Diagnosis should be relatively straight forward, the patient will complain of numbness and loss of muscle function in the face, if as a result of the procedure this should commence immediately or within 24-48 hours of the procedure. Ultimately the first response should be to rule out more time critical and medical emergency such as stroke, use the FAST approach:

FACE – drooping?

ARM weakness

SPEECH difficulty

TIME to call an ambulance quickly

The best way to determine if the medical condition is a stroke or a facial palsy caused by a viral infection, is to see if the patient can move the frontalis muscle. If the cause IS from a stroke, both sides of the frontalis muscle will still be able to be moved by the patient. However, this will not be possible in the lower portion of the face. If cause is bells palsy, it will be the side of the face effected by the virus that will not be able to move, the other side will be mobile. This means the paralysis will be unilateral as opposed to bilateral as with a stroke. If in doubt call for emergency medical help always.

When you have ruled out more serious medical related conditions, referring to your initial consultation and before photos will be helpful in diagnosing possible procedural nerve damage.

Other methods of identifying loss of nerve function is remembering the function of the facial nerve won’t be limited to the areas in which have been treated. Branches of such will control, taste on the anterior section of the tongue, loss of sensory function near the ear, decrease function of salivary glands, mucous glands of the nose and lacrimal gland affecting the eye on the side of the procedure.

The best way to effectively relate the patients’ symptoms to the procedure is with the use of time frames and considering the anatomy and related symptoms to the injection site.

MECHANICAL NEUROPRAXIA – symptoms in hours but not immediate

AXONOTMESIS – immediate onset by axon damage

NEUROTMESIS – immediate as full sever of the nerve

PROCEDURE TRIGGERED INFECTION – 24-48 hours, up to a week

Out with these time frames, it is unlikely that any nerve symptoms are to be related to the procedure.