Facial palsy
Facial palsy
Overview
Facial palsy is a weakness of the facial muscles. It causes loss of movement in your face and can affect 1 or both sides of your face.
If you have symptoms of facial palsy, get help as soon as possible. Treatment for facial palsy is more effective if started early (within 24 hours).
Common Symptoms
Symptom information is not available for this condition yet.
Emergency Warning Signs
Phone 999 or go to A&E if:
- your face droops on 1 side (your mouth or eye may have drooped)
- you can’t lift up both arms and keep them there
- you have difficulty speaking (your speech may be slurred or garbled)
These can be signs of a stroke, which is a medical emergency.
Contact your GP practice urgently if:
- you have symptoms of facial palsy
If your GP practice is closed, phone 111.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Phone 999 or go to A&E if:
- your face droops on 1 side (your mouth or eye may have drooped)
- you can’t lift up both arms and keep them there
- you have difficulty speaking (your speech may be slurred or garbled)
These can be signs of a stroke, which is a medical emergency.
Contact your GP practice urgently if:
- you have symptoms of facial palsy
If your GP practice is closed, phone 111.
Causes
Sometimes the exact cause is unknown. Some of the most common causes of facial palsy are:
- Bell's palsy: the exact cause is unknown, but it's believed to happen when the nerve controlling the muscles in your face becomes inflamed and swollen
- viral infections like Ramsay Hunt Syndrome: symptoms can also include severe pain, a rash in the hairline, ear or mouth, vertigo or dizziness, and loss of hearing and tinnitus
- tumours of the face or neck pressing on the facial nerve
- surgery to remove tumours of the face or neck
- tumours at the base of the skull like acoustic neuroma (vestibular schwannoma)
- bacterial causes like Lyme disease or after a middle ear infection
- trauma or injury to the face and nerves
Who's most at risk of facial palsy
Anyone of any age can be affected, at any point in life. During pregnancy, the risk of developing facial palsy is higher, most often in the 3rd trimester or within 7 days of having a baby.
Diagnosis
Facial palsy happens when the facial nerve is damaged, either for a short time or permanently.
When this nerve stops working properly, or isn't there at all, the muscles of the face stop getting the signals they need to move normally. The result is weakness or paralysis in the affected part of the face. Depending on the case, this can affect movement of one or both eyes, the mouth, or other parts of the face.
In some people, only the lower half of the face is affected. In others, one entire side is affected, and in some cases both sides of the face are affected together.
Facial Palsy UK offers more detailed information on how the facial nerves work.
Treatment
Facial palsy treatment depends on what's causing it.
Bell's palsy
Oral corticosteroid tablets can help bring down the swelling of the facial nerve.
Ramsay Hunt syndrome
This is usually treated with oral corticosteroids along with an antiviral medicine for the shingles virus. Both are taken as tablets.
Lyme disease
Lyme disease is a bacterial infection passed to humans through infected tick bites, and it can also lead to facial palsy. It is usually treated with antibiotics.
Non-surgical treatment
If you find it hard to close your eye, you may be given eye drops to use during the day, along with an ointment for use at night. Tape can also be used to keep the eye closed while sleeping. Wearing sunglasses outdoors can help too, as it reduces dryness and irritation. Talk to your doctor or optometrist if eye dryness or irritation gets worse or starts affecting your vision.
Specialist facial physiotherapy helps you understand how the facial nerve works, and you will be given guidance on caring for your eyes and mouth. You may also get practical tips to make eating, drinking, and speaking easier. The therapist may design a home exercise plan for you, which can include massage, stretching, and other facial exercises.
Many people with facial palsy develop synkinesis, a tightness or flickering in the facial muscles, often felt around the eyes and neck. Botulinum toxin injections can help ease this.
Surgical treatment
Surgery may be suitable for some people. It is best to discuss whether surgery is right for you with a surgeon who specialises in facial palsy care. Surgical options include:
Eye surgeries that protect eye function, ease symptoms such as dryness or watering, and improve overall appearance.
Smile surgeries that restore balance to the face at rest or help create a smile on the affected side.
Procedures that improve facial symmetry and address drooping.
Surgeries that improve comfort in the lower face when synkinesis, the tightness or flickering of facial muscles, is a problem.
Complications
Facial palsy can sometimes leave lasting effects. These include:
- weakness in the face that does not fully go away
- problems with the eye on the affected side
- trouble speaking, eating or drinking
- a weaker sense of taste
- unwanted twitching of the facial muscles as the nerve heals (called synkinesis)
- ongoing pain in the face
- feelings of stress or low mood because of how the condition affects daily life
- discomfort or difficulty tolerating loud sounds
Coping with facial palsy
Living with facial palsy can understandably leave you feeling low, anxious or under stress. If it is affecting your mental wellbeing, it is worth talking to your doctor about it.
Facial Palsy UK's website has further information, including details of support groups, self help tools and videos. If you get in touch with them or similar groups, avoid sharing personal details such as your name, location or any health conditions you have.