be detected early by electrical examination of the nerve and / or by testing the muscle tone of the facial muscles 1,46 . This test imagined by Georges Freyss consists in giving each facial muscle (10 lateral and medial muscle groups) a grade be-tween 0-30 depending on its degree of motricity (0 -total paralysis, without muscle contracture; 30normal contraction) 44 .…”