The stages of facial palsy 

There are three stages of recovery:

1) Flaccid stage

2) Paresis stage

3) Synkinetic stage

Flaccid stage

Immediately following the onset of facial paralysis, the facial muscles lose their natural “springiness”. Due to the effects of gravity on decreased muscle tone,  the muscles become elongated and floppy. This results in many effects on the forehead, eye region, cheek, mouth and neck. For example, the eyebrow droops. Paralysis of the muscles that circle the eye means that it does not close fully which can cause dryness and a sore eye. This can eventually cause damage to the delicate eye surface. The corner of the mouth may droop, affecting one’s ability to keep food or drink inside the mouth.

If the facial paralysis does not resolve after one month, you should be referred to a facial palsy specialist.  This could be an ENT consultant, neurologist or plastic surgeon.

Paresis stage

As the nerves start to recover and resupply the face, there is a gradual increase in springiness of the facial muscles. The muscles shorten towards their more natural length which improves the facial symmetry when the face is at rest. The muscles may still not be able to fully contract, which means that expressions may still be imbalanced. During this phase, patients may notice that their face gets tired quite easily and that the asymmetry worsens during the course of the day.

Synkinetic stage (synkinesis) 

If recovery takes a long time, the regrowth of the facial nerve may cause some muscles to move in a linked fashion.  For example, on smiling the eye on the affected side my close involuntarily. Alternatively, when closing the eyes or blinking, muscles in the cheek, chin or neck may contract simultaneously. This is called synkinesis, from the Greek “syn” meaning together (as in synchronising i.e. at the same time), and “kinesis” derived from the term meaning movement (as in kinetic energy). Unlike muscles in our limbs, facial muscles lack sensors that provide feedback to the brain about their state of activation.  This means that control of movement is difficult once synkinesis becomes established unless there is a way to gain feedback about what the muscles are doing. A small amount of feedback is provided by the movement of the skin overlying the muscles, but this does not provide precise information.

Read more

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Photo by Kira auf der Heide on Unsplash