Facial Palsy Explained: Expert Insights and Advice

Facial Palsy ( Facial nerve and its paralysis ) 

The facial nerve ( 7th cranial ) is a mixed nerve. It supplies all the muscles of the face concerned with expression. The sensory part carries sensation from the anterior two-third of tongue through chorda tympani. The nucleus of the 7th cranial nerve lies in the pons. The fibers of facial nerve hook around the 6th nerve nucleus in the pons, and then it comes out of pons at its lower border. After leaving the pons, it enters the internal auditory meatus with acoustic nerve ( 8th cranial ) , passes through the middle ear and comes out of skull at stylomastoid foramen, from where, it passes behind the parotid gland at the angle of the jaw and subdivides to supply muscles of face. 

Causes and site of facial nerve palsy

Facial palsy can result from various causes, ranging from infections to neurological disorders. Here are some common causes:

  • Infections: Other infections, such as Lyme disease, herpes zoster (Ramsay Hunt syndrome), and otitis media, can lead to facial nerve inflammation and palsy.
  • Trauma: Physical trauma to the head or face, including fractures of the temporal bone, can damage the facial nerve.
  • Bell’s Palsy: This is the most common cause, typically resulting in sudden, unilateral facial paralysis. The exact cause is unknown, but it is believed to be linked to viral infections such as herpes simplex.
  • Neurological Disorders: Conditions like Guillain-Barré syndrome, multiple sclerosis, and stroke can affect the facial nerve, leading to palsy.
  • Congenital Conditions: Some individuals are born with facial palsy due to developmental anomalies or birth trauma.
  • Autoimmune Diseases: Diseases like sarcoidosis or systemic lupus erythematosus can cause inflammation of the facial nerve.
  • Diabetes: Poorly managed diabetes can lead to neuropathy, including facial nerve involvement.

Facial palsy, also known as facial paralysis, typically affects the facial nerve (cranial nerve VII) and can manifest in various regions of the face. The most common sites include : 

  • At Pons
  • At cerebellopontine
  • At middle ear

Other possible sites include both sides of the face (bilateral facial palsy), although this is rarer and often associated with conditions like Guillain-Barré syndrome or Lyme disease. Additionally, facial palsy can be localized to specific regions such as the forehead or the area around the eye, depending on the underlying cause and the extent of nerve involvement.

Symptoms of Facial palsy 

Facial palsy symptoms vary depending on the severity and cause of the condition. Common signs include: 

  • Sudden weakness or paralysis on one side of the face
  • Drooping of the mouth or eyelid
  • Inability to close the eye on the affected side
  • Loss of taste sensation
  • Increased sensitivity to sound in one ear
  • Drooling
  • Difficulty with facial expressions, such as smiling or frowning
  • Reduced lacrimation

Here are some key investigations commonly performed : 

  • Medical History and Physical Examination: A detailed medical history and thorough physical examination help to identify the onset, progression, and characteristics of the facial palsy, as well as any associated symptoms. 
  • Neurological Examination: This includes assessing the function of other cranial nerves, muscle strength, reflexes, and sensory responses to determine the extent of nerve involvement. 
  • Electromyography (EMG): EMG measures the electrical activity of facial muscles, helping to assess the severity of nerve damage and muscle response. 
  • Nerve Conduction Studies (NCS): These tests evaluate the speed and strength of signals traveling along the facial nerve, providing insight into the degree of nerve dysfunction. 
  • Imaging Studies:
    • Magnetic Resonance Imaging (MRI): MRI scans can detect tumors, inflammation, or other abnormalities along the path of the facial nerve.
    • Computed Tomography (CT) Scan: CT scans are useful for identifying fractures, tumors, or structural issues in the head and face.

  • Blood Tests: Blood tests can help identify underlying conditions such as infections (e.g., Lyme disease), autoimmune disorders, or metabolic imbalances (e.g., diabetes).
  • Lumbar Puncture (Spinal Tap): In certain cases, a lumbar puncture may be performed to analyze cerebrospinal fluid for signs of infection, inflammation, or other central nervous system disorders. 
  • Audiometry: Hearing tests may be conducted to check for associated auditory nerve involvement, especially in cases of suspected acoustic neuroma or Ramsay Hunt syndrome.
Management and treatment

The disease is benign and self-limiting. Recovery is the rule . Complete recovery can be expected within 4-12 weeks in more than 75% patients. Treatment for facial palsy depends on the cause and severity. For Bell’s palsy, corticosteroids are often prescribed to reduce inflammation. Antiviral medications may be used if a viral infection is suspected. Physical therapy and facial exercises can help maintain muscle tone and improve function. In some cases, surgical intervention may be necessary to decompress the nerve or repair damaged structures.


The factors that suggest a poor prognosis from a facial palsy include : 

  • Complete palsy
  • Age >60 years
  • No signs of recovery within 3 weeks
  • Associated hypertension, diabetes etc. 
Experts advice for managing facial palsy
  • Early Intervention: Seek medical attention as soon as you notice symptoms of facial palsy. Early diagnosis and treatment can improve outcomes and prevent complications. 
  • Protect Your Eye: If you cannot close your eye on the affected side, use lubricating eye drops and an eye patch to prevent dryness and injury. 
  • Physical Therapy: Engage in regular facial exercises to strengthen the muscles and maintain mobility. A physical therapist can provide a tailored exercise program. 
  • Psychological Support: Facial palsy can impact self-esteem and emotional well-being. Consider joining a support group or seeking counseling to cope with the emotional challenges. 
  • Healthy Lifestyle: Maintain a healthy diet, exercise regularly, and manage underlying conditions such as diabetes to support overall nerve health.

Facial palsy is a complex condition with various causes and symptoms. Understanding the underlying factors, seeking timely medical intervention, and following expert advice can significantly improve the management and prognosis of facial palsy. If you or someone you know is affected by facial palsy, consult with healthcare professionals to explore the best treatment options and support available.

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