Facial Paralysis

What is facial paralysis?

Facial paralysis is a loss of facial movement due to nerve damage. Your facial muscles may appear to droop or become weak. It can happen on one or both sides of the face. Common causes of facial paralysis include:

• 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 happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last for 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 cause of facial paralysis. Every year, around 40,000 Americans experience sudden facial paralysis due to Bell’s palsy. This condition causes inflammation of the facial nerve, which commonly causes the muscles on one side of the face to droop.

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 people with Bell’s palsy recover completely in about six months.


A more serious cause of facial paralysis is stroke. Facial paralysis occurs during a stroke when nerves that control the muscles in the face are damaged in the brain. Depending on the type of stroke, damage to the brain cells is caused by either lack of oxygen or excess pressure on the brain cells caused by bleeding. Brain cells can be killed within minutes in each case.

Other causes

Other causes of facial paralysis or weakness include:

• skull fracture or injury to the face

• head or neck tumor

• middle ear infection or other ear damage

• Lyme disease, a bacterial disease transmitted to humans by a tick bite

• Ramsay-Hunt Syndrome, a viral reactivation that affects the facial nerve

• autoimmune diseases such as multiple sclerosis, which affects the brain and spinal cord, and Guillain-Barré 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. You can also have facial paralysis at birth due to certain congenital syndromes, such as Mobius syndrome and Melkersson-Rosenthal syndrome.


What are the symptoms of facial paralysis?

Bell’s palsy

While facial paralysis is often alarming, it does not always mean that you are having a stroke. The most common diagnosis is in fact Bell’s palsy. Symptoms of Bell’s palsy can include a combination of:

• facial paralysis on one side (rarely are both sides of the face affected)

• loss of blinking control on the affected side

• decreased tearing

• drooping of the mouth to the affected side

• altered sense of taste

• slurred speech

• drooling

• pain in or behind the ear

• sound hypersensitivity on the affected side

• difficulty eating or drinking


People experiencing a stroke often experience the same symptoms associated with Bell’s palsy. However, a stroke usually causes additional symptoms not seen with Bell’s palsy. The following symptoms in addition to the symptoms of Bell’s palsy could indicate a stroke:

• changes in level of consciousness

• confusion

• dizziness

• loss of coordination

• seizure

• changes in vision

• weakness in arms or legs on one side of your body

Often times people experiencing a stroke will still have the ability to blink and move their foreheads on the affected side. This is not the case with Bell’s palsy.

Since it is sometimes hard to distinguish between a stroke and other causes of facial paralysis, it is a good idea to get your loved one to a doctor quickly if you notice facial paralysis.

If you believe that you or a loved one may be experiencing a stroke, call 911 as soon as possible.


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 vast majority of people with Bell’s palsy will fully recover on their own, with or without treatment. 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 who don’t recover fully, cosmetic surgery can help correct eyelids that won’t fully close or a crooked smile.

The greatest danger of facial paralysis is possible eye damage. Bell’s palsy 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.

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


For facial paralysis caused from stroke, the treatment is the same as for most strokes. If the stroke was very recent, you may be a candidate for a special stroke therapy that can destroy the clot causing the stroke. If the stroke happened too long ago for this treatment, the doctor may treat you with medications to reduce risk of further brain damage. Strokes are very time sensitive, so if you are concerned at all that you or a loved one may be having a stroke, you should get them to an emergency room as soon as possible!

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

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.

For people who have had a stroke, getting medical attention quickly can greatly improve the possibility of a full recovery with limited damage to your brain and body. Rehabilitation and preventative measures will vary depending on the type and severity of your stroke.

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