Facial Paresis

Facial paresis is a condition where you lose the ability to move muscles on one or both sides of your face due to damage to the facial nerve. This nerve damage can happen suddenly or develop gradually, affecting your ability to smile, close your eyes, eat, and express emotions.

Table of contents

• What is facial paresis?
• What causes facial paresis?
• How does facial paresis feel?
• How is facial paresis diagnosed?
• How is facial paresis treated?
• What can you expect during recovery?

What is facial paresis?

Facial paresis happens when your facial nerve (also called the seventh cranial nerve) becomes damaged. This nerve controls the muscles that allow you to make facial expressions, blink, smile, and perform other important functions.^[1]

The damage results in weakness, drooping, and loss of movement on one side of your face (called unilateral paralysis) or on both sides (called bilateral paralysis).^[1] The paralysis can be complete or partial, and it may be temporary or permanent depending on what caused the nerve damage.^[1]

The facial nerve is a paired nerve, meaning there is one on each side of your body. It originates from your brain and travels to the muscles of your face. Along the way, it controls not only the muscles that create facial expressions but also parts of your tongue for taste, glands in your head, and a small muscle in your ear.^[4]

What causes facial paresis?

Some people are born with facial nerve paralysis. In people who develop it later in life, the condition occurs because either the facial nerve itself becomes damaged or swollen, or the area of the brain that sends signals to facial muscles becomes damaged.^[1]

The most common cause of facial paresis is Bell’s palsy, which accounts for about 70% of cases.^[3] Bell’s palsy occurs when the facial nerve becomes inflamed for unknown reasons, though experts believe it may be related to viral infections. It typically affects one side of the face and develops suddenly, usually within 24 to 48 hours.^[3]

Other causes of facial paresis include:^[1]

• Stroke – when blood flow to part of the brain is blocked
• Trauma – injuries to the head, including skull fractures or damage during surgery
• Infections – such as middle ear infections, Lyme disease, or Ramsay Hunt syndrome (caused by the herpes zoster virus)
• Tumors – growths in the head, neck, or brain that press on the facial nerve
• Autoimmune diseases – conditions like multiple sclerosis or Guillain-Barré syndrome where the body’s immune system attacks its own nerves
• Sarcoidosis – an inflammatory disease that can affect nerves

Trauma-related facial nerve damage occurs in 10 to 23% of cases and can result from fractures of the temporal bone (part of the skull), facial wounds, or accidental injury during surgical procedures involving the ear, parotid gland, or acoustic neuroma.^[3]

How does facial paresis feel?

Facial paresis usually begins with a sudden feeling of weakness or complete inability to move one side of your face. In some cases, symptoms develop more gradually over time.^[6]

Common symptoms include:^[1][2]

• Drooping of one side of your face
• Difficulty making facial expressions, such as smiling or frowning
• Inability to close your eye on the affected side
• Trouble raising your eyebrow
• Drooling from one side of your mouth
• Difficulty eating and drinking
• Problems with speech
• Pain around the jaw or behind the ear
• Increased sensitivity to sound on the affected side
• Loss of taste on the front part of your tongue
• Changes in tear or saliva production

The inability to close your eye properly is particularly important to address, as it can lead to chronic dry eye or damage to the cornea (the clear front surface of your eye).^[6]

Important: If you experience sudden facial weakness, seek medical care immediately. These symptoms can also indicate a stroke, which is a medical emergency. Call an ambulance if facial weakness is accompanied by confusion, weakness in your arms or legs, vision changes, fever, or severe headache.^[6]

How is facial paresis diagnosed?

A healthcare provider will diagnose facial paresis by asking about your symptoms and reviewing your medical history. They will perform a physical examination where they ask you to make various facial movements, such as:^[1]

• Opening and closing your eyes
• Raising your eyebrows
• Smiling
• Frowning
• Showing your teeth

An important part of the diagnosis is determining whether the paralysis is caused by damage to the facial nerve itself (called a lower motor neuron palsy) or by damage to the part of the brain that controls the facial nerve (called an upper motor neuron palsy). This distinction helps identify the likely cause and guides treatment.^[3]

In lower motor neuron palsy, all facial muscles on one side are affected, including those in the forehead and around the eye. In upper motor neuron palsy (such as from a stroke), the forehead and eye muscles may still work because they receive nerve signals from both sides of the brain.^[4]

Your healthcare provider may also request additional tests to determine the cause and severity of the nerve damage:^[1]

• MRI (magnetic resonance imaging) – uses magnets and radio waves to create detailed images of your brain and facial nerve
• CT (computed tomography) scan – creates 3D images using X-rays to look for tumors, fractures, or other problems
• EMG (electromyography) – measures the electrical activity of muscles and nerves to assess nerve damage and predict recovery
• Blood tests – can help identify infections like Lyme disease or rule out other conditions

How is facial paresis treated?

Treatment for facial paresis depends on the underlying cause. The goal is to improve facial nerve function, reduce nerve damage, and protect your eye from injury.^[1]

Nonsurgical treatments

Medications: If the cause is Bell’s palsy or inflammation, your healthcare provider may prescribe:^[1][8]

• Corticosteroids – medications that reduce inflammation and swelling in the facial nerve. Studies show these are highly effective when started early, within the first few days of symptoms.^[8]
• Antivirals – medications to fight possible viral infections, though evidence for their benefit is limited
• Botox injections – used to treat synkinesis, a secondary condition where facial muscles move involuntarily

Eye protection: Because the eye on the affected side may not close properly, protecting it is essential:^[8]

• Use lubricating eye drops throughout the day
• Apply eye ointment at night
• Wear glasses or goggles to protect from wind and debris
• Tape your eyelid closed while sleeping if needed

Therapy: Various types of therapy can help improve facial function and quality of life:^[1]

• Physical therapy – includes gentle facial exercises and massage to improve facial symmetry, increase muscle strength, and restore coordination. A physical therapist can teach you proper techniques to avoid interfering with nerve healing.^[1]
• Speech therapy – helps you regain speech and swallowing function
• Occupational therapy – assists with improving facial expressions and communication skills

Surgical treatments

Surgery may be necessary if facial paralysis is severe, long-lasting, or caused by certain conditions. Surgical options include:^[1][9]

Eyelid surgery: Various procedures can help your eye close properly and make blinking more efficient, protecting your cornea from damage.

Nerve transfer surgery: For paralysis that has lasted generally 1.5 years or less, a surgeon can connect a nearby working nerve to the damaged facial nerve to restore movement. Common procedures include connecting the nerve that controls your jaw muscle (masseter nerve) or tongue nerve (hypoglossal nerve) to the facial nerve.^[12]

Reanimation surgery: This includes several advanced techniques to restore facial movement:^[1][9]

• Muscle transplants – taking muscle from another part of your body (often the leg) and transplanting it to your face to restore smile movement
• Nerve grafts – using a nerve from another body part to repair or replace the damaged facial nerve
• Tendon transfers – repositioning tendons to help restore facial symmetry
• Static procedures – techniques like brow lifts or facial slings that improve the resting position of your face

Tumor removal: If facial paralysis results from a tumor pressing on the nerve, surgery to remove the tumor may be necessary.

What can you expect during recovery?

The outlook for facial paresis varies greatly depending on the cause. For Bell’s palsy, which is the most common cause, most people recover well. Symptoms usually start to improve within a few weeks, with complete recovery occurring in about six months for most patients.^[2] However, recovery can take up to one year in some cases, and about 13% of patients may have incomplete recovery.^[3]

For Bell’s palsy patients, about 70% with complete facial paralysis and 94% with partial paralysis recover within six months.^[3] A small number of people continue to have some symptoms for life, and Bell’s palsy can rarely recur in about 10% of patients.^[3]

Recovery from other causes of facial paresis depends on the specific condition and severity of nerve damage. With modern treatments, including advanced microsurgical techniques, many people with long-term facial paralysis can experience significant improvement in facial function and appearance.^[9]

During recovery, it’s important to:

• Follow your treatment plan carefully
• Protect your eye consistently
• Perform prescribed facial exercises correctly
• Attend regular follow-up appointments
• Be patient, as nerve healing takes time
• Seek mental health support if needed, as facial paralysis can affect emotional well-being