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Facial nerve paralysis

Facial nerve paralysis frequently asked questions

What are the causes of facial paralysis?

Bell’s Palsy

One of the most common causes of facial paralysis is Bell’s Palsy. While nobody knows exactly what causes this, it might be related to a viral infection of the facial nerve. It comes on suddenly over 24 to 72 hours (one to three days) and almost always will be on one side of the face. Most people will start to see recovery within 2 to 3 weeks and see a full recovery in three months. It is important to see your health care provider as soon as possible because medications such as steroids and possibly anti-viral treatment given early will help improve your chance for recovery.


Facial drooping can be one of the first signs of stroke. Frequently on one side of the face or body, it can be combined with weakness in the arms and legs, confusion, trouble speaking, vision problems, dizziness, loss of balance or headache. If you are experiencing any combination of these symptoms, call 911 immediately.

Lyme disease

Lyme disease is caused by ticks. Symptoms of early Lyme disease may present as a flu-like illness (fever, chills, sweats, muscle aches, overly tired, nausea and joint pain) and a rash. Some patients will also develop facial drooping, and this can be on BOTH sides. Because Lyme disease needs to be clinically diagnosed, it is important to see a health care provider if you think you have been exposed or might be infected.

Brain tumor

Facial paralysis that is due to a brain tumor usually develops slowly. Symptoms can include headaches, seizures, vertigo (dizziness) or hearing loss, and should be evaluated by an otologist (ear surgeon) or neurosurgeon (brain surgeon). This is commonly called an acoustic neuroma or vestibular schwannoma, although there may be other less common tumors possible.

Head or neck tumor

The facial nerve exits the brain from behind the ear and travels through a large salivary gland called the parotid, located in front of the earlobe. Tumors of the parotid gland, or located in the head and neck, can cause facial paralysis.


Facial paralysis can result from head trauma, which causes either facial nerve swelling or can severing the facial nerve when there is a fracture to the skull.

Ramsay Hunt syndrome

This is caused when a shingles outbreak occurs near one of your ears and may also affects the facial nerve and/or the hearing nerve. It can cause a severe case of facial paralysis in the ear affected by shingles. Prompt treatment can reduce your risk of complications.


The Facial Nerve Clinic can evaluate children born with a facial nerve problem. Present at birth, the most frequent cause of congenital facial nerve paralysis is trauma during the birth process.

Do I need to see a facial nerve specialist?

The Facial Nerve Clinic sees patients with chronic facial paralysis. This is weakness or any other problem in the facial nerve that has been present for over three months. However, we recommend all patients experiencing new facial nerve weakness that have not been evaluated, see a health care provider immediately. If you cannot schedule with a provider, go to nearest emergency room to rule out any serious cause.

Is there anything I can do to improve my recovery during the first few months after experiencing facial nerve weakness or paralysis?

First, if you have new facial paralysis and have not been evaluated, see a health care provider immediately. You provider may prescribe medications that improve your chance of recovery. After this, it very important to pay attention to your eye to ensure that it is protected.

What eye care is necessary when experiencing facial nerve weakness or paralysis?

All types of facial nerve weakness may also affect your ability to close your eyelids. Without taking steps to protect the exposed eye, this could lead to permanent damage. It is important that the eyelids close completely when sleeping and blinking. Major drying of the eye can cause decreased vision, infection, scarring, loss of sight, and loss of the eye in extreme cases. It is very important to use eye protection when the eye cannot close. We recommend all patients see an eye care doctor with incomplete eye closure. You should seek urgent evaluation for any sign of eye irritation which can include burning, watering, decreased vision, sensitivity to light, and eye pain. More about eye care in facial paralysis

Who will I see at the Facial Nerve Clinic?

During your appointment with UW Health’s Facial Nerve Clinic, you will be seen by an otolaryngologist (ear, nose and throat specialist), an occupational therapist with expertise in facial retraining, and a nurse coordinator. The full evaluation includes intake forms, capturing photographs and a video to record your muscle movement, and an evaluation with the Facial Nerve Clinic team.

We employ a team approach to patient care, and our clinic staff will help coordinate any follow-up appointments with our team of facial plastic surgeons, neurosurgeons, oculoplastic surgeons, neurologists, head and neck surgeons, and health psychologists, who all work together to create the best treatment plan for you.

What are the types of chronic facial paralysis?

If the muscles are still weak, this is called “paresis”. Where there is no muscle movement, then this is called “flaccid facial paralysis”. For some patients, as the paralysis recovers, the facial muscles do not heal properly. This results in facial tightness, spasm, or unwanted muscle movement, called “synkinesis”. Sometimes, there can be synkinesis AND parts of the face with weakness called “mixed” facial paralysis.

How is flaccid facial paralysis treated?

Your treatment will be customized to your specific needs:

  • Nonsurgical Treatment

  • Botulin toxin injections

  • Facial retraining therapy

  • Speech therapy

  • Surgical Treatment

If full recovery isn’t obtained through nonsurgical treatments, surgery can often help restore facial function.

How is synkinesis treated?

Facial retraining therapy is used for synkinesis to train the facial muscles to once again work in a coordinated and natural way.

Botox injections are often recommended in addition to other treatments for abnormal muscle movement in synkinesis. It is commonly used in conjunction with facial retraining, but Botox can relax over working muscles on the normal side to improve symmetry between the two sides of the face. The effects of Botox are temporary, typically lasting 3 to 4 months and can be repeated as needed.

I’ve had my facial paralysis for years, is there anything that can be done?

After two years into facial paralysis, the muscles begin to break down and can no longer be used to restore strong facial movement. However, there are procedures that can lift sagging/drooping parts of the face or improve eyelid positioning (see static repair), and procedures that transfer new muscle from the upper leg to the face to recreate movement.