Facial Paralysis

Written by Danielle Moores
Medically Reviewed by George Krucik, MD

What Is Facial Paralysis?

Facial paralysis is loss of facial movement because of nerve damage. Your facial muscles droop or become weak. It usually happens on just one side of the face and is typically caused by:

  • infection or inflammation of the facial nerve
  • head trauma
  • head or neck tumor
  • stroke

Facial paralysis can come on suddenly (in the case of Bell’s palsy, for example) or can happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last a short or extended period of time.

What Causes Facial Paralysis?

Bell’s Palsy

According to the National Institute of Neurological Disorders and Stroke, Bell’s palsy is the most common form of facial paralysis. Every year, 40,000 Americans experience sudden facial paralysis due to Bell’s palsy [NINDS]. This condition causes the muscles on one side of the face to droop noticeably.

No one knows exactly why Bell’s palsy occurs. It may be related to a viral infection of the facial nerve. The good news is that most patients with Bell’s palsy recover completely in about six months.

Other Causes

Other causes of facial paralysis or weakness include:

  • skull fracture or injury to the face
  • head or neck tumor
  • stroke
  • chronic middle ear infection or other ear damage
  • high blood pressure
  • diabetes
  • Lyme disease, a bacterial disease transmitted to humans by a tick bite
  • Ramsay-Hunt Syndrome, a viral infection of the facial nerve
  • autoimmune diseases such as multiple sclerosis, which affects the brain and spinal cord, and Guillain-Barre syndrome, which affects the nervous system

Birth can cause temporary facial paralysis in some babies. However, 90 percent of babies with this type of injury recover completely without treatment [NYEEI]. You can also have facial paralysis at birth due to certain congenital syndromes, such as Moebius syndrome and Melkersson-Rosenthal syndrome.

What Are Symptoms of Facial Paralysis?

Facial paralysis has a major impact on a person’s quality of life. You may lose confidence and feel embarrassed. In addition, facial paralysis can cause:

  • facial pain
  • headaches or dizziness
  • earaches, ringing in one or both ears, and sensitivity to sound
  • difficulty talking
  • inability to express emotion
  • difficulty eating or drinking
  • drooling
  • muscle twitching
  • tearing of the eye
  • dryness of the eye and mouth

Patients who aren’t able to close their affected eye will need to take extra care to help prevent long-lasting eye damage.

How Is the Cause of Facial Paralysis Diagnosed?

Be sure to discuss all your symptoms with your doctor, and share information about any other conditions or illnesses you may have.

Your doctor may also ask you to try to move your facial muscles by lifting your eyebrow, closing your eye, smiling, and frowning. Tests such as electromyography (which checks the health of muscles and the nerves that control them), imaging scans, and blood tests can help your doctor learn why your face is paralyzed.

How Is Facial Paralysis Treated?

Bell’s Palsy

The American Academy of Otolaryngology estimates that about 85 percent of those with Bell’s palsy will recover on their own, with or without treatment [AAO]. However, studies have shown that taking oral steroids (such as prednisone) and antiviral medications immediately can help boost your chances of complete recovery. Physical therapy can also help strengthen your muscles and prevent permanent damage.

For those patients who don’t recover fully, cosmetic surgery can help correct eyelids that won’t fully close or a crooked smile.

Other Facial Paralysis

Facial paralysis due to other causes may benefit from surgery to repair or replace damaged nerves or muscles, or to remove tumors. Small weights may also be surgically placed inside the upper eyelid to help it close.

Some patients may experience uncontrolled muscle movements in addition to paralysis. Botox injections that freeze the muscles, as well as physical therapy, can help.

Eye Care

The greatest danger of facial paralysis is possible eye damage. Facial paralysis often keeps one or both eyelids from closing fully. When the eye can’t blink normally, the cornea may dry out, and particles may enter and damage the eye.

Patients with facial paralysis should use artificial tears throughout the day and apply a lubricant at night. They may also need to wear a special clear plastic moisture chamber to keep the eye moist and protected.

What Is the Outlook for Facial Paralysis?

Although it can take six months or more to recover from Bell’s palsy, most people will recover completely, with or without treatment.

Unfortunately, even with surgery, some cases of facial paralysis may never completely go away. For these patients, physical therapy and eye care can help prevent any further damage and improve quality of life.

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