Facial Paralysis

What is facial paralysis?

Facial paralysis happens when your facial nerve (cranial nerve #7) becomes damaged. This results in weakness, droopiness and a loss of facial movement on one side (unilateral) or both sides (bilateral) of your face.

Facial nerve damage can occur for several reasons, including infection, trauma or stroke. It can also occur without a known cause, which is referred to as Bell’s palsy. Face paralysis may complete or partial and can be temporary or permanent.

What causes facial paralysis?

Some people are born with facial nerve paralysis. In people who aren’t born with facial paralysis, the condition develops for one of two reasons:

1. Your facial nerve, which transmits signals from your brain to your facial muscles, becomes damaged or swollen.
2. The area of your brain that carries signals to your facial muscles becomes damaged.

Facial paralysis causes may include:

• Stroke.
• Bell’s palsy.
• Middle ear infection.
• Skull fracture.
• Autoimmune diseases, such as multiple sclerosis.
• Head, neck or brain tumor.
• Facial nerve schwannoma (a slow-growing, usually noncancerous tumor on your 7th cranial nerve).
• Lyme disease.
• Sarcoidosis.
• Ramsay Hunt syndrome.
• Guillain-Barré syndrome.

How is facial paralysis diagnosed?

A healthcare provider will ask about your symptoms and review your medical history. They’ll perform a physical examination and ask you to try to make various facial movements, like:

• Opening and closing your eyes.
• Raising your eyebrows.
• Smiling.
• Frowning.

In addition to a physical examination, your healthcare provider may request imaging tests, such as:

• MRI (magnetic resonance imaging).
• CT (computed tomography) scan.
• EMG (electromyography).

How is facial paralysis treated?

Facial paralysis treatment depends on the underlying cause. For example:

• If you develop facial paralysis as a result of stroke, your healthcare provider will focus on treating stroke.
• If facial paralysis is a result of a tumor, your provider will discuss options to remove the tumor.
• If the cause is Bell’s palsy, then your provider may prescribe medications and recommend facial strengthening exercises.

There are several nonsurgical and surgical facial paralysis treatments available:

Nonsurgical treatments may include

• Corticosteroids to reduce inflammation and swelling in your facial nerve.
• Antivirals to fight possible infection.
• Botox injections to treat synkinesis — a secondary condition that results in involuntary muscle movements. (This is common with Bell’s palsy.)
• Physical therapy to improve facial symmetry, increase muscle strength and regain facial coordination.
• Speech therapy to help you regain your speech and swallow function.
• Occupational therapy to help you improve functions like facial expressions and interpersonal communication.

Surgical treatments may include

• Eyelid surgery.In order to help your eye close, various procedures may be performed to support your eye and make blinking more efficient.
• Reanimation surgery. There are various types of reanimation surgery. For some procedures, a surgeon takes muscles and/or nerves from other areas of your body (some nearby and some from remote sites) and uses them to restore facial movement. Facial reanimation may involve nerve transfers, tendon transfers or muscle transplants, depending on the specific goals of treatment.
• Surgery to remove a tumor. If facial paralysis is the result of a tumor, a surgeon may perform surgery to remove it and take pressure off your facial nerve.
• Cosmetic surgery. There are several cosmetic surgery procedures that can restore balance and symmetry to your face. These procedures may include brow lifts, facelifts, facial slings and eyelid surgery.

Each case is unique and each person has their own set of specific needs. Your healthcare provider will talk to you in detail about a treatment option that’s right for you.

Facial paralysis and your eyes

If face paralysis affects your eyes, it can lead to chronic dry eyes and other complications. In these cases, your healthcare provider will recommend treatment to prevent your eyes from drying out too much. This might include:

• Eye drops and ointments.
• Taping your eyelids.
• Eye patches.
• Temporary closure of your eyelid with sutures.
• Surgery to place small weights in your eyelids to help them close.

Can I reduce my risk of facial paralysis?

In many cases, you can’t prevent the conditions or situations that may result in facial paralysis — particularly in cases of trauma. And in instances like Bell’s palsy, symptoms often occur with no warning.

You can, however, take steps to reduce your risk of stroke — which will, in turn, reduce your risk for stroke-related facial paralysis:

• Keep your cholesterol and blood pressure in check.
• Treat and manage health conditions like diabetes and heart disease.
• Take all medications as prescribed.
• If you smoke, talk to your healthcare provider about quitting.
• Limit your intake of beverages that contain alcohol.
• Exercise regularly.
• Eat plenty of whole grains and fresh fruits and vegetables.
• Maintain a weight that’s healthy for you.

When should I see my healthcare provider?

If you develop facial paralysis, call a healthcare provider immediately. They can determine what caused your symptoms and treat any underlying conditions.

If you or someone you know develops stroke symptoms — such as difficulty walking, coordination issues, blurred vision or slurred speech — call 911 or head to your nearest emergency room.

Is facial nerve paralysis permanent?

In some cases, facial paralysis is permanent. However, many people may see improvement or complete recovery with time and/or treatment. (Bell’s palsy usually goes away on its own in a few months.)

Is facial paralysis caused by stress?

Though experts haven’t been able to prove it yet, many healthcare providers recognize a significant link between stress and the onset of Bell’s palsy. Experts believe that stress can weaken your immune system, resulting in damage to your facial nerve.

Is face paralysis serious?

Facial paralysis itself isn’t dangerous, but it can cause significant symptoms while present. It can also indicate a serious underlying condition, such as stroke. You should never ignore facial paralysis. If you or a loved one develop facial paralysis, call a healthcare provider right away.

A note from Cleveland Clinic

If you develop facial paralysis — whether gradually or instantaneously — you should see a healthcare provider immediately. Though facial nerve paralysis isn’t dangerous itself, you might have a serious underlying health condition. Prompt medical treatment is the best way to foster a full recovery with limited damage. Even so, sometimes, facial paralysis is permanent. In these cases, your healthcare provider will work with you to reduce your risk of further damage and improve your quality of life.