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Bell's Palsy Facial Nerve Reconstruction - Cranial Nerve Palsy
Cranial nerve palsy is a condition in which one or more cranial nerves are damaged so that they are not able to function correctly. It often leads to complications, such as paralysis of the facial muscles, drooping eyelids, and difficulty making some common facial expressions. Medical professionals typically treat this condition with physical therapy and medication.
It is possible, however, for some patients with cranial nerve palsy to experience long-term issues with their facial nerves. Eyelid surgery (blepharoplasty) can often help in such cases. This procedure can fix the sagging and drooping of the upper eyelid and can also restore their function and appearance. Furthermore, it can create facial symmetry.
In this article, you will learn how cosmetic eyelid surgery can help you deal with cranial nerve palsy and its consequences. Nevertheless, prior to exploring the treatment methods, it is important first to look at and understand the essence of this condition.
What are cranial nerves and what types of cranial nerve palsy exist?
Cranial nerves are those nerves that connect our brain to various parts of our body such as the neck and head. We normally have 12 pairs of cranial nerves. Each of them serves a specific function, has a distinctive name, and corresponds to a Roman number (I through XII). For example, the first nerve, which is the olfactory nerve is responsible for the ability to distinguish between different smells, whereas the optic nerve, which is numbered II, assists the ability to perceive colours.
The oculomotor nerve which is the third nerve affects eye muscles and upper eyelids movement. Obviously, this list can go on until XII.
Cranial nerve palsy occurs when one or more of your nerves are damaged. As a consequence, you may have difficulty moving and feeling. Cranial nerve palsies can be divided into several different categories depending on which nerve is affected. The following are some examples.
- Third cranial nerve palsy. As the names suggest this condition affects cranial nerve III which is called the oculomotor nerve. It has an impact on eye movement. The oculomotor nerve has a very important role since it is responsible for supplying 4 of the 6 extraocular muscles.
- Fourth cranial nerve palsy. The fourth nerve is known as a trochlear nerve and is responsible for the movements of the superior oblique muscle (the muscle that controls the inward, outward and downward movements of the eye).
- Sixth cranial nerve palsy. It corresponds to the so-called Abducent nerve, which also controls the lateral rectus muscle, hence the eye movement.
- Seventh cranial nerve palsy. The condition is more commonly known as Bell’s palsy and leads to partial or complete paralysis of the facial muscles.
- Microvascular nerve palsy. It affects two cranial nerves – the fourth one (trochlear nerve) and the sixth one (Abducens nerve). As a result, the eye has a hard time moving in a particular direction and double vision is present.
Damage to any of those nerves can not only affect your vision and ability to move your eye normally but can also have a significant impact on your facial appearance.
How can eyelid surgery help you with cranial nerve palsy?
Eyelid surgery can be a highly effective option for treating cranial nerve palsy. The condition often results in unpleasant changes in the face area, such as drooping eyelids and brows, eye asymmetry, and so on. Eyelid surgery can successfully resolve such issues, making your eyes more even and your smile more attractive.
Different surgical approaches are available, and which one is used depends on the degree of severity and the type of cranial nerve palsy you have, whether it is oculomotor palsy, bell's palsy or abducens nerve palsy. Here are some of your options.
Eyelid lift surgery (Blepharoplasty)
You may benefit from this surgery if you have sagging upper eyelid skin caused by third nerve palsies or bells palsy. Blepharoplasty will lift your heavy eyelids, improve your vision, and improve the appearance of your eyes. With this procedure, the surgeon can remove or reposition fat from the upper eyelids, so you will no longer have puffy eyes. The excess skin that causes droopiness and sagginess around the eyes is also removed.
Typically, this is a relatively easy procedure that is often done under local anaesthesia. Recovery is generally not longer than two weeks, and complications are fairly uncommon.
Ptosis repair surgery
Bell's palsy and oculomotor nerve palsy often cause drooping of the upper eyelid which is known as ptosis. The problem typically occurs due to the paralysis of the levator palpebrae superiors (the muscle that lifts the upper eyelids). In such cases, ptosis repair surgery can be very beneficial since it raises the levator muscles.
It will help you achieve a higher position of your eyelids and a more harmonious contour of your eyes. It is also a straightforward surgery that has a low risk of complications and a quick recovery time.
Brow lift
Ptosis of the eyebrow is not uncommon in people with cranial nerves III, VI and VII palsies. This is where the brow lift procedure comes in handy. There are several ways to conduct the surgery depending on the severity of your ptosis and what you intend to accomplish. You can either elevate just the eyebrows laterally or lift them entirely.
If you want to know what type of surgery would be best for you, you should consult a plastic surgeon. Your doctor will evaluate your condition and degree of droopiness. He/ she will also ask you about your goals to determine which cosmetic procedure is right for you.
What other treatments are available for cranial nerve palsy?
While there is a chance for the condition to go away on its own, there are some treatments that can speed up the healing process. Based on the type and severity of the affected nerve, your doctor may recommend medications, physical therapy, chemodenervation injections with botox or surgery. Here is some information about each of these options.
Medications
Mild cases of bells palsy and sixth nerve palsy are often addressed through antiviral drugs or corticosteroids. Oculomotor nerve palsy is normally not treated through medications since it is a more serious condition. Non-steroid anti-inflammatory medicines can be prescribed to manage the pain.
Physical therapy
Oftentimes, vision therapy is recommended for patients who have third nerve palsy. It enables you to have more normal vision. You will, however, typically need a number of sessions to see results.
The use of physical therapies is also highly effective in treating Bell's palsy and sixth nerve palsy. The therapist will instruct you on how to exercise your facial and eye muscles so that you can improve your condition and prevent it from occurring again.
Chemodenervation injections with Botox
Botulinum toxin or Botox is known for its ability to paralyze the muscles. This property makes it beneficial in alleviating bell's palsy symptoms. When it is injected into the affected area of the face, it weakens the facial muscles, thereby relieving the symptoms.
This treatment can also be used to correct poor alignment associated with sixth nerve palsy or partial third nerve palsy.
Surgery
Surgery is very rarely required for Bells palsy and sixth nerve palsy, but it is one of the most efficient ways to alleviate symptoms of oculomotor nerve palsy.
Several surgical options can be used to correct problems like asymmetry in smiling, improper eye closing, and so forth. Below are a few examples.
- Strabismus Surgery (eye muscle surgery). The procedure is suitable when the eyes do not align properly to focus on an object. This is a common problem in patients with oculomotor nerve palsy. It normally causes deviation of the affected eye to the side and downwards due to the paralysis of muscles called the medial rectus and inferior oblique muscles. In strabismus surgery, the doctor adjusts these muscles so that your eyes remain straight ahead.
- Tarsorrhaphy surgery. If you have facial paralysis and can't close your eyelids correctly, then this procedure may help prevent painful drying of your eyes. This surgery involves joining the lower and upper lids to cover either the whole or part of the eye. Although this procedure may seem frightening, you should realize that it is usually used as a temporary measure. Once you heal your eyelids and your neurological function returns, the sutures in the tarsorrhaphy will be removed.
- Ectropion repair surgery. It can help improve sagging eyelids as well as eliminate constant tearing. It is a relatively simple procedure where the lid is tightened and the tendon of the outer corner of the eye is reinforced. Permanent sutures are placed to restore the normal appearance and functioning of the eyelids.
What causes cranial nerve palsy?
Some cranial palsies may occur due to diseases like diabetes or high blood pressure, while others can simply be caused by infection or a cold.
In this sense, some types of paralysis are potentially dangerous, and this is especially true for cranial nerves iii palsies. As for Bel's palsy and sixth nerve palsy, they are generally not dangerous.
In this section, we will discuss some of the possible causes of different types of cranial neuropathies.
What causes third cranial nerve damage?
- Diabetic disease
- Increased blood pressure
- Injury to the head
- Aneurysm
- Increased intracranial pressure by tumour or posterior communicating artery aneurysm or uncle herniation
- Autoimmune disorders such as myasthenia gravis
- Migraine and others.
What are the causes of sixth cranial nerve palsies?
- Infections
- Meningitis
- Lyme disease
- Diabetic conditions
- Heart attack or high blood pressure
- Brain aneurysm, etc.
What are the causes of bel's palsy?
- Cold or influenza B virus infection
- Viruses such as herpes simplex (genital herpes) or chickenpox and shingles (herpes zoster)
- Hand-foot-and-mouth disease
- Infections like mononucleosis and cytomegalovirus
- Diseases of the respiratory system, etc.
What are the symptoms of cranial nerve palsy?
Symptoms of third nerve palsy
- Diplopia or the so-called double vision
- Ptosis (eyelid drooping)
- Eye deviation in the direction of the outward and downward
- You cannot move your eye upwards or inwards
- Too large and dilated pupil which does not respond to light normally
Symptoms of sixth nerve palsy
- Double vision
- Strabismus and crossed eyes due to poor eye alignment
- Drooping eyelids
- Weakness of the face
- Fever
Symptoms of bells palsy
- Asymmetrical paralysis of the face
- You have a hard time smiling or closing your eyes
- Earache or jaw pain
- Constant tearing.
In general, there is no specific method of diagnosing the condition. You will usually be asked to describe your symptoms to a doctor, and he or she may recommend that you undergo tests such as blood tests, magnetic resonance imaging (MRI), computerized tomography (CT) scans, and electromyograms (EMGs).
Why is the third nerve palsy the most worrisome?
Oculomotor nerve palsy is one of the most worrisome paralysis conditions since a subset of these cases is associated with life-threatening aneurysms. It is an ocular emergency that should be addressed immediately.
The oculomotor nerve serves many important functions and has a very complex anatomy. This is why its damage can lead to many problems, some of which could be serious. Here are the main functions of this cranial nerve.
- Motor function. Cranial nerve III is responsible for the normal function of four out of the six extraocular muscles, I.e., the medial rectus muscle (moves the eyes towards the nose), the superior rectus (moves the eyes upwards), the inferior rectus (moves the eyes downwards), and inferior oblique (moves the eyes inwards).
- Sympathetic function. The oculomotor nerve controls the levator palpebrae superior which has a crucial role in the proper function of the upper eyelids.
- Parasympathetic function. The nerve also connects with neurons in the ciliary ganglion (it supplies nerve impulses to the sphincter pupillae), as well as the ciliary muscles (they correct the ocular lens shape to allow clear vision at close range).
The third cranial nerve is composed of parasympathetic and somatic fibers. Located along the periphery of the nerve, the parasympathetic nerve fibers (pupil) are responsible for controlling the pupil. Somatic motor fibres (extraocular) are found deep inside the oculomotor nerves.
They receive their blood vessels supply through the internal carotid artery and are responsible for controlling extraocular muscles.
The oculomotor nerve fibers originate in the oculomotor nucleus of the midbrain. From here they travel to the orbit of the eye, along the way dividing into different branches called superior branch and inferior branch. Each of these superior and inferior branches supplies different eye muscles.
Is cranial nerve palsy curable?
Most of the time, sixth and seventh nerve palsies are just temporary conditions that will go away after a few weeks. Medical treatment and physical therapy can successfully manage the symptoms of the illnesses.
On the other hand, cranial nerve III palsy often requires surgery to heal. The condition can be completely reversed, however, it really depends on the underlying cause.
