Facial palsy: when and why to refer for specialist care.

Abstract

Facial paralysis causes significant functional and psychological morbidity, including anxiety and depression.1 The muscles of facial expression play a critical role in protecting the eye, maintaining oral competence, and are essential for portraying emotions to facilitate social interaction. The management of patients with facial palsy can be challenging because there are over 50 aetiologies that can result in facial muscle paralysis, and measuring severity is challenging. Facial palsy encountered in primary care can fall into one of three broad groups that help guide the management in both primary and secondary care. These are acute flaccid facial paralysis (AFFP), longstanding flaccid facial paralysis (LFFP), and post-paralytic facial palsy (PPFP).2 This article aims to provide guidance on when and why to refer patients with facial palsy to secondary care. The critical distinction between AFFP and LFFP relates to the presence or absence of viable facial mimetic muscles. The exact time at which the facial muscles become non-receptive to re-innervation remains unknown; however, many would consider 12 months as the point when a patient would transfer into the LFFP group.3 The majority of patients with AFFP will have Bell’s palsy.4 The exact cause of Bell’s palsy is unknown, but it is thought to result from facial nerve swelling within the …