What to Expect With Facial Nerve Palsy (2022)

Facial nerve palsy is the diminished function of the facial nerve or one of its branches. Bell’s palsy, which results in the complete inability to move one side of the face, is the most common cause of facial nerve palsy. This condition completely or partially improves within a few months, and it doesn’t cause harm to overall health.

There are other types and causes of facial nerve palsy, and they tend to be longer-lasting and more concerning than Bell’s palsy.This article will discuss the symptoms, causes, diagnosis, and treatment of facial nerve palsy.

What to Expect With Facial Nerve Palsy (1)

Facial Nerve Palsy Symptoms

Facial nerve palsy affects one side of the face. It can affect the whole side or just part of a side of the face. The main symptom is weakness, but sometimes sensory changes, like tingling or loss of sensation, can also occur.

Symptoms of facial nerve palsy include:

  • Droopy eyelid
  • Eyelid that won’t close
  • Droopy cheek
  • Flattening of the nasolabial fold (the crease above the smile)
  • Lopsided smile
  • Uneven face

These symptoms can affect the forehead, the lower part of the face, or the upper and lower part of the face. Facial nerve palsy affects only one side of the face.

Associated symptoms can include tingling, numbness, burning, pain, diminished sensation, hearing loss, or dizziness.Facial nerve palsy can cause complications due to the inability to move parts of the face. Complications are more likely if the condition lasts for a long time and if the weakness is severe.

Complications

Problems that can occur due to facial palsy include:

  • Dry eye
  • Corneal damage(damage to the clear dome of tissue at the front of the eye)
  • Infection of the eye
  • Vision problems due to a droopy eyelid
  • Difficulty chewing
  • Trouble swallowing
  • Choking on food, drinks, or saliva
  • Trouble breathing

These complications can be serious, but they can often be prevented with measures such as wearing an eye patch to protect the eye.

Causes

Facial nerve palsy can be caused by inflammation or damage to the facial nerve. The most common condition that causes facial nerve palsy is Bell’s palsy. It is considered idiopathic (without a known specific cause or trigger) and is believed to result from inflammation.

Other causes can include trauma or an injury to the facial nerve or one of its branches. This may occur due to an accident or as a result of a procedure, such as the removal of a tumor that has grown near the facial nerve.

Ramsay Hunt syndrome is a condition involving facial nerve weakness that can occur as a complication of shingles (a painful rash that can occur years after recovering from a chicken pox infection).

Neuropathy (nerve disease), inflammatory diseases (such as lupus), an infection, or cancer invading the nerve may cause facial nerve palsy as well—although these causes are not common.

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Diagnosis

Facial nerve palsy is diagnosed based on a history of symptoms and a physical examination. Weakness of the face caused by a facial nerve problem can affect the forehead, whereas weakness of the face caused by a problem in the brain—like a stroke—will not typically affect the forehead.

A careful neurological examination can help determine whether facial weakness is caused by a condition affecting the nerve or by a condition affecting the brain.

An examination of the mouth, throat, and face can determine if there is swelling or evidence of an infection. Examination of eye movements and vision can help identify whether other cranial nerves besides the facial nerve are involved.

Sometimes tests may be needed to help identify the cause of facial nerve palsy.

These can include:

  • Blood tests may identify features of an infection or inflammation.
  • Brain imaging studies may identify other potential causes of facial weakness, such as a brain aneurysm (bulge in an artery in the brain) or multiple sclerosis (a condition in which the immune system mistakenly attacks the protective lining of the nerves).
  • Electromyography (EMG) or nerve conduction studies (NCV) can examine the function of the muscles and nerves, which may help identify unusual patterns of nerve damage.
  • Rarely, a spinal tap (also called a lumbar puncture) is done to look for signs of infection, inflammation, or cancer in the spinal fluid.

When to See a Healthcare Provider

Get medical attention if you develop new facial weakness, numbness, swelling, pain, trouble speaking, or difficulty chewing or swallowing.

The Difference Between Bell's Palsy and Stroke

Treatment

Sometimes medical or surgical interventions can help alleviate some of the effects and symptoms of facial nerve palsy. Generally, Bell’s palsy improves without treatment, but often, treatment with oral steroids can speed up recovery and reduce long-term effects.

If facial nerve palsy occurs in association with an inflammatory disorder, anti-inflammatory medication may be prescribed. And for treatment of a bacterial infection, antibiotics and drainage of an abscess (walled-off pocket of infection and pus) may be necessary.

Surgery may benefit some people who have facial nerve palsy. Procedures can include nerve transfer, muscle transfer, or repair of the nerve. Chemotherapy is an option for people who have facial nerve palsy due to cancer.

Physical Therapy

For anyone who has facial nerve palsy of any cause, lifestyle modifications and rehabilitation can help with movement and with preventing complications. This can include speech and swallow therapy, as well as facial exercises.

Summary

Facial nerve palsy is damage or disease of the facial nerve. It causes weakness of movement on one side of the face. Bell’s palsy, a nerve injury, and Ramsay Hunt syndrome are the most common causes. Other less common causes include an infection, inflammation, cancer, and neuropathy.

Differentiating facial nerve palsy from brain disease, such as stroke or multiple sclerosis, is important because the urgency and treatment differ based on the cause of facial weakness.

The treatment of facial nerve palsy often involves anti-inflammatory medication and physical therapy. Other treatments, such as antibiotics, chemotherapy, or surgery, are specific to the cause.

A Word From Verywell

Coping with facial weakness can be stressful. Seek medical attention if you develop this symptom. Facial nerve palsy will usually resolve, but it’s important to maintain preventive strategies to avoid complications—such as eye damage from being unable to close the eyelid.

After you recover from an episode of facial nerve palsy, you can continue to do your muscle exercises until you feel that you have regained adequate control of your facial movements.

(Video) 2-Minute Neuroscience: Bell's Palsy

Frequently Asked Questions

  • What is the most common cause of facial nerve palsy?

    Bell’s palsy is the most common cause of facial nerve palsy. It is often considered idiopathic (without an identifiable cause), and it is sometimes preceded by an infection or inflammation. This condition is not dangerous.

    Generally, Bell’s palsy causes severe facial weakness on one side of the face, including the forehead, and it resolves on its own.

  • How long does facial nerve palsy typically last?

    It depends on the cause. Bell’s palsy can last between a few weeks and a few months, sometimes with mild facial weakness persisting for a year or longer. Other causes of facial nerve palsy—like nerve damage—may be permanent until they are treated.

  • Can stress cause facial paralysis?

    Stress does not cause facial paralysis, but it is associated with Bell’s palsy. The condition can cause stress, and stress may worsen the condition and prolong symptoms.

    (Video) Hope for Facial Nerve Paralysis

5 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.

  1. Wihlidal JGJ, Bysice A, Rammal A, Yoo J, Matic D, Mendez A. Thematic analysis of Canadian patient-reported outcomes in facial nerve paralysis: A combined interpretive description and modified Delphi approach. Facial Plast Surg Aesthet Med. 2022 Apr 29. doi:10.1089/fpsam.2021.0325

  2. Boschetti CE, Lo Giudice G, Spuntarelli C, Apice C, Rauso R, Santagata M, Tartaro G, Colella G. Kabat rehabilitation in facial nerve palsy after parotid gland tumor surgery: A case-control study. Diagnostics (Basel). 2022;12(3):565. doi:10.3390/diagnostics12030565

  3. Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial paralysis in skull base osteomyelitis - comparison of surgical and nonsurgical management. Laryngoscope. 2022 May 12. doi:10.1002/lary.30161

  4. Fana M, Centofanti B, Kuriakose P. Chemotherapy as treatment for acute myeloid leukemia (AML)-induced facial nerve palsy. Cureus. 2022 Mar 31;14(3):e23710. doi:10.7759/cureus.23710

  5. Cole KL, Cole C. A detailed account of severe Bell's palsy: an autobiographical case report. Cureus. 2021;13(11):e19837. doi:10.7759/cureus.19837

What to Expect With Facial Nerve Palsy (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.

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(Video) Bell's palsy: One Loyola patient's story

FAQs

How would you expect someone with a facial nerve injury to present? ›

Symptoms of facial nerve paralysis include drooping skin around the brow, eye, cheek, and mouth. When a muscle loses motor function, it relaxes completely, and the skin above the muscle relaxes as well.

How do I know if facial nerve damage is healing? ›

People will start to tell you how much better you are looking but your movements may still be very weak. There may be a tingling sensation in your face which can be a sign of nerve recovery – a therapist may test for this using Tinel's sign.

How do you know if Bell's palsy is getting better? ›

You're likely to notice gradual improvement after about two weeks. Within three months, most people have recovered full motion and function of their face. A delay in recovery is often accompanied by some form of abnormal facial function.

How long does it take for facial nerves to repair? ›

If activity continues to increase, the nerve is recovering and a person can regain control of facial muscles without surgical intervention. Complete recovery may take three to six months.

How long does it take to recover from facial palsy? ›

Symptoms of facial weakness or paralysis get worse over the first few days and start to improve in about 2 weeks. It can take 3 to 6 months to fully resolve. Medicine and eye care are important in treating Bell's palsy.

What are the stages of nerve healing? ›

To achieve full recovery, the nerve must undergo three main processes: Wallerian degeneration (the clearing process of the distal stump), axonal regeneration, and end-organ reinnervation.

Does sleep help Bell's palsy? ›

The 5 Musts-Do's When First Diagnosed with Bell's Palsy:

REST (If you have a new baby, this means calling in the family or a night nanny. You MUST sleep for the nerve to regenerate.

What does facial nerve damage feel like? ›

Episodes of severe, shooting or jabbing pain that may feel like an electric shock. Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth. Attacks of pain lasting from a few seconds to several minutes. Pain that occurs with facial spasms.

What symptoms would one exhibit with damage to their facial nerves? ›

A facial nerve disorder may produce some of the following signs and symptoms:
  • Difficulty eating, drinking and speaking.
  • Loss of movement in the facial muscles.
  • Neuropathic pain in areas connected to the damaged nerve.
  • Numbness in the face, jaw, cheeks, tongue, or gums.

What helps Bells Palsy heal faster? ›

Commonly used medications to treat Bell's palsy include: Corticosteroids, such as prednisone. These are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, the nerve will fit more comfortably within the bony corridor that surrounds it.

Is Bells Palsy a big deal? ›

Bell's palsy temporarily weakens or paralyzes facial muscles. A pinched facial nerve causes this paralysis, or palsy. People with this type of facial nerve palsy develop a droopy appearance on one — or sometimes both — sides of the face. The condition isn't serious and often resolves in a few months without treatment.

Should you rest with Bell's palsy? ›

Although no certain cause has been established, people newly diagnosed with Bell's palsy should understand that they are unwell. It is important to get plenty of rest even if they have no other symptoms and to maintain a healthy diet. If you are at work or school, it may be necessary to take some time to recover.

What does it feel like when nerves are healing? ›

As your nerve recovers, the area the nerve supplies may feel quite unpleasant and tingly. This may be accompanied by an electric shock sensation at the level of the growing nerve fibres; the location of this sensation should move as the nerve heals and grows.

Is facial nerve damage permanent? ›

Paralysis of the face may be temporary or permanent. The facial plastic surgery team determines the best treatment based on how long the paralysis has been present, the cause and whether it is a complete paralysis, or an incomplete (or partial) paralysis.

Do facial nerves recover? ›

Unlike motor nerve injury, the time between injury and repair is less critical for sensory nerves, and sensation in the face can be recovered 1-2 years after injury.

Is facial palsy a disability? ›

Bell's Palsy that has caused severe and lasting nerve damage may make an applicant eligible for disability.

Can you still smile with Bell's palsy? ›

Bell's palsy causes sudden weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.

Can facial palsy spread? ›

Pregnancy, obesity, and diabetes mellitus are risk factors for Bell's palsy. While the condition is not contagious, it is likely caused by the reactivation of a virus. These include upper respiratory illnesses, like the flu or a cold, herpes simplex 1, measles or chickenpox, mumps, amongst other kinds of viruses.

What does a damaged facial nerve feel like? ›

Episodes of severe, shooting or jabbing pain that may feel like an electric shock. Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth. Attacks of pain lasting from a few seconds to several minutes. Pain that occurs with facial spasms.

What happens if you damage a nerve in your face? ›

A trigeminal nerve injury may affect a small area, like part of your gum, or a large area, like one side of your face. The injury can cause problems with chewing and speaking. The extent depends on where the nerve damage occurs. You may have ongoing numbness or facial pain in the area that the nerve serves.

How do you check for facial injury? ›

Symptoms
  1. Changes in feeling over the face.
  2. Deformed or uneven face or facial bones.
  3. Difficulty breathing through the nose due to swelling and bleeding.
  4. Double vision.
  5. Missing teeth.
  6. Swelling or bruising around the eyes that may cause vision problems.

Videos

1. Don't wait -- surgical options exist for Bell's palsy
(Loyola Medicine)
2. Bells Palsy and Stroke
(The Noted Anatomist)
3. Understanding Facial Palsy
(Queen Victoria Hospital)
4. Facial Nerve Palsy
(Learning in 10)
5. Cranial Nerve 7 | Facial Nerve Assessment for Physiotherapists
(Physiotutors)
6. Facial Nerve Palsy presentation and features in 260 seconds
(Dr. Aman Arora - Arora Medical Education)

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