One-sided swelling of the facial nerve within its canal which gives rise to paralysis or weakness of the facial muscles supplied by the nerve. Most commonly Idiopathic and/or familial, occasion ally associated with Herpes zoster or simplex, sometimes caused by exposure to cold.

Usually arises suddenly (over a few days) and presents with total or partial paralysis of facial muscles, mild numbness, and drooling. There may be loss of taste, earache, or excessive tear production on the affected side. When there is inadequate tear production, the eye is closed and patched to prevent corneal abrasions.

Medical treatment includes corticosteroids immediately after the onset of the palsy; steroid treatment four days after onset is considered to be of little benefit. Unless severe (total denervation), full early recovery is expected; when severe, there may be only partial recovery with some long-term complications (crocodile tears, hemifacial spasms).

ANATOMY

The facial nerve is the seventh cranial nerve; it supplies the muscles of the face, auricle, scalp, and platysma as well as the posterior belly of the digastric, the stylohyoid, and the stapedius. Its terminal branches appear at the margins of the parotid gland and fan out into six branches:

-cervical (platysma and lower lip),

-temporal (all the muscles above that level),

-zygomatic (infraorbital region),

-buccal (buccinator and other muscles of the cheek),

-mandibular (lower lip and chin)

-posterior auricular (passes backward).

MEDICAL EVALUATION IS NECESSARY

Paralysis of the facial nerve may be caused by a number of associated conditions, some of which are serious medical problems (cancer, parotid gland tumors, sarcoidosis, brainstem stroke, multiple sclerosis, fracture). Bilateral facial nerve palsy is unusual and may be a sign of Guillain-Barre syndrome or chronic meningitis.

CLINICAL

Bodywork that contributes to a better balance between the neck and head will be helpful. The swelling of the nerve is within the temporal bone, so there is little danger of further injury to the nerve with gentle manipulation. However, there is a need for caution when working with weakened or paralyzed muscles. A light touch is advised, with great attention to the flaccidity of the tissue. As tone is regained, further bodywork can be firmer and address underlying muscle tensions. Since there is a danger that there may be cancer associated with facial nerve paralysis, bodywork is CONTRAINDICATED until there has been medical evaluation. In addition, there are sometimes problems of altered tissue tone associated-with corticosteroid use. Again, great attention to the quality of the tissue and a light touch are needed.Bell’s Palsy