Facial palsy
Facial palsy is weakness of the facial muscles from damage to the facial nerve. It can result in facial paralysis. Call 999 if you or someone you’re with suddenly develops facial or limb weakness, or speech problems, as this may be a stroke. There are less serious causes of facial weakness.
Symptoms of facial palsy
The symptoms of Facial palsy vary from person to person.
It can affect the lower half of the face, one side of the face, or in some cases, both sides of the face.
Facial palsy on one side of the face affects the brow, eye, cheek and mouth. The face may appear droopy and movement may be lost.
It can affect the ability to blink or close the eye.
When to seek medical advice
Facial weakness or paralysis can also be a sign of a more serious condition, such as a stroke.
The sooner a person receives treatment for a stroke, the less damage is likely to happen.
Contact your GP or emergency health care service urgently if you experience any type of facial weakness.
Common causes like Bell’s palsy and Ramsay Hunt syndrome need prompt treatment within 72 hours for the best chance of recovery.
If you have noticed gradual facial weakness over a period of time, this should also be treated as a medical emergency.
Causes of facial palsy
Some of the main causes of facial palsy are:
- Bell’s palsy-the exact cause is unknown but it is believed to happen when the nerve that controls the muscles in your face becomes inflamed and swollen
- viral infections such as Ramsay Hunt syndrome -this may be accompanied by severe pain; a rash in the hairline, ear or mouth; vertigo or dizziness and loss of hearing and tinnitus
- tumours from face or neck cancers may press on the facial nerve or cause facial palsy during surgery to remove them, for example, acoustic neuroma, facial nerve neuroma or parotid gland tumour
- bacterial causes such as Lyme disease or following a middle ear infection
- trauma or injury to the face and nerves
There are more than 60 different causes of facial palsy.
Speak to your GP if you need further information.
Who is affected by facial palsy
Anyone of any age can be affected by facial palsy at any time in their life.
Women in the last trimester of pregnancy are a high-risk group for developing Bell’s palsy, the most common cause of facial palsy.
Complications of facial palsy
Complications include:
- persistent facial weakness
- eye problems
- difficulty with speech, eating and drinking
- reduced sense of taste
- facial muscle twitching (known as synkinesis)
- facial pain
- psychological distress
- sensitivity to or intolerance of loud noise
Treating facial palsy
Treatments vary depending on the cause of facial palsy.
Below are details of the initial treatment you may receive when first diagnosed with one of the more common causes of facial palsy, once stroke is ruled out.
Bell’s palsy
Corticosteroids may be used to reduce the swelling of the facial nerve. Your GP can discuss whether this treatment is suitable for you.
Ramsay Hunt syndrome
Normally treated with corticosteroids as well as an antiviral to treat the shingles virus. Your GP can discuss whether this treatment is suitable for you.
Lyme disease
Lyme disease is normally treated with antibiotics.
Your GP will discuss which medication is suitable for you.
Preservative-free eye drops for use in the day and ointment for use at night should be used if you are unable to close your eye.
Tape may also be used to close the eye while sleeping.
There are also a number of surgical and non-surgical options to treat facial palsy that does not get better.
Non-surgical options
Specialist facial therapy
Specialist facial therapy involves learning about how the facial nerve works and getting advice on caring for your eye(s) and mouth.
It also includes tips to make eating and drinking easier and help with speech.
The therapist might give you a home exercise plan with massage, stretches, and exercises.
Botox or botulinum toxin injections
Botox or botulinum toxin injections can be used to help relieve pain and overactivity or spasm of facial muscles caused by facial palsy.
Surgical options
Surgical options include:
- facial nerve decompression – performed early on to relieve pressure on the nerve to allow it to work better
- oculoplastic surgeries – procedures designed to protect eye function, improve symptoms of dryness and tearing, and overall appearance
- smile surgeries – operations designed to restore symmetry at rest or even create a smile movement to the affected side
- procedures which improve symmetry and address facial drooping, such as brow-lift, face lift, mid-face lift and fat grafting
- surgeries aimed at improving facial comfort where synkinesis is an issue in the lower face
Talk to your GP
You should see your GP if you are struggling with ongoing complications from facial palsy and are not under a specialist health care team.
Also see your GP if you have symptoms of anxiety or feel depressed.