• Monday July 13,2020

Facial palsy (facial paralysis)

Facial paralysis or paralysis of the facial nerve is the paralysis of the 7th cranial nerve (facial nerve), which allows movement of the facial muscles. The paralysis is usually half-sided, typical is a drooping corner of the mouth and the missing face facial expression. The treatment of facial nerve paralysis is based on the cause.

What is facial paralysis?

Since the facial nerve supplies the mimic muscles, it comes in a failure to characteristic, half-sided changes in facial expression. In mild facial palsy, the symptoms are only discrete, the asymmetric changes are more pronounced in a stronger paresis.
© Henrie - stock.adobe.com

Facial paralysis or paralysis of the face completely or partially paralyzes or weakens the facial nerve so that the facial muscles can no longer be sufficiently moved.

A distinction is made between central and peripheral facial palsy. Central facial paralysis is caused by damage at the site of the nerve, namely the brain. Peripheral facial palsy occurs by damage directly to the nerve.

Often, however, the cause of the paralysis is not known, in this case one speaks of idiopathic facial paralysis, that is: without detectable cause. Idiopathic paralysis is also called Bell's palsy (English Bell's Palsy) after the English doctor Charles Bell.


The most common facial nerve paralysis is idiopathic, which means that in most cases the cause of facial paralysis is unknown. Peripheral paralysis, if the injury is directly on the nerve, can have different triggers. Often there are inflammations, such as a otitis media or zoster oticus, a herpes infection on the ear.

Even injuries such as fractures of the skull bone can affect the nerve in its function. Likewise, tumors in the ear that press on the facial nerve through their growth may be responsible for peripheral facial palsy. Central facial palsy is triggered by damage in the brain where the nerve originates. The facial nerve remains intact and is not damaged itself, it can only transport the information from and to the brain no longer.

Common causes of central facial nerve palsy are strokes or brain tumors. In the case of stroke, the area of ​​origin of the facial nerve is damaged by a bleeding or undersupply; in the case of a brain tumor, the growing tumor presses on the area, so that the functions are disturbed and facial paralysis occurs.

Symptoms, complaints & signs

Since the facial nerve supplies the mimic muscles, it comes in a failure to characteristic, half-sided changes in facial expression. In mild facial palsy, the symptoms are only discrete, the asymmetric changes are more pronounced in a stronger paresis. In the symptomatology, peripheral and central facial paresis can be differentiated.

Both central and peripheral paralysis are associated with a drooping corner of the mouth and an incomplete eyelid closure. Things like whistling, smiling or drinking become difficult or even impossible. The "bell phenomenon" is the fact that the attempt to close the eyelid reveals the typical upward rotation of the eyeball.

In peripheral, as opposed to central paralysis, it is also not possible for the patient to frown on the affected side. Since the facial nerve is also responsible for some of the taste sensations on our tongue, taste disorders may be the result of damage.

Another symptom is decreased salivary and tear secretion. In combination with incomplete eyelid closure, there is a risk of corneal damage due to dehydration of the eye. Some of the patients also complain of noise hypersensitivity with pain on the affected side behind the ear.

Diagnosis & History

The typical symptom of facial paralysis is unilateral sagging facial muscles. A corner of the mouth hangs down, one eye can no longer be completely closed and frowning is not possible. The entire facial expression looks slightly displaced. If there is a central facial palsy, there may be additional complaints.

The salivation is less and because the nerve also supplies the tongue, it can lead to a reduction in the ability to taste (see taste disturbance). Likewise, the formation of tear fluid may be reduced, the eye of the affected side is dry. The pronunciation also suffers from facial paresis, because the lips and tongue muscles can not articulate properly, that is, the sounds can no longer be formed correctly.

The doctor already sees the first signs of facial paralysis due to the obvious signs of paralysis. Further information will be given on the history of the patient as well as various tests, a blood test to rule out infections, X-rays of the skull, an electromyography to measure the nerve conduction or a CSF examination (liquid withdrawal from the spinal column).

These investigations first of all find the cause and then the correct treatment of facial palsy.


The complications of facial nerve palsy (facial paralysis) depend on what caused the paralysis. Otitis media (middle ear infection) is often the cause of facial paralysis. Bacterial inflammation can be associated with severe pain and a range of other complications.

Due to the proximity of the facial nerve to the ear, there is a risk that the infection will spread and permanently damage the facial nerve in severe infections. Facial palsy can also be the result of Lyme disease. The bacterium Borrelia burgdorferi that causes the infection is transmitted by ticks. The disease is progressively in various stages.

First, the so-called Erythema migrans and nonspecific signs such as headache and body aches, weakness and fever occur. In the next stage, paralysis along the puncture site or facial paralysis associated with lymphadenopathy may occur. Even with Lyme disease, it can lead to permanent damage to the facial nerve.

In severe cases, the facial expression is permanently limited, the face can look crooked and the corners of the eyes and mouth hang down. Occasionally, the trigger of shingles, the herpes zoster virus, the ear and the ear canal. The virus can then spread to the facial nerve causing temporary paralysis. Permanent damage to the nerve is rare in these cases. However, the infection is usually extremely painful.

When should you go to the doctor?

If signs of facial paralysis are noticed, a doctor must be consulted. Most of the complaints are based on a serious illness, which must be clarified. Whether it is a facial paralysis, only the physician can determine. At the latest, if complications occur, a doctor's visit is required.

If, for example, inflammation develops, it must be clarified immediately and treated if necessary. Medical advice is also required when symptoms of Lyme disease are added. Signs such as headache and body aches, fever and the typical wandering flush indicate that facial paralysis is due to an infectious disease that needs to be treated.

People who suffer from facial malformations as a result of delayed facial nerve paralysis should consult a specialist. The risk groups - including those who have recently suffered from a herpes infection on the ear, a middle ear infection or a tumor in the ear - should speak immediately with the family doctor in the mentioned warning signs. Patients suffering from appropriate symptoms after a stroke or brain tumor are best advised to consult their physician. A medical treatment is required in case of facial paralysis in any case.

Treatment & Therapy

About 70 percent of the facial paresis occurring heal completely. The treatment always depends on the present cause. When facial nerve palsy is caused by a bacterial infection, antibiotics are usually administered. In viral inflammation (caused by viruses) help so-called antivirals, which prevent the multiplication of the virus.

If the facial nerve is damaged by an injury, surgery can restore the function of the nerve. In addition, accompanying movement exercises are necessary to train the facial muscles. This is done by occupational therapists or physiotherapists. If facial nerve palsy is caused by a pathological process in the brain, inpatient treatment is essential.

The dryness of the eye which occurs during facial nerve paralysis can be alleviated with an ointment or artificial tear fluid. It is recommended to close the eye with a bandage overnight so it does not dry out. If facial nerve palsy is idiopathic, treatment focuses on alleviating the symptoms, and cortisone is given as a supportive measure.

Outlook & Forecast

The cause of a Fasfachisparese (facial paralysis) determines the prognosis. The severity of the disease as well as the individual symptoms and the age of the affected patient influence how the disease progresses. Generally speaking, the chance of complete healing decreases with age.

Especially with the idiopathic facial paralysis, the chance for a cure is quite good. If the therapy is carried out correctly, 90 percent of those affected will clearly lose their symptoms. After about four months, more than two-thirds of these patients also have a complete cure. However, complete healing may take several years, depending on the severity of the seventh cranial nerve injury, although such long-term therapies are rare.

If it is a peripheral or central facial paralysis, but the prognosis looks bad. Of course, the decisive factor here is the extent of the damage. In case of complete paralysis, late treatment or wrong medication, the prognosis is rather negative.

In many cases, incomplete regeneration, known as so-called defect healing, occurs. In retrospect, patients may still suffer from twitching, increased tension in the facial muscles or uncontrollable tears. However, it may be possible to restore the destroyed nerve fibers in an operation.


Direct prevention of facial nerve palsy is not possible, as it most often occurs with unknown causes. Immediate treatment is recommended in the presence of causative disorders so as not to damage the nerves and possibly prevent facial nerve paralysis.


In cases of facial nerve paralysis, affected people in most cases have no special options for follow-up care. These are primarily dependent on the proper treatment of the disease to prevent further complications. The focus is on the identification and treatment of the cause of facial nerve palsy to prevent further spread to the entire body.

The earlier the disease is recognized, the better the progression of the disease. In most cases, treatment of facial nerve paralysis is medicated. In this case, the affected must pay attention to a correct dosage and also on a regular intake, in children, especially the parents have to control the intake.

For side effects or ambiguity, a physician should be consulted. Furthermore, some complaints of facial nerve palsy can be treated with the help of physiotherapy. Many of the exercises from this physiotherapy can also be done at home to restore the movement of the muscles. As a rule, the life expectancy of the affected person is not limited by facial paralysis. Frequently, the contact with other people affected by this disease makes sense.

You can do that yourself

In addition to a medical treatment, those affected have some options for self-help.

For paid therapies, it is advisable to discuss in advance with the health insurance. These include lymphatic drainage, acupuncture, physiotherapeutic measures and the presence of an osteopath. From homeopathy, the globules Aconitum C9 and Causticum C5 prove themselves. The intake of vitamin B is said to alleviate, but is not statistically proven. The same applies to the treatment by light showers.

Facility gymnastics and facial expressions are possible at any time. Not only the effort, but also the relaxation of the muscles is important. Autogenic training and relaxing facial massages also have a positive effect on the mental state of the person affected. Patients should integrate simple but effective exercises into the daily routine.

Making faces, such as raising both eyebrows and corners of the mouth, or forming a kiss are helpful, as well as pressing lips and eyes together, compressing the nose and inflating the cheeks or a balloon. Any facial expressions from the evil eye to the expression of great joy are helpful.

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