Misdiagnosis in Facial Palsy

Misdiagnosed, misinformed and misunderstood. Do any of these terms sound familiar??? One of the most common themes that arise during the initial assessment of people with Facial Palsy is that of misdiagnosis. Misunderstandings around this complex condition remain far too common among patients and healthcare professionals alike. In this blog, we explore why accurate diagnosis, appropriate treatment, and compassionate understanding are so essential for those living with facial palsy.

The terms Bell’s Palsy and Facial Palsy are not interchangeable. Bell’s Palsy, although the most common cause of Facial Palsy, is merely one of about 80 different causes of Facial Palsy.

Other possible causes of Facial Palsy include:
• Viral infections other than Bell’s, such as Ramsay Hunt syndrome;
• Bacterial infections such as Lymes disease and ear infections,
• Autoimmune conditions
• Trauma
• Neurological conditions such as stroke or guillian barre syndrome,
• Vascular conditions
• Congenital conditions
• Tumours, some of which are benign and unfortunately, while very rare, some are malignant.

Whilst sometimes the cause of Facial Palsy is quite obvious, for example, following trauma, there are unfortunately scenarios where the onset of Facial Palsy is much more difficult to classify. There are subtle differences in both the onset and behaviour of Facial Palsy that is due to neurological or autoimmune conditions compared with infectious causes that can help differentiate. Strong clinical suspicion and a thorough knowledge of “red flags in Facial Palsy” are required. Thorough questioning and clinical assessment are absolutely critical. It is not acceptable that medical professionals assume the cause of facial weakness is either due to a stroke or Bell’s Palsy. A much higher level of suspicion for all causes of Facial Palsy is required.

Unfortunately, we currently do not have any hope of increasing this awareness, when the only national guideline in Ireland that exists around Facial Palsy is referred to as “Bell’s Palsy: Management in the Emergency Department”. This sets the assumption that Bell’s Palsy could be the only diagnosis. Another service that patients often first present with symptoms to is their GP. A GP on sees on average one new case of Facial Palsy every 2 years. It is therefore very difficult to stay informed on how to thoroughly assess and treat this condition. In addition, there are no Facial Palsy guidelines available to GPs in Ireland. A quick check on the HSE website of A-Z of health conditions, highlights that neither Facial Palsy nor Bell’s Palsy are listed. So where should one, be it the medical practitioner or the person suffering from Facial Palsy find suitable information here in Ireland? This year in Facial Palsy UK is petitioning to have a dedicated page for Facial Palsy on the NHS website and to have updated guidelines in Emergency Departments and General Practice highlighting the gold standard assessment and treatment of Facial Palsy that should be expected.

Misinformation is another consequence of lack of knowledge and conflicting available information. It is all too often that people with Facial Palsy have been advised to use out-dated treatment methods. There is more robust scientific data available demonstrating not only the lack of effect of some of these treatment methods (electrical muscle stimulation!!) but also the negative side-effects and outcomes they cause. To gain the most up to date appropriate treatment methods people with Facial Palsy should seek out a Specialist Facial Therapist, and not simply a Chartered Physiotherapist. Chartered Physiotherapists have a basic but unfortunately out-dated knowledge of the management of Facial Palsy. Specific Facial Palsy post graduate training is required to proficiently assess and treat Facial Palsy. As a quick note, generic facial exercises; chewing gum nor electrical muscle stimulation should not be used nor prescribed by any medical professional. Misinformation also extends to prognosis. If the diagnosis is not accurate, then the information given about recovery rates will not be accurate nor reflect the prognosis for the cause of an individual’s Facial Palsy.

And finally, being misunderstood. Knowledge is the key to reducing misunderstanding. It is imperative that the medical practitioner you attend also understands that Facial Palsy is not simply a cosmetic condition, but rather a communicative disorder that has many functional, physical and mental health issues associated with it. Many people with Facial Palsy suffer with pain and extreme fatigue, is this a result of the condition that led to their Facial Palsy, or is it a result of the Facial Palsy itself, or a combination of the two?? How many people are aware that the rate of anxiety and depression is far higher in the population that have Facial Palsy, than those that do not. To highlight the communicative aspect of Facial Palsy, misunderstandings frequently occur when someone with Facial Palsy tries to smile for example and it is perceived as a grimace, or if they are suffering from synkinesis at rest they may appear cross all the time. Often it is not visible how much the individual with Facial Palsy is working or concentrating to simply just be present. Increasing awareness of how Facial Palsy impacts all facets of an individual’s life helps society appreciate what a disabling condition Facial Palsy can be if it doesn’t completely resolve.

At PMC Physiotherapy, we offer specialist facial therapy rooted in up-to-date clinical knowledge and a deep understanding of the lived experience of facial palsy. If you or someone you know is navigating this condition, don’t settle for uncertainty. Book an appointment with our expert team and access the dedicated care you deserve. We provide accurate diagnosis, evidence-based treatment, and empathetic support, all in one place.