Facial palsy

Facial palsy is a weakness of the muscles in your face. You lose some movement, and it can affect 1 or both sides of your face.

If you have symptoms of facial palsy, get help as soon as possible. Treatment works better when it's started early (within 24 hours).

• 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.

• you have symptoms of facial palsy

If your doctor's chamber is closed, phone a doctor or the 16263 health line.

With facial palsy, the muscles in your face may droop, become weak or be paralysed. The symptoms can affect different areas of your face.

You might notice:

• loss of forehead wrinkles
• not being able to frown
• a droopy eyebrow

With facial palsy, you might:

• not be able to close your eye or fully blink
• notice your lower eyelid drooping, which can make your eye look wider
• have soreness or redness in the white of your eye

With facial palsy, you might notice some of these changes around your mouth:

• the corner of your mouth pulls down or droops
• you can't smile on the affected side
• you can't puff up your cheeks, whistle, blow or pout
• you drool from the weak corner of your mouth
• you find it hard to speak because your lips and cheek are weak

You might notice:

• pain in or near the affected ear
• loss of hearing
• higher sensitivity to high pitched noise

When facial palsy affects your nose, you may find you can't do certain things with it. These can include not being able to:

• flare your nostril or nostrils
• wrinkle your nose

Facial palsy happens when the facial nerve is damaged, either for a short time or for good. If that nerve isn't working, or is missing, the muscles in the face don't get the right signals and can't work as they should. The result is paralysis of the part of the face that nerve controls. This can affect the movement of one or both eyes, the mouth, or other areas.

Sometimes only the lower half of the face is affected. In other people one whole side of the face is affected, and in some cases both sides are.

How facial palsy is treated depends on what caused it.

Corticosteroids taken by mouth as tablets can be used to bring down the swelling of the facial nerve.

Doctors normally treat Ramsay Hunt syndrome with oral corticosteroids and an antiviral medicine, which deals with the shingles virus. You can take both of them as tablets.

Lyme disease is a bacterial infection that people catch from the bite of an infected tick. It can also cause facial palsy. Doctors normally treat it with antibiotics.

If you can't close your eye because of facial palsy, you might be offered eye drops to use during the day. You might also be given an ointment for the night. Tape may be used as well, to keep the eye closed while you sleep.

Wearing sunglasses when you're outside may help too, as they can cut down dryness and irritation. If the dryness or irritation gets worse, or starts to affect your vision, speak to your doctor or an optometrist (optician).

Specialist facial physiotherapy starts with learning how the facial nerve works. After that, you'll be given advice on caring for your eyes and mouth. You might also get tips to make eating and drinking easier and to help with speech. The therapist might give you a home exercise plan, which can include massage, stretches and exercises.

Many people with facial palsy develop synkinesis. This is tightness or flickering of the facial muscles, and it's often felt around the eyes and the neck. Botulinum toxin injections can be used to help relieve it.

Surgery may be an option for some people with facial palsy. If you're thinking about it, talk to a surgeon who specialises in treating facial palsy, and decide together whether surgery is right for you.

The surgical options include:

• eye surgeries to protect eye function, improve symptoms like dry or watery eyes, and improve overall appearance
• smile surgeries to restore symmetry at rest or create a smile movement for the affected side
• procedures which improve symmetry and address facial drooping
• surgeries aimed at improving facial comfort where synkinesis (tightness or flickering of the facial muscles) is an issue in the lower face

Sometimes the exact cause of facial palsy isn't known. These are some of the most common causes:

• Bell's palsy, where the exact cause is unknown, but it's believed to happen when the nerve that controls the muscles in your face becomes inflamed and swollen
• viral infections like Ramsay Hunt Syndrome, where 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

Facial palsy can affect anyone, at any age, and at any point in your life.

Pregnancy raises your risk of developing it. It's more likely to happen in the 3rd trimester, or within 7 days of having a baby.

Facial palsy can lead to a number of complications:

• persistent facial weakness
• eye problems
• difficulty with speech, eating and drinking
• reduced sense of taste
• facial muscle twitching (known as synkinesis)
• facial pain
• psychological distress
• sensitivity to or intolerance of loud noise

Living with facial palsy can leave you feeling depressed, stressed or anxious. If it's affecting your mental health, speak to your doctor.

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