Treatment of sequelae after facial paralysis: a global approach.

It was none other than Charles Darwin who stated more than 100 years ago that 'the movements of expression in the face and body, whatever their origin may have been, are in themselves of major importance for our welfare' (Darwin, 1872). This means that every time a patient suffers a facial paralysis his welfare may be at risk because we know that, when degeneration of the nerve develops, 100 per cent recovery is no longer possible. Unilateral associated movements (synkineses) will develop; these are evidence of denervation (Taverner et al., 1971). Slight degeneration resulting in some associated movements and some asymmetry in the face is usually not very disturbing, unless the face is very important in professional life, as it is for models, actors etc. More degeneration will produce a deficiency in the face amounting to a lasting handicap in facial expression and communication for the rest of the patient's life. In a younger person this will have far greater consequences than in older people. Young people are more easily disturbed in this respect.