Not seeking immediate medical assistance diminishes total recovery from facial paralysis

In Mexico, facial paralysis ranks on the first 10 places on medical assistance in rehabilitation clinics. Information gathered from the Instituto Nacional de Rehabilitación (National Institute of Rehabilitation) reveals an important increase of facial paralysis cases (212 cases in 2004, and 542 in 2006). This causes concern to improve the results. The incidence is of 20 to 30 cases for every 100 thousand individuals a year. 80% of facial paralysis cases are identified as idiopathic (meaning the specific cause is unknown). 70% of cases the recovery is relatively quick and complete.

According to the National Institute of Neurological Disorders and Stroke (NIH), facial paralysis is a syndrome that complicates the facial nerve function, causing an interruption of the messages the brain sends to facial muscles.  In peripheral facial paralysis it is also affected all facial muscles (forehead, eyes, and mouth), with an evident impairment of upper and inferior face mimicry.

Each facial nerve runs the muscles from one side of the face, even those that control blinking and closing the eye, as well as facial expressions like smiling or frowning. Additionally, the facial nerve transports nervous impulses to the tear glands, salivary glands, and the muscles of a small bone situated in the middle of the ear called stirrup. The facial nerve also transmits sensations from taste coming from the tongue. All of the aforementioned is affected by this syndrome.

There have been various proposed theories as to what causes this syndrome, including:

• Diabetes mellitus
• Hypertension
• Vascular dysfunction (damage or obstruction of blood vessels)
• Viral infection
• Immunological disorders and inflammation

A type of this syndrome is the Bell’s palsy, which is a form of temporary facial paralysis that is produced by damage or trauma to one of the facial nerves. There is evidence that suggests the main cause of this kind of paralysis is a Herpes family virus (HSV-1 and 2, HCMV, EBV, and VZV), or viral meningitis. Researchers point out that the facial nerve becomes swollen as a reaction to the infection. This disorder has been associated also with influenza and typical colds from cold seasons, headaches, middle ear chronic infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma like skull fracture or facial injury.

Bell’s Palsy symptoms vary from one person to another and vary in severity, including tics, weakness, paralysis on one side or both sides of the face, eyelid drooping and corner of the mouth, drooling, dryness of the eye or mouth, deterioration of taste and excessive tearing of the eye. Frequently, these symptoms lead to a substantial facial distortion, generally staring suddenly and maxing out in 48 hours.

Early attention of this disease is a factor for a good diagnosis. A prospective, longitudinal, descriptive, and observational study, including 251 patients with Bell’s palsy diagnose was performed by the National Institute of Rehabilitation in 2010. The study had the objective of determining the prognosis factors on Mexican patients with this syndrome. Socio-demographical, season, laterality, symptoms, and therapeutic options to determine prognosis factors for recovery were studied as characteristics.

Results show that 39% of patients had full recovery, and 41.5% had incomplete recovery. Marital status, gender, etiology, symptoms, laterality, House-Brackmann degree, and treatment did not represent substantial prognosis factors for recovery. However, the higher age of 40 (OR=2.4, IC 95% 1.3-4.3, p=0.002), and the lack of physical therapy (OR=6.4, IC 5% 1.4-29.6, p=0.006) were substantial prognosis factors for incomplete recovery. The proportion of cases with incomplete recovery is high because patients did not seek immediate medical assistance; that is, within the first 72 hours of symptoms manifested.

It is recommended to begin medical treatment during the first 72 hours of ailment with proper medication, corticosteroids, antiviral, and eye drops for a better recovery prognosis, as well as attending physiotherapy for pain treatment, and relaxation of the affected musculature.

Sources:

• Article: “Parálisis Facial: Un estudio prospectivo, longitudinal, descriptivo y observacional de los factores pronósticos para la recuperación en pacientes mexicanos”. Dra. Sánchez Chapul y sus colaboradores
• Article: “Caso clínico: Parálisis de Bell, reporte de un caso”. Rev Esp Cir Oral Maxilofac. 2013; 3 5(4):162–166.
• Diagnóstico y manejo de la parálisis de Bell. (Parálisis facial idiopática). ISBN: 978-607-8270-06-4
• National Institute of Neurological Disorders and Stroke