Blog Stories

Facial Nerve Paralysis - series 2

  • Facial Nerve Paralysis- Sequelae- Series
  • Presentations. A 32 yr old gentleman developed- Left BELL's Palsy (Facial Nerve Paralysis) about 1 yr back spontaneously (no cause) on the night of Mahasivaratri festival. He developed symptoms and signs of Facial nerve paralysis which include-
    • Inability to lift Eye brows.
    • Inability to close eyelids (which is the most significant functionally).
    • Inability show teeth properly and deviation of angle of mouth to opposite normal side on attempted smiling (gives impression that abnormality is on that normal side and is the most disturbing to patient).
    • Recovery
    • He recovered some of the functions slowly over a period of time (in a few months)- approx. 70% recovery in some like closure of eye lids but very minimal recovery in Eye brows lift & Mouth deviation...But developed some paradoxical movements-that is the opposite function of Facial muscles, especially in the recovered Eye closure function, that means he developed frequent INVOLUTARY spasms of eye lid closing muscle (Orbicular is Occult), which can happen...leading to frequent winking of eye and narrow eyelid aperture, which he is trying to compensate by raising Eye brows voluntarily. Normally recovery in Bells palsy is up to 90%, but variations do occur. He did not undergo any surgery till now. Now he presented to us with above disturbing narrowed eyelid aperture and winking.
    • Discussion
    • Now he requires widening of Eyelid aperture and decrease of winking on left side and there is reasonably good recovery of Facial muscles function- we decided NOT to operate on him and administer Inj. BOTOX to the culprit muscles 9Orbicularis Occult & Zygomati cus major and minor on left side and altogether 10 units BOTOX were given.
    • Result
    • Now he is relieved of the symptoms-winking and narrow eyelid aperture. Hence our management seemed appropriate with a happy patient. But minus point is- BOTOX needs to be given often, which is worth it in this case than any surgery
    DrYVRao twitter DrYVRao facebook DrYVRao Google Plus DrYVRao pinterest