What is facial paralysis?

What is facial paralysis?

Facial paralysis is the development of loss of movement in the facial mimic muscles due to nerve damage. It can be seen on one or both sides of the face and is called facial paralysis in the medical literature. Common causes of facial paralysis include facial nerve inflammation, head trauma, stroke, and head and neck tumors. Depending on the cause, the paralysis may pass quickly or last for a long time. Facial muscles may appear flabby or weak in those who have had facial paralysis.

What is facial paralysis? 

Facial paralysis is the development of facial movement loss as a result of damage to the facial nerve fibers, which stimulate the facial mimic muscles from the brain, for various reasons. Facial paralysis can occur suddenly, or it can develop gradually over a period of time.

What causes facial paralysis? 

Facial paralysis; It may occur for different reasons such as head trauma, cerebral vascular occlusion, head and neck tumors, facial nerve injury. The causes of facial paralysis are explained in detail below.


The most common cause of facial paralysis is a clinical condition called Bell’s palsy. Bell’s palsy is a sudden onset of facial paralysis of unknown cause that affects only the muscles on one side of the face. There is no obvious cause such as an underlying tumor or head trauma. It is thought to occur as a result of edema in the facial nerve and compression of the bone structures through which it passes. It is presumed to be related to viral infection of the facial nerve. Nearly 90% of patients with facial palsy due to Bell’s palsy recover completely within about six months.


A more serious cause of facial paralysis is stroke . It develops as a result of damage to the nerve cells that control the facial muscles in the brain due to stroke. There is no direct damage to the facial nerve in stroke-related facial paralysis. In this case, facial paralysis is caused by brain damage and the inability to transmit messages correctly to the facial nerve. Causes of damage to brain cells, depending on the type of stroke;

  • lack of oxygen
  • It can be listed as excessive pressure in the brain cells due to bleeding.


Other causes of facial paralysis include:

  • Skull fracture and brain injury
  • facial injuries
  • Head or neck tumors
  • middle ear infection
  • Other damage to the ear
  • Lyme disease:  A bacterial infectious disease transmitted to humans through tick bites 
  • Ramsay-Hunt Syndrome. It is the repetitive activation of the varicella zoster virus, which is the causative agent of chickenpox. Facial paralysis develops if the facial nerve is damaged as a result of this disease.
  • Autoimmune diseases such as multiple sclerosis  and Guillain-Barré syndrome  that affect the brain and spinal cord 
  • Surgical reasons: Injury to the facial nerve, for example, during removal of an acoustic neuroma or facial nerve tumor, or when performing surgeries on the parotid gland, which is the largest of the salivary glands.
  • Abnormal development of the facial nerve or facial muscles in the uterus
  • Congenital facial paralysis may occur due to congenital syndromes such as Moebius, Charge, or Melkersson-Rosenthal syndrome.
  • Birth trauma: Some babies may have facial nerve injury due to the use of forceps or facial presentation during birth. As a result, temporary facial paralysis may develop. 90% of babies who develop this type of nerve injury recover completely without treatment.

What are the symptoms of facial paralysis?

There are many different symptoms of facial paralysis, and they vary from person to person, depending on the cause.


Symptoms of Bell’s palsy may include:

  • Unilateral facial paralysis
  • Loss of control of blinking and forehead wrinkles on the affected side
  • decreased tears
  • drooping in the mouth
  • Involuntary movements, such as twitching in muscles
  • Altered sense of taste on the affected side
  • speech disorder
  • excessive saliva production
  • difficulty eating or drinking
  • Pain in or behind the ear
  • Pain around the jaw joint
  • Hypersensitivity to sounds in the ear on the affected side
  • Headache

The listed symptoms occur on the affected side. In rare cases, Bell’s palsy can affect nerves on both sides of the face.

Patients with stroke-related facial palsy often show the same symptoms seen in Bell’s palsy. However, there are some additional symptoms in stroke. In addition to those seen in Bell’s palsy, there are the following symptoms;

  • Consciousness changes
  • Confusion
  • dizziness
  • balance problems
  • vision problems
  • epileptic seizures
  • Weakness in the arms or legs on one side of the body

In contrast to Bell’s palsy in patients with stroke-related facial palsy, the ability to blink and crease on the affected side is preserved.

Because it is difficult to distinguish between stroke and other causes of facial paralysis, the best thing to do as soon as signs of facial paralysis are noticed is to call 911 and call for emergency help.

How is facial palsy diagnosed? 

For the diagnosis of facial paralysis, the doctor evaluates the muscle movements by asking the patient to make gestures such as raising eyebrows, blinking, smiling, and frowning. For differential diagnosis, electromyography (testing to check the health of the muscles and the nerves that control them), imaging scans such as MRI and CT, and blood tests may be done. With the help of tests, the cause of facial paralysis is tried to be determined.

How is facial paralysis treated? 

Treatment of facial paralysis is planned according to the underlying cause.

Treatment of facial palsy due to Bell’s palsy 

The majority of people with Bell’s palsy resolve spontaneously with or without treatment. However, studies have shown that taking steroids such as prednisone and antiviral medications by mouth immediately when facial palsy develops can help increase the chances of a full recovery. In addition, physical therapy practices can help strengthen muscles and prevent permanent damage.

For those who do not fully heal, plastic surgery can be used to correct eyelids that do not close completely or to correct a crooked smile.

The greatest danger to facial paralysis is possible eye damage. Bell’s palsy usually prevents one or both eyelids from closing completely. When blinking problems occur, the cornea can dry out and foreign particles can enter the eye and cause damage. For this reason, people with facial paralysis should use artificial tears throughout the day. They may also need to wear an apparatus made of clear plastic to keep the eye moist and protected.

For the treatment of facial paralysis caused by stroke, the stroke must be treated first. If the stroke is very recent and is caused by a clot, treatment is applied to dissolve the clot. If the stroke happened a long time ago, medication may be started to reduce the risk of further damage to the brain. It is very important to treat the stroke in the early period so that it does not become permanent.

Treatment for facial paralysis caused by other causes 

In the treatment of facial paralysis caused by other reasons, methods such as surgically repairing damaged nerves or muscles or removing tumors, if any, can be used. Small weights may be surgically placed inside the lid to help close the upper eyelid.

Some people may experience uncontrolled muscle movements in addition to paralysis. Temporarily paralyzing these muscles with botox injections as well as physical therapy applications can help control involuntary muscle movements.

How does facial paralysis pass? 

In addition to medical treatment for facial paralysis, complementary medicine methods such as acupuncture can give effective results. It may be beneficial to apply an average of 10-12 sessions of acupuncture treatment in the first 6 months after facial paralysis.