Nasal dysfunction – the silent side effect of unilateral facial paralysis
Reviewed by Shivanchan Rajmohan

Nasal dysfunction is often overlooked in the context of unilateral facial paralysis. Clinical management of facial paralysis conventionally focuses on oral competence, ocular protection, facial symmetry and facial reanimation; however, impairment in nasal breathing may also impact quality of life. This one-year prospective cross-sectional study executed in Thailand included 27 adult patients with complete unilateral facial palsy. Authors compared paralysed and non-paralysed sides using peak nasal inspiratory flow (PNIF), nasal Schirmer testing, photographic assessment, Cottle’s manouevre, rigid endoscopy and Thai-NOSE questionnaire. PNIF was significantly lower on paralysed side (48L/min paralysed side vs. 61 L/min non-paralysed side). Mucosal secretion was also reduced on the paralysed side. Noteworthy is the fact these physiological discrepancies were not reflected in the internal or external nasal valve grading, illustrating that conventional anatomical assessment may underestimate functional impairment. Whilst 81.5% subjects reported nasal obstruction, the majority had mild or absent Thai-NOSE scores. This may be explained by compensation by the unaffected nasal cavity, which highlights the limitations of purely relying on subjective symptoms when assessing unilateral nasal dysfunction. Moreover, longer facial paralysis duration was noted to result in progressive morphological distortion, but did not worsen physiological impairment, which poses the question: does functional impairment occur early in facial paralysis and then remain stable while structural deformity progresses? Surgically, authors recommend restoring superolateral support to alar base and lateral nasal wall with fascia lata slings, or alar base repositioning in select cases. Overall, this study supports the integration of objective nasal assessment into routine facial paralysis evaluation and emphasises the need for further studies to clarify significance of these findings and guide optimal timing of intervention.

Impact of unilateral facial nerve paralysis on nasal airway function.
Jirawatnotai S, Muangsai K.
PLAST RECONSTR AESTHET SURG
2026:121;180–7.