When you develop an acute facial palsy from Bell’s palsy or Ramsay Hunt syndrome, most of the damage is done to the nerve in the first 24 hours by the inflammatory process. It is well documented that 50 to 60 mgs of prednisone is the treatment of choice and is most effective at minimizing damage to the nerve in the first 24 hours.
Facial synkinesis is one of the more troublesome consequences after a facial palsy. It occurs as a result of aberrant nerve regrowth so that two or more movements become connected. The most typical one is a connection between the eye and the mouth, for example when you pucker or chew, the eye closes and vice versa. Synkinesis can be reinforced by stress, tiredness, cold and over exerting to produce movements in the face. It is also enhanced by the use of electrical stimulation to the face. Treatment of synkinesis is challenging, but can be quite successful with dedicated work. Heat, stretching and training isolation of movements is the key to treatment. Essentially, the brain is being trained to separate movements. A trained facial therapist can help you to learn how to separate your movements and decrease synkinesis.
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