Facial Paralysis Overview

The facial nerve innervates the muscles used for facial expression. Damage to this nerve leads to paralysis of the facial muscles. This in turn leads to muscular atrophy and weakness. As there are separate facial nerves for each side of the face, paralysis in either one or both sides of the face may occur. The resultant inability to smile or express facial emotion is a devastating problem. Patients also have functional difficulty with speech and eating. It is quite common and can affect both children and adults. Facial paralysis is an under recognized and under appreciated problem.

Causes of facial paralysis are many and varied, including the following etiologies:

  1. Bell's Palsy – This is the most common cause of facial paralysis. Patients will have full hemiparalysis in 1-3 days. The majority of patients will make a full recovery. It is caused by viral infections such as Herpes Simplex virus.
  2. Ramsay Hunt Syndrome – This is caused by the varicella zoster virus (chicken pox) and is associated with skin or oral vesicles and hearing loss.
  3. Lyme Disease – Caused by the bacterium Borrelia Burgdorferi and spread by ticks. Named after Lyme, Connecticut but found across the USA.
  4. Congenital – Facial nerve paralysis which is present at birth, such as Mobius syndrome and related craniofacial anomalies. Birth trauma may also be a cause.
  5. Stroke (vascular thrombotic or bleeding event)
  6. Autoimmune – When the body's mechanism for fighting infection manufactures antibodies to attack itself. Patients may have recurrent episodes or bilateral paralysis.
  7. Traumatic injury - Head injury damaging the temporal (ear) bone or cut across the face.
  8. Ear infections - Severe bacterial or viral ear infections may erode the bone, insult the nerve, and cause facial paralysis.
  9. Surgical Procedures which result, or risk resulting, in facial paralysis. These include:
    • Surgical transection of the facial nerve to remove a brain tumor.
    • Vestibular Schwannoma (Acoustic Neuroma) – tumors of the hearing nerve, which is very close to the facial nerve as it leaves the brain.
    • Other brain tumors such as meningiomas, facial nerve schwannoma, and other cerebellopontine angle tumors.
    • Parotid salivary gland surgery, orthognathic surgery, or other head and neck surgery.

Types of Facial Paralysis

When first seen by a physician, the facial paralysis may exhibit one of two patterns. It may be described as flaccid (completely droopy) or synkinetic (excess tightening).

After an acute episode of flaccid paralysis, the patient may recover fully (70%), may have partial flaccidity (15%), or may recover and then become synkinetic with excess involuntary movement (15%).

  • Synkinesis – This form of paralysis (nonflaccid) results from abnormal regeneration of the facial nerve after injury. As nerve branches (axons) regenerate from the brain to the face, it is possible for them to regrow in the wrong direction to the wrong muscles, resulting in involuntary muscle movement. For example, when a person smiles, the eye on the affected side closes or visa versa.
  • Flaccid Paralysis - There is absolutely no movement or tone on the affected side.

At The Facial Nerve Center, we treat a variety of conditions. The following terms have been used by lay people to describe diminished movement in one side of the face.

Contact The Facial Paralysis Center today to schedule a consultation with one of our specialists.