What Is Facial Paralysis?

It is common knowledge that one of the main functions of the face is physical and social interaction, but did you know that irregular facial movements may lead to anxiety and depression?

Facial paralysis, also known as facial palsy, is a condition with temporary weakness or. in rare cases, permanent damage of facial muscles resulting from a dysfunction of the facial nerve. The muscles in the face stop receiving signals when the facial nerve stops working. This results in a complete lack of movement of either one or both sides of the face. Lack of facial movement causes asymmetry and affects a person’s confidence and social well-being.

Fortunately, facial paralysis therapy offers feasible ways to manage and improve the condition.

Overview

The facial nerve is the seventh cranial nerve and is branched into the facial muscles. These muscles are responsible for facial expressions such as smiling, blinking and raising eyebrows, tears and saliva production, swallowing and complex movements of the jaw in different ways.¹ Facial nerve paralysis has been described in patients of all ages, with numbers being similar regardless of gender.

The pathogenesis of the condition is unknown in most cases. Based on the damage to the nerve, there are two types of facial palsy.²

1. Central facial palsy: It occurs when there is damage to areas of the brain that control the facial nerve. It is commonly associated with neurological disorders like multiple sclerosis, brain tumours or stroke. It usually affects specific parts of the face or the lower part of the face.

2. Peripheral facial palsy: It occurs when there is damage to the facial nerve itself. This can be due to injury to the face or conditions like Bell’s palsy, otitis media or infections. It often results in sudden onset of paralysis on one side of the face.

The side of the damage and cause of the paralysis are equally important in effective treatment.

Causes of facial paralysis

There are numerous causes of facial nerve paralysis, and hemifacial (affecting one half of the face) weakness is often referred to as Bell’s palsy. It is an idiopathic peripheral nerve palsy characterised by unknown origin and typically exhibits a high rate of recovery. In contrast, other causes of facial palsy often lead to poor recovery.³

The various causes of facial nerve palsy include:

• Congenital (genetic factors) – Mobius syndrome 
• Trauma – facial injury or injury to the brain and skull, forceps delivery (birth trauma), 
• Neurological disorders and/or idiopathic - Guillain-Barré syndrome, Bell’s palsy, multiple sclerosis, myasthenia gravis, osteopetrosis, sarcoidosis 
• Tumours – head and neck cancer, brain tumours, cholesteatoma, facial nerve schwannomas and other benign tumours 
• Infection – otitis media (ear infection), herpes zoster, Lyme disease (bacterial infection), influenza, Ramsay Hunt syndrome (viral infection) 
• Metabolic – pregnancy, hyperthyroidism, diabetes 

Signs and symptoms of facial paralysis

The onset of facial paralysis symptoms can vary, and it's possible for symptoms to appear suddenly or have a delayed onset of 48-72 hours. Symptoms range from mild to severe. In most cases, 70-75 % of patients recover with or without treatment within a few weeks.⁴

Symptoms may include:

• Facial weakness: lack of movement on one side of the face, loss of facial expressions (inability to smile or raise the eyebrows or frown)
• Difficulty speaking clearly
• Difficulty swallowing foods or liquids 
• Hearing loss
• Pain or discomfort behind the ears or in the face

Signs and symptoms vary depending on the severity. It is important to consult a healthcare professional to recommend appropriate treatment.

Management and treatment for facial paralysis 

A wide variety of treatment options are available, ranging from medication and physical therapies to surgery.^5,6,7,8

Medication:

Corticosteroids are considered effective when administered within 72 hours of symptoms starting. Studies have shown that high doses of prednisolone increase the recovery rate. 

The use of antivirals alone is not recommended but in combination with corticosteroids, there may be a small benefit. It is important to follow this prescribed treatment plan under the guidance and supervision of a healthcare professional. 

Botulinum toxin is advised to improve facial symmetry and weaken overactive facial muscles. First treatment must be under the supervision of a medical professional. Subsequent treatments can be carried out by a consultant, registrar or nurse. 

Ocular management: 

Some people may need eye care if the surface of the eye (cornea) is affected. Your eye is at greater risk if the paralysis has affected the cornea because you cannot feel it becoming dry and irritated and must be referred to eye specialists for advice and monitoring. Eye drops or eye gel are recommended along with taping your eye shut during the night to prevent the eye from drying. 

Surgery: 

Surgery is usually considered as a last option due to limited benefit and it is recommended for patients with little or no recovery. Surgery options may include oculoplastic surgeries (eyelid surgeries), smile surgeries (cross-facial nerve graft, facial nerve transfer), and rejuvenating procedures (reconstructive surgery).  

Physical therapy: 

Due to the low risks associated with physiotherapy, it should be considered in all patients with chronic facial paralysis. Rehabilitation of abnormal facial movements is achieved by allowing the brain to learn and use the recovered facial nerve functions.

Programs include education, massage, mirror exercises, electromyography (EMG) biofeedback, and facial neuromuscular retraining. The training is usually delivered by a physical therapist or a speech and language specialist.  

Physiotherapy for facial paralysis may last for several months, but if you stay dedicated and receive ongoing support from your therapist, it will greatly improve your chances of making the best possible recovery in your specific situation. Additionally, psychological therapy sessions are useful in helping to regain confidence.

Diagnosis

There are no diagnostic tests specific to facial paralysis, but tests can include the following:  

• MRI scan – for gradual onset or other neurological disorders  
• Chest X-ray 
• CT scan
• ACE testing – to check for sarcoidosis 
• Clinical evaluations
• Other tests as per the clinical findings 

FAQs

How can I prevent facial paralysis?

It is not possible to prevent facial paralysis but you can reduce the risk by following a few steps like getting vaccinated for viral infections like influenza or shingles. Prenatal care must be taken to prevent congenital facial paralysis. Always consult your therapist for professional advice and guidance. 

How common is facial paralysis?

Bell’s palsy is one of the most common disorders affecting a single nerve, representing nearly 80% of facial paralysis cases. It affects an estimated 20 to 30 individuals per 100,000 people per year. 

Is facial paralysis permanent?

The recovery rate of facial paralysis is high and in other instances, it can be permanent. This occurs due to neurological disorders or trauma where the nerve may not be able to regain its function. It is crucial to seek medical guidance for proper diagnosis as early intervention can improve the condition. 

Who is at risk of facial paralysis?

Men and women are equally affected by facial nerve palsy. Various factors that put you at risk are family history, viral infections, older adults with heart disease that may result in stroke-related facial paralysis, pregnant people exposed to harmful chemicals or trauma and people involved in sports activities or accidents. Most of the cases occur with an unknown risk factor. 

When should I see a doctor?

You need medical attention if there is a sudden onset of symptoms like difficulty in closing or opening the eye, pain or discomfort or numbness on the affected side of the face, facial weakness or paralysis on one or both sides of the face, or difficulty in swallowing or speaking.  

Summary

Facial paralysis is loss of facial movement because of damage to the facial nerve leading to a range of symptoms such as weakness, inability to control facial expressions, drooling, and more. 

Treatment for facial palsy depends on the underlying cause and severity of the condition. Treatment options may include medications, physical therapy, or surgery. In some cases, facial palsy may resolve on its own without treatment. 

If you encounter any symptoms that concern you, it is always advisable to seek guidance from a healthcare professional.