Facial paralysis is a far more common disorder than people think. It can affect anyone, including Hollywood celebrities. Most recently, facial paralysis has affected the actress Angelina Jolie. She joins a slew of famous celebrities who have been diagnosed with the disease.
What is Facial Paralysis?
Facial paralysis refers to not being able to voluntarily move some or all of the muscles of the face, which is typically the result of some type of damage to the facial nerve (also referred to as cranial nerve [CN] VII). These muscles are responsible for vital functions such as chewing, speaking, closing the eyes, and expressing moods and emotions. As a result, facial paralysis has the potential to be a devastating condition. Most commonly the paralysis occurs on one side of the face (unilateral); less commonly the paralysis occurs on both sides of the face (bilateral). Facial paralysis can occur suddenly and many people awake with it. It can also have an insidious, gradual onset. The length of symptoms depends on the cause and can be short (weeks) to an extended period of time (months to years).
What Celebrities Have Experienced Facial Paralysis?
Celebrities that have been diagnosed with Bell’s palsy, the most common form of facial paralysis, include:
The actress was diagnosed with Bell’s palsy in 2016 and opened up about her battle with facial paralysis. She has since fully recovered with the help of acupuncture. Jolie has made headlines in the past for decision to undergo a double mastectomy with breast reconstruction as well as removal of her ovaries after testing positive for the breast cancer gene.
The actor was stricken with the disease as a 14-year-old. He joked that beginning your freshman year of high school was “a bad time for having half your face paralyzed.” He recovered after 9 months.
The former James Bond hero had the disease in the 1980s, which affected the right side of his face. He was treated with prednisone, a steroid, and recovered after several weeks. As he was filming during that time, he had his film shot from the left side to cloak the disease.
The, actor famous for his roles as “Rocky Balboa” and “John Rambo”, was actually born with facial paralysis resulting from birth complications. The residual effects of Bell’s palsy are responsible for his crooked smile and slurred speech pattern.
The former Mrs. Tom Cruise and actress from Dawson’s Creek was also a victim of facial paralysis. It is thought the residual effects of Bell’s palsy are responsible for her classic facial smirk.
Signs and Symptoms of Facial Paralysis
Most of the signs and symptoms of facial paralysis are readily apparent. Signs and symptoms of facial paralysis may include:
- Facial/mouth drooping, most commonly one-sided and on the affected side
- Inability to voluntarily raise the eyebrow on the affected side
- Inability to blink or close an eyelid, which increases the chances of the cornea drying out
- Reduced tear production
- Loss of ability to raise, lower, or pucker the lips on the affected side, leading to inability to smile or frown, drooling, dribbling when drinking, and slurred speech
- Decreased sense of taste, especially in the front area of the tongue
Causes of Facial Paralysis
Facial paralysis is typically caused by damage or swelling of the facial nerve, which controls the movement of the facial muscles, or damage to the part of the brain responsible for sending messages to the facial muscles. Common causes of facial paralysis include:
- Infection or inflammation of the facial nerve, including Bell’s palsy, Ramsay Hunt syndrome, Lyme disease, and meningitis
- Trauma, including basal skull fractures and facial injuries
- Diabetes mellitus
- Tumors of the head, neck, and brain
- Birth trauma as a result of forceps delivery
- Autoimmune diseases, such as multiple sclerosis (MS) and sarcoidosis
Diagnosing the Cause of Facial Paralysis
In addition to a physical examination, physicians may schedule electromyography (EMG) to investigate the strength of the facial muscles and nerves responsible for their control. Imaging studies such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) may be used to diagnose etiologies, such as strokes, infections, or tumors of the head, neck, and brain. Additionally, blood tests may give insight into infectious causes such as Lyme disease, chickenpox, herpes simplex virus (HSV), and influenza (the flu).
Treatment of Facial Paralysis
Treatment of facial paralysis is dependent upon a number of factors, including the age of the patient, etiology of the paralysis, severity of paralysis, and duration of paralysis. For example, Bell’s palsy, the most common cause of facial paralysis, is often treated with steroids (prednisone or prednisolone) and antivirals (valcyclovir). Additionally, most individuals achieve full recovery from Bell’s palsy within 6 months.
One of the significant dangers of facial paralysis is eye damage as a result of the altered blinking response. Blinking keeps the cornea moist and prevents particles from entering the eye that may cause damage. Without the normal blink response, individuals affected by facial paralysis are encouraged to frequently use artificial tears to decrease the odds of eye damage. Cosmetic surgery is sometimes needed to place small weights in the upper eyelids to help them close properly. Additional cosmetic procedures that may be helpful for individuals with facial paralysis, especially those with an altered blinking response, include brow lifts and injections of hyaluronic gel (Juvéderm®, Restylane®).
Injections of botulinum toxin (Botox®) are becoming commonplace in the treatment of facial paralysis. Everyone is familiar with the use of Botox in anti-aging programs, but it is also helpful in individuals with facial paralysis experiencing involuntary spasms of facial muscles. Botox works by paralyzing muscles, thereby, improving the facial asymmetry caused by facial drooping.
Unfortunately, not everyone is able to recover from facial paralysis. In these individuals, surgery becomes a necessity and the following procedures may have to be performed:
- Direct nerve reattachment
- Selective neurolysis
- Nerve grafts with or without muscle flaps
- Temporalis tendon transfer
- Trigeminal-facial nerve transfer
- Static slings
The above surgical techniques are often combined with facial muscle retraining and physical therapy to optimize patient outcomes.
Thankfully, La Peer employs one of the top facial paralysis surgeons in the country, Dr. Babak Azizzadeh. Dr. Azizzadeh has helped many patients recover from facial paralysis disorders, and has also been featured on such outlets as the New York Times and the Oprah Winfrey Show. Learn more about Dr. Azizzadeh and his practice.