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What is Facial Paralysis?

Facial paralysis is a loss of facial movement on one or both sides of the face due to nerve damage. The muscles in your face may become weak or appear to droop.

Common causes of facial paralysis include:

  • Infection or inflammation of the facial nerve
  • Head trauma
  • Head or neck tumor
  • Stroke

Facial paralysis can occur 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 particular cause, the paralysis duration will vary, and 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. Each year, about 40,000 Americans experience sudden facial paralysis due to Bell’s palsy. This condition causes inflammation of the facial nerve, which often causes the muscles on one side of the face to droop.

Although 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.

Stroke

Stroke is a more serious cause of facial paralysis. During a stroke, facial paralysis occurs when nerves that control facial muscles 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 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. Facial paralysis can also occur 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

Although facial paralysis is certainly a serious condition, it does not always mean that you are having a stroke. The most common diagnosis of facial paralysis is Bell’s palsy, and the symptoms 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

Stroke

The symptoms of a stroke are often similar to those 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
  • People experiencing a stroke will often 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 can be difficult to distinguish between a stroke and other causes of facial paralysis, 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?

During your appointment, 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 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 determine 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 immediately taking oral steroids (such as prednisone) and antiviral medications can help boost your chances of complete recovery. In addition, physical therapy can 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.

Possible eye damage is the greatest danger of facial paralysis. Bell’s palsy often keeps one or both eyelids from closing fully. When the eye cannot 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.

Stroke

For facial paralysis due to 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.

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