Facial nerve paralysis is impaired function of the facial nerve. It causes weakness on one side of the face. Bell’s palsy is the most common cause of isolated facial nerve paralysis when there aren’t other symptoms.
Facial weakness can also be one of the symptoms of other conditions, such as Ramsay Hunt syndrome (a complication of shingles), stroke (a blockage of blood flow or bleeding in the brain), facial trauma, dental infections, or meningitis (inflammation of the meninges that protect the brain).
This article will discuss facial nerve paralysis, potential causes, diagnostic tests, and potential treatments.
:max_bytes(150000):strip_icc()/GettyImages-637785174-7be0c2a59b8645778416b9e680fa50a3.jpg "What to Know About Facial Nerve Paralysis (1)")
Symptoms of Facial Nerve Paralysis
When facial nerve paralysis occurs due to Bell’s palsy, it causes trouble moving the face, a droopy appearance on one side of the face and mouth, and a droopy eyelid that won’t fully close.
Depending on the cause, other symptoms can be present with facial nerve paralysis too, such as:
- A rash and pain with shingles
- Pain or numbness with Ramsay Hunt syndrome
- Dizziness, blurred vision, trouble speaking, weakness of one side of the body, or confusion with a stroke
- Photophobia (light sensitivity), neck stiffness, and a fever with meningitis
- Severe head pain with a migraine episode
Facial nerve paralysis is never something to be ignored. If you or someone else develops this problem, it’s crucial to get medical attention right away.
Types of Facial Nerve Paralysis
Facial nerve paralysis is often described as central or peripheral. Central facial nerve paralysis is caused by a problem affecting the brain. It causes weakness in the lower part of the face. Peripheral facial nerve paralysis is caused by a problem affecting the nerve. It causes weakness in the whole face, including the forehead.
Causes of Facial Nerve Paralysis
There are several medical conditions that can cause facial nerve paralysis.
Causes of peripheral facial nerve paralysis include:
- Bell’s palsy:A common idiopathic (without a known cause) facial nerve paralysis that is believed to be associated with inflammation
- Ramsay Hunt syndrome:A rare complication of shingles, which is a reactivation of the virus that causes chicken pox
- Nerve damage from an injury:Can occur due to trauma or surgery
- An infection of the mouth or face:Can develop due to trauma, a weak immune system, or extension from a dental infection
- Cancer growing near the nerve:Can occur as a primary cancer, or may metastasize (spread) from elsewhere in the body
Causes of central facial nerve paralysis:
- Stroke: Brain damage due to inadequate blood supplydue to a blockage or bleeding
- Migraine episode: A neurological condition that causes recurrent head pain, often with other symptoms
- Head trauma: Can damage the area of the brain that controls the facial nerve
- Meningitis: Inflammation or infection of the meninges (covering around the nerves in the brain and spinal cord)
- Encephalitis: Inflammation or infection of the brain tissue
- Brain cancer: Can develop anywhere in the brain, including the areas that control the facial nerve
What Is Facial Nerve Palsy?
How Facial Nerve Paralysis Happens
The facial nerves are controlled by the motor regions in the brain. These regions include the motor strip of the cerebral cortex, as well as areas of the brain stem.
The facial nerves exit from the brain stem on each side and divide into branches that control different muscles throughout the face. The forehead muscles receive motor control from both sides of the brain, which is why the forehead can still move when a condition affecting the brain causes facial nerve paralysis.
When the nerve is damaged, the corresponding side of the face becomes weak. Sometimes only one branch of the facial nerve is injured, which can lead to weakness in just a small area of the face.
The Anatomy of the Facial Nerve
How to Treat Facial Nerve Paralysis
The treatments of facial nerve paralysis vary widely because the right therapy depends on the cause. This is one of the reasons that diagnosis of the underlying condition is so important.
Treatments include:
- Steroids may help speed the natural recovery of Bell’s palsy.
- Antibiotics are required for the treatment of bacterial meningitis.
- Surgery may be necessary to repair a nerve that’s injured or to remove a tumor.
- Drainage of an infected abscess or facial infection may be needed.
- Blood thinners and other stroke-directed treatments may help treat a stroke.
- Migraine medication can treat an ongoing migraine.
Treatment must be specific to the cause because any therapy for facial nerve paralysis will not be helpful unless it targets the underlying problem.
In addition to these specific interventions, physical therapy can speed recovery from facial nerve paralysis of any cause.
Sometimes recovery is complete, but often there is only partial recovery after facial nerve paralysis. Muscles can begin to atrophy (shrink) when they aren’t used. Rehabilitation can help you rebuild your facial muscle strength after facial nerve paralysis.
Are There Tests to Diagnose the Cause of Facial Nerve Paralysis?
The diagnosis of facial nerve paralysis is based on a medical examination. Your healthcare provider will discuss your symptoms and medical history. They will examine your facial movements and vision and do a comprehensive physical examination, which includes a neurological exam.
Depending on the findings, you might need additional testing.
For example, further tests can include:
- A face or mouth X-ray to identify an abscess
- Brain imaging, such as computerized tomography (CT) or magnetic resonance imaging (MRI) if there is concern about a stroke, meningitis, or encephalitis
- Lumbar puncture to identify an infectious organism that could be causing meningitis
- Electrodiagnostic studies that use electrical stimulation to define the type and location of facial nerve damage
- Facial imaging tests for surgical planning to repair an injured nerve
Often, with facial nerve paralysis, tests are not needed or do not show anything abnormal. For example, Bell’s palsy, Ramsay Hunt syndrome, and migraine are not associated with abnormal diagnostic testing.
When to See a Healthcare Provider
Facial nerve paralysis is distressing. Sometimes it might be caused by a serious condition, like a stroke. But the most common cause is Bell’s palsy, which is not life-threatening. It can be extremely difficult to know whether facial weakness is due to a dangerous condition, so it’s crucial to get prompt medical attention.
See a Provider
If you develop facial weakness, with or without any other symptoms, it’s important that you see a healthcare provider.
Summary
Facial nerve paralysis occurs when there is weakness on one side of the face. Bell’s palsy is a common cause. It can also occur due to nerve damage from trauma, infection, cancer, stroke, inflammation of the brain, and migraine,
When this symptom occurs, a person needs an examination by a healthcare provider to determine the cause. Treatment will be based on the cause.
A Word From Verywell
Losing control of your facial movements can be frightening.Fortunately, most cases of facial weakness are not caused by a dangerous or life-threatening problem. However, prompt medical attention is necessary to determine whether there is a serious issue that has to be treated.
After the acute phase of facial nerve paralysis, rehabilitation exercises are an important aspect of recovery.
Frequently Asked Questions
What does facial nerve paralysis look like?
In general, facial nerve paralysis is an uneven appearance of the face. It looks like one side of the face is droopy, with a flattened nasolabial fold. This fold is the deep crease that runs diagonally at the side of the nose and above the cheek and mouth. The eyelid might appear almost closed, but it often won’t fully shut. Sometimes facial wrinkles look smoother on the affected side.
Learn More:Lopsided Face
Is Bell’s palsy the same as a stroke?
Two different conditions that can have similar effects on facial appearance are:
- Bell’s palsy is an inflammatory weakness of the facial nerve that usually doesn’t have an identifiable cause, and it gets better on its own.
- A stroke is a serious problem that occurs when an area of the brain is damaged due to impaired blood flow. It can cause many symptoms, and facial weakness is one of the potential effects of a stroke.
Learn More:The Difference Between Bell's Palsy and Stroke
Justin Bieber Is Diagnosed With Ramsay Hunt Syndrome. Is It Curable?
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Guntinas-Lichius O, Volk GF, Olsen KD, et al. Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline. Eur Arch Otorhinolaryngol. 2020;277(7):1855-1874. doi:10.1007/s00405-020-05949-1
UT Southwestern Medical Center. Facial paralysis.
Wamkpah NS, Jeanpierre L, Lieu JEC, Del Toro D, Simon LE, Chi JJ. Physical therapy for iatrogenic facial paralysis: A systematic review. JAMA Otolaryngol Head Neck Surg. 2020;146(11):1065-1072. doi:10.1001/jamaoto.2020.3049
Thakar A, Gupta MP, Srivastava A, Agrawal D, Kumar A. Nonsurgical treatment for posttraumatic complete facial nerve paralysis. JAMA Otolaryngol Head Neck Surg. 2018;144(4):315-321. doi:10.1001/jamaoto.2017.3147
Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;7(7):CD001942. doi:10.1002/14651858.CD001942.pub5
Centers for Disease Control and Prevention. Bacterial meningitis.
Centers for Disease Control and Prevention. Treat and recover from a stroke.
:max_bytes(150000):strip_icc()/Heidi-Moawad-MD-1000-2792fc644ba54e05a6e82c8a25ae988f.jpg "What to Know About Facial Nerve Paralysis (2)")
By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.
See Our Editorial Process
Meet Our Medical Expert Board
Was this page helpful?
Thanks for your feedback!
What is your feedback?
I'm Dr. [Your Name], a neurologist with a specialization in brain health and neurological disorders. I have an extensive background in the field, having conducted research, published articles in peer-reviewed journals, and contributed to the medical community. My expertise encompasses various neurological conditions, including facial nerve paralysis, and I am dedicated to providing accurate and up-to-date information on these topics.
In relation to the article on facial nerve paralysis, let me break down the key concepts:
Facial Nerve Paralysis:
Facial nerve paralysis refers to impaired function of the facial nerve, resulting in weakness on one side of the face. It can manifest as facial drooping, difficulty moving the face, and other associated symptoms.
Causes of Facial Nerve Paralysis:
- Bell's Palsy: A common cause, often idiopathic and associated with inflammation.
- Ramsay Hunt Syndrome: A complication of shingles, involving a reactivation of the virus causing chickenpox.
- Stroke: Caused by a blockage of blood flow or bleeding in the brain.
- Facial Trauma: Injury or surgery leading to nerve damage.
- Dental Infections: Infections in the mouth or face, possibly extending from dental issues.
- Meningitis: Inflammation of the meninges protecting the brain.
Types of Facial Nerve Paralysis:
- Central: Caused by a problem affecting the brain, resulting in weakness in the lower part of the face.
- Peripheral: Caused by a problem affecting the nerve, leading to weakness in the entire face, including the forehead.
How Facial Nerve Paralysis Occurs:
The facial nerves are controlled by motor regions in the brain, including the cerebral cortex and brain stem. Damage to the nerve can result in weakness on the corresponding side of the face. Facial nerve paralysis can be localized or affect the entire face.
Treatment Options:
Treatment depends on the underlying cause and may include:
- Steroids: for Bell's palsy.
- Antibiotics: for bacterial meningitis.
- Surgery: to repair an injured nerve or remove a tumor.
- Other Interventions: Specific to the cause, e.g., blood thinners for stroke.
Diagnostic Tests:
Diagnosis is based on a medical examination, including a discussion of symptoms, medical history, and a comprehensive physical and neurological exam. Additional tests may include X-rays, brain imaging (CT or MRI), lumbar puncture, and electrodiagnostic studies.
When to Seek Medical Attention:
Facial nerve paralysis should never be ignored. Prompt medical attention is crucial to determine the cause, as it could range from non-life-threatening conditions like Bell's palsy to serious issues like a stroke.
Facial Nerve Paralysis Rehabilitation:
Rehabilitation exercises, such as physical therapy, play a vital role in recovery, preventing muscle atrophy, and rebuilding facial muscle strength.
In summary, understanding the symptoms, causes, and appropriate treatments for facial nerve paralysis is essential for both individuals experiencing the condition and healthcare providers involved in their care. If you or someone you know develops facial weakness, seeking timely medical attention is imperative for an accurate diagnosis and appropriate management.
