Bell’s Palsy & Facial Paralysis in NYC & NJ
Bell’s palsy is a form of temporary facial paralysis that results from injury or damage to one of the facial nerves and can cause significant facial distortion.Dr. Monica Tadros specializes in Bells’s Palsyand facial paralysis treatment for patients in NYC & NJ. Disorders of the facial nerve, including paralysis, develop from a variety of causes. Abnormal movement or paralysis of the face can result from infection, injury, or tumors, and an evaluation by your physician is needed to determine the cause. Dr. Tadros has advanced training and extensive experience in managing the full range of facial nerve disorders for her patients in NYC & NJ.
Dr. Tadros accepts most POS and PPO insurance in NYC & NJ for any medical issues as an out of network provider. Please contact us today or call NYC: (212) 532-4590 or NJ: (201) 408-5430.
Bell’s Palsy & Facial Paralysis In Depth
by Monica Tadros, M.D., F.A.C.S.
What Is the Facial Nerve?
The facial nerve resembles a telephone cable and contains about ten thousand individual nerve fibers. Each fiber carries electrical impulses to a specific facial muscle. Information passing along the fibers of this nerve allows us to laugh, cry, smile, or frown, hence the name, “the nerve of facial expression.” Among the most complex nerves in our body, the facial nerve is central to our ability to manipulate our expression in countless ways, adding layers of emotion to the way we communicate. When there is nerve damage, facial weakness occurs. If these nerve fibers are irritated, then movements of the facial muscles appear as spasms or twitching. The facial nerve not only carries nerve impulses to the muscles of the face, but also to the tear glands, to the saliva glands, and to the muscle of the stirrup bone in the middle ear (the stapes). It also transmits taste from the front of the tongue. Since the function of the facial nerve is so complex, many symptoms may occur when the fibers of the facial nerve are disrupted. A disorder of the facial nerve may result in: twitching, weakness or paralysis of the face such as Bell’s Palsy dryness of the eye or the mouth or even disturbance of taste for patients in NYC & NJ.
How Does the Facial Nerve Work?
The anatomy of the facial nerve is very complex. The facial nerve passes through the base of the skull in transit from the brain to the muscles of facial expression. After leaving the brain, the facial nerve enters the bone of the ear (temporal bone) through a small bony tunnel (the internal auditory canal) in very close association with the hearing and balance nerves. Along its course within the temporal bone, the facial nerve winds around the three middle ear bones, in back of the eardrum, and then through the mastoid (the bony area behind the part of the ear that is visible). After the facial nerve leaves the mastoid, it passes through the salivary gland in the face (parotid gland) and divides into many branches, which supply the various facial muscles. The facial nerve gives off many branches as it courses through the temporal bone: to the tear gland, to the stapes muscle, to the tongue (for taste sensation), and to the saliva glands.
Bell’s Palsy and Other Causes of Facial Weakness
The most common cause of facial weakness for patients in NYC & NJ which develops suddenly is referred to as “Bell’s palsy.” The etiology of this disorder is unknown, but is probably due to the body’s response to a virus: in reaction to the virus the facial nerve within the ear (temporal) bone swells, and this pressure on the nerve in the bony canal damages it.
In order diagnose facial nerve disorders and determine the cause of the facial weakness, a special set of questions will be asked. After an examination of the head, neck, and ears, a series of tests may be performed.
The most common tests include:
- Hearing Tests: Determine if the cause of damage to the nerve has involved the hearing nerve or inner ear.
- Imaging: CT (computerized tomography) or MRI (magnetic resonance imaging) may determine if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve
- MRI is the gold standard for diagnosis of facial nerve disorders; CT scans are used in cases of mass lesions or trauma.
- Electrical Tests:By stimulating the facial nerve, electrical tests can be used to assess how badly the nerve is damaged. They include Nerve Excitability Test (NET) to determine the extent of nerve fiber damage in the case of total paralysis. If the test is normal despite paralysis, this may suggest a higher chance of recovering function. Electroneurography (ENoG) uses electrodes placed on the face and a small current to stimulate the facial nerve. During stimulation, a computer measures the muscular response. Electromyography (EMG) is an electrical test that measures the muscles during rest, during voluntary movements, and during electrical stimulation. It is used to determine if the nerve and muscles are recovering. These tests may be repeated at frequent intervals to monitor recovery.
Treatments for Bell’s palsy and Facial paralysis Disorders
The standard of treatment for Bell’s palsy and facial paralysis for patients in NYC & NJ is to treat the cause. Our facial plastic surgeons work with our patients to accurately determine the cause of the disorder and prescribe the best treatment for the condition. For Bell’s palsy, the usual regimen includes steroids and antiviral medications. Surgical decompression and rehabilitative procedures including gold weights and reanimation surgery may also be appropriate.
If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses such as Bell’s Palsy or Ramsay Hunt) may be used. If simple swelling is believed to be responsible for the facial nerve disorder, then steroids are often prescribed.
In cases of trauma or for some patients with Bell’s palsy, surgical removal of the bone around the nerve (decompression) may be necessary.
Protecting the Eye in Facial Nerve Disorders
When the facial nerve is paralyzed, considerable attention must be given to maintaining a healthy eye, which requires a constant flow of tears. These tears are spread out over the eye by blinking, but blinking is diminished or eliminated in facial nerve paralysis. Diminished blinking and the absence of tearing together can reduce or eliminate the flow of tears across the eyeball, resulting in drying, erosion, and ulcer formation on the cornea and possible loss of the eye. The eye is kept moist initially with artificial tears during the day and ointment at night. It may also be taped shut. When weakness is profound and/or prolonged, the cornea may be exposed and at risk for exposure keratitis. In these circumstances, a gold weight may be placed. Gold weight insertion is a simple, reversible procedure that may be performed in the office setting, to provide effortless eye closure and protection.
Alternatively, Dr. Tadros has pioneered a technique of using injectable hyaluronic acid filler to simulate a gold weight for patients where recovery is still uncertain. This non-surgical option is rapidly reversible in the office upon return of eylid function.
Complex eye disorders may result from prolonged paralysis, including chronic tearing, lower lid laxity and ectropion. A number of corrective procedures are available to treat these conditions and protect the delicate eye area.
Rehabilitation from Facial Nerve Disorders
Best face surgeon NYC & NJ offers the most advanced medical therapies to treat the individual etiologies of early facial paralysis to swiftly optimize potential recovery. In circumstances of permanent paralysis, alternative treatments must be tailored to the individual on the basis of etiology, duration/ location of paralysis and degree of weakness. Patients with permanent facial paralysis may be rehabilitated through a variety of surgical procedures including gold eyelid weights, orbital reconstruction, nasal airway repair, muscle transfers and nerve substitutions. Other medical treatments for complications of facial paralysis including excessive motion of the face or muscle spasm and may involve surgical division of overactive muscles or weakening them by chemical injection using small amounts of BOTOX® .
The significant emotional and psychological issues that often accompany disorders of the face, are especially significant in cases of paralysis where patients cannot smile or adequately convey their emotions. The impact of this for both the patient and family is devastating and should not be underestimated. Behavioral changes limiting public exposure or display of emotion, should be discussed openly and highlight the importance of rehabilitation.
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ABOUT DR. MONICA TADROS
Dr. Tadros is a distinguished Facial Plastic Surgeon & Reconstructive Surgeon and Educator.
She is one of a small number of surgeons to attain dual board certification in Otolaryngology-Head & Neck Surgery and Facial Plastic & Reconstructive Surgery and has combined the two specialties in her unique practice of aesthetic medicine.
Dr. Tadros has received numerous awards and accolades for her forward thinking, teaching and innovations in Aesthetic Facial Surgery. She was appointed the Director of Facial Plastic & Reconstructive Surgery and Asst. Professor of Otolaryngology-Head & Neck Surgery at the prestigious Columbia University in 2006, where she taught many generations of residents and medical students. She has received numerous awards and accolades for her forward thinking, teaching and innovations in Aesthetic Facial Surgery.
Interested in learning more about Bell’s palsy and facial paralysis treatment in NYC & NJ? Please contact Dr. Tadros at NYC: (212) 532-4590 or NJ: (201) 408-5430 to schedule your consultation. Her office is conveniently located near 300 Grand Ave, Englewood, NJ, 07631. Dr. Tadros believes that the initial consultation is most important and should be done face to face with your surgeon. After listening closely and carefully to your concerns, Dr. Tadros is able to do a critical evaluation and make the correct recommendations to address your specific needs for your Bell’s palsy and facial paralysis treatment in NYC & NJ.