In long standing facial palsy, muscles on the normal side overcontract and pull the face across to the good side causing difficulty in articulation, eating and drinking, as well as cosmetic embarrassment and psychological effects as patients lack confidence in public.
Even though the face may look reasonable at rest, with volitional movement there is marked asymmetry from overaction on the normally acting side, especially in the nasolabial fold area, and of the mouth. Botox® is very successful in improving symmetry of the face, especially with movement, and leads to improved speech, reduced symptoms, improved cosmesis, mood and confidence. This is even greater for the younger patient who have good tissue tone. Side effects can consist of temporary drooling (a few days), and not being able to seal the lips.
Aberrant regeneration is the misdirected regrowth of nerve fibres and is commonly seen after facial nerve palsy. It can lead to unwanted and uncontrollable movements on the side of the palsy affecting the eye or face. Mild regeneration is usually not treated, but when the movements are moderate or severe, they can cause functional blindness (as the eye closes) or tightness of the face and cosmetic embarrassment. Botox® helps to relax the unwanted contractures and movements.
Crocodile tears are excess watering of the eye when eating. This is another form of aberrant regeneration. Botox ™ injected into the lacrimal gland abolishes the watering during eating.
In facial palsy, the eyelids may not close adequately over the front of the eye, causing it to be dry, develop ulcers or lose vision. Botox® can be injected in the upper eyelid to make it droopy so that the eyelids stay closed and allow the underlying corneal exposure to heal.
Benefits and Risks of Botox
Some of the advantages of Botox® include lack of known allergy and that there usually no signs of the treatment having been given. Rarely a patient may be resistant to Botox®, or under or over correction may occur. If no effect or a partial effect is seen, the Botox® injections can be repeated. The injections are less predictable for lines of the lower face or neck. Most complications occur due to local spread of Botox®. There is a small risk of ptosis (drooping of the eyelid – this is usually no more than 1-2 mm), lip ptosis (after injections of crow's feet), brow ptosis and double vision due to local spread of Botox®. These effects are temporary (usually last 2-10 weeks) and are reversible. Bruising may occur as with any other injection. Any headache is usually mild and lasts for a few hours only. Botox® should not be used in patients who have had a recent tetanus injection, who are pregnant or breast feeding, allergic to albumin or normal saline injections, have muscle disease (e.g. myasthenia, myopathy) or are taking antibiotics in the aminoglycoside group (e.g. gentamicin).
If you have been affected by any of the symptoms mentioned above, please don't hesitate to give us a call.
We have a team of experts on stand-by who are ready to take your call at our Manchester (0161 907 2685) Clinic or our Blackpool (01253 308 031) Clinic.