Facial Paralysis/Seventh Nerve Palsy
Injury to the seventh cranial nerve can cause facial weakness or paralysis. Also called a facial nerve palsy or seventh nerve palsy, the condition can be particularly dangerous for the eye since eyelid function if affected. Due to this, oculoplastic surgeons are often consulted and commonly treat patients with seventh nerve injuries. The facial nerve originates in the brain, exits the skull base near the ear, and then travels throughout the face to control many of the facial muscles including the eyelids. Injury anywhere along its course can cause problems with facial and eyelid movement. Common causes of nerve injury include Bell’s palsy, stoke, trauma, tumor, and surgery in the area of the nerve. Bell’s palsy is a type of seventh nerve injury that is thought to be due to a viral infection although this is difficult to confirm.
Signs of a seventh nerve injury include facial droop, eyebrow droop, lower eyelid ectropion, and poor eyelid closure (called lagophthalmos). Symptoms include blurred vision, tearing, eye pain, and a red eye. Poor eyelid closure can lead to corneal abrasion, and potentially corneal infection or scarring.
Treatment of a seventh nerve injury depends on the cause and severity. Some nerves will recover with time, and symptomatic treatment with eye lubrication, closing the lid at night, and potentially placing a temporary plug in the tear duct may be enough. If the seventh nerve palsy is more severe or does not recover, then surgical treatment may be necessary.
Several different surgical procedures can be performed for a seventh nerve injury. Raising and tightening the lower lid (paralytic ectropion repair), upper eyelid weight loading (gold or platinum weight placement), and a brow lift can be performed. Lower face lifting can also be beneficial. Occasionally a tarsorrhaphy (surgically adjoining the upper and lower lid) may need to be performed and can be temporary or permanent. Surgery for seventh nerve palsy is usually performed as an outpatient and is highly customized for each individual patient’s case. The goal of surgery is both cosmetic and functional, as to achieve a balanced facial appearance and maintain the health of the eye.