Every person that is affected by swallowing difficulties dysphagia after a stroke, also has a central facial dysfunction or paralysis central facialis pares: usually caused by an injury in one of the two brain hemispheres. The injury is indicated by paralysis in the lower half of the face on the opposite side to the injured hemisphere, and can be, for example, one side of the mouth drooping. [1–7]
Sudden paralysis or muscle weakness in one half of the face, peripheral facial paralysis - also known as Bell’s palsy has no identified cause and is the most common cause of facial paralysis. Bell’s palsy is the commonest cause of facial palsy, accounting for approximately 60 per cent of all cases. It affects between 20 per 100,000 to 40 per 100,000 people per year (which in the UK means between 12,400 and 24,800 people per year). It is difficult to know the exact incidence of Bell’s palsy as not all people with the condition are diagnosed or recorded.
Facial paralysis is caused by injury to the facialis nerves or their cores in the brainstem. [10–12]. Usually 70% of the these people become healthy again without treatment within 3 to 4 months, but the remaining proportion may need treatment. 
In this section we shall look at the differences between central- and peripheral facial paralysis, and then focus on the latter. Finally, we will talk about how IQoro® can help to retrain facial musculature. IQoro is a new and unique neuromuscular treatment method that requires just 30 seconds’ exercise, three times per day
Even if there are big differences between a central and a peripheral facial paralysis there are also some things in common. In both cases it is the expressive musculature in the face which is affected and makes it difficult to convey emotions like happiness, sorrow, anger or bewilderment etc. The muscle activity is reduced, or non-existent in one half of the face. Sometimes both halves are affected.
A central facial paralysis is caused by an injury; often in one brain hemisphere, but sometimes in both. The injury shows itself as a paralysis in the lower half of the face on the opposite side to the affected brain hemisphere, e.g. through a slack mouth on one side. [1–7] The reason can be, for example, a stroke, trauma to the head, or a brain tumour.
As long as the paralysis is only on one side, it is easy to distinguish between a central facial paralysis and a peripheral one. With a central injury the person can wrinkle his forehead or raise his eyebrows on both sides. With a peripheral injury the person has difficulty in performing these exercises on one side of the face.
A person with a central injury can wrinkle his forehead because the nerves leading to this area are doubled, and the undamaged hemisphere compensates. The latest research shows however that 74% of stroke survivors with swallowing difficulties dysphagia also have paralysis in the musculature of the forehead. It also shows that 52% have a facial dysfunction in all four quadrants. [1–3, 9] This should be observed carefully when performing a diagnosis.
Sudden paralysis or muscle weakness in one half of the face, peripheral facial paralysis also known as Bell’s palsy has no identified cause. Facial paralysis is caused by an injury to the facial nerve facialis or its core in the brainstem. The nerve damage can have been caused by, for example,
If a person with peripheral facial paralysis is asked to raise his eyebrows, close his eyes, and smile at the same time it can be seen in the paralysed half that the facial expressiveness is depressed and that the person can have difficulty in:
The injured facial nerve, facialis, affects:
Usual symptoms are:
If the facial paralysis is on both sides, Borrelia is always suspected.
Peripheral facial paralysis, where the cause is unknown, can affect people of all ages, but is more common between the ages of 15 to 45. Pregnant women and people with diabetes can be seen to have an increased risk. Usually 70% become well again without treatment within 3 to 4 months, but the remainder can need treatment. 
An early intervention with cortisone treatment has been shown to have a positive effect against Bell’s Palsy. If the peripheral facial paralysis has been caused by Borrelia the patient will be given antibiotics, if the sickness can be traced to a virus infection he can expect virus repressive medicine.
If one eye is affected with a drooping lower eyelid this will be treated with different types of protection for the eye depending on the degree of seriousness. In the first case, protection can be in the form of eyedrops or eye salve, or in more difficult cases taping of the eye, closely-fitting spectacles (ski goggles) or a transparent plastic screen.
Within six months, 70% of people regain their normal facial functions. The remainder, 30%, develop chronic problems in the form of reduced strength in the face muscles, involuntary movements following deliberate ones, synkinesis, other involuntary muscle movements and ticks (spasms) or tears in the eye on the affected side. They also have difficulties with speech and in being able to eat. 
In order to regain as much as possible of the face’s mobility and function they often combine physiotherapy, surgery and Botox treatment. People that still have total paralysis at their one month follow-up visit are often referred to a physiotherapist, or a speech therapist specialising in this area. After assessment, muscle training or other expressive exercises can begin with a physiotherapist.
Persons with severe palsy 3 to 4 months later, and with problems around the eyes or mouth, may find that plastic surgery is necessary. If the person has a pronounced problem with synkinesis synchronisation of the musculature - where treatments with the physiotherapist have had insufficient effect - treatment with Botox may be considered.
It is not scientifically proven that training with IQoro has an effect on peripheral facial paralysis. But, that IQoro can function effectively as an alternative treatment, or as a complement to other treatments, is credible from all clinical experience and over 20 years’ research, which shows that, amongst other things, paralysed musculature in the face and pharynx regains its function (see studies # 1-3 and 15). The same research also shows that IQoro actively stimulates the sensory nerves in the mouth and by doing this reaches the brain’s control system for the swallowing process, which is closely linked to other bodily functions including breathing, the ability to form speech sounds, facial expressions, postural control, and more.
During the swallowing process signals are sent via various fibres up to the brain stem and the brain where they are converted to impulses down to the muscles and glands to be activated to perform the process - in total some 148 muscles.
This explains why exercising with IQoro is able to have an effect even on peripheral facial paralysis, because this type of paralysis is caused by an injury, of varying degree, to the facial nerves.
If neuromuscular training with IQoro is to be used as a treatment for peripheral facial paralysis, it should initially be performed more gently, and for shorter duration than is recommended for all other conditions. A guideline is to start with 3 seconds’ pull, repeated twice, and these two repetitions are performed two times per day. If this feels comfortable, continue like this for the rest of the first week; during the second week the regime can be increased by one second to 4 seconds for each of the two pulls. If this causes discomfort, roll back the regime to the former level, or stop the treatment. Training is best done in front of a mirror to check for balance and symmetry in the pulling action. Contact IQoro customer service with any doubts or questions that you may have.
There is a requirement for further research in this area, not least because peripheral facial paralysis reduces the quality of life of those affected.
Text by: Dr. Mary Hägg, Doctor of Medicine, Post-doctoral researcher at Uppsala University specialising in orofacial medicine, Head of Department at the Speech and Swallowing Centre: Ear, Nose and Throat Clinic at Hudiksvall Hospital, Sweden. Registered Dentist. In cooperation with MYoroface.
October 2016. (Translation from the original Swedish text by T.W.Morris, Myoroface)
(English translation: ”Focus report: dysphagia”).
(English translation: ”Internet medicine”).
(English translation: ”Focus report: dysphagia”).