Dysfunction in the region of the mouth is said to have the greatest influence on the emotional milieu of patients. In a study by Neely and Neufeld, patients felt facial paralysis worse than synkinesis in the area of the mouth, while synkinesis was experienced as the more debilitating limitation in the area of the eye complex. At the beginning of the facial paralysis, the functional restriction the eye is the most concerning region, while later the perioral region dominates; the greatest wish of many patients is a beautiful, "normal" smile. By restricting the smile, the patient experiences less positive reactions. Additionally, there are empirical results which demonstrate that the activation of the zygomaticus major muscle and peripheral feedback from the smile contribute to positive emotions.
Facial neuromotor disorders do not show a greater general impairment of facial movements in patients with depression, but a greater impairment of the smile compared to the non-depressed patients. Pensak et al. postulate that patients are more affected by psychological restrictions than by physical symptoms. This is confirmed by Van Swearingen et al., who found that physical, social, and emotional difficulties at the individual level correlated more strongly with anxiety and depression, than physical and anatomical problems at the organ or tissue level. In the development of social problems based on neuromuscular disorder after facial paralysis, not enough attention is paid to its psychological ramifications.
A patient from our cohort described for us her emotional world in connection with her facial paralysis particularly aesthetically:
"At the young age of 36, I was struck by a bolt of lightning out of the blue, suddenly 40 years old, looking and feeling like an unfortunate stroke patient! Nobody could really help me. This plunged me into a deep crisis and depression that I had to struggle with for years..."
You can read the detailed description and how the story ended positively for the lady here.