Facial nerve paralysis

Overview

Central facial nerve paralysis or palsy originates in the brain, while peripheral facial nerve paralysis is caused by damage to the facial nerve itself. The resulting facial paralysis is usually easy to see. A cause often can't be identified (idiopathic peripheral facial palsy). Facial nerve paralysis should be treated by a doctor.

Symptoms

The facial nerve sends impulses to the mimic muscles that make expressions of emotions and moods possible (closing the eyes, wrinkling the forehead, laughing, whistling, etc.).

Peripheral facial nerve palsy

• Usually, an entire side of the face is affected, from the forehead to the chin
  • Weak, partial or complete paralysis
  • The masticatory muscles are not affected (a different nerve)
• Dynamics of paralysis
  • Often preceded by a few days of persistent pain behind one ear or in the cheek, sometimes also a stiff neck
  • Paralysis then occurs suddenly (within a few hours)
• Facial expression
  • As facial expression is missing on one side, the face looks like a mask
  • The skin of the forehead is smooth; inability to frown
  • Soft and sagging cheek and corner of the mouth
  • Impossible to purse lips or whistle
• (Partial) sensory deficits
  • Impaired feeling of touch, pain or temperature
  • Loss of taste in the front half of the tongue on one side
  • Hearing problems (noises are too loud)
• Eye problems
  • Eye can't be closed any more
  • Can’t blink and the edge of the lower eyelid is turned outward
  • Risk of drying out as well as keratitis andconjunctivitis
• Course
  • Good prospects for at least partial recovery; the spontaneous healing rate is 60 to 80%
  • A few residual symptoms sometimes remain (e.g. twitching facial muscles, asymmetrical face)

Central facial nerve paralysis

• Mainly the lower half of the face is affected (e.g. area around the mouth)
• Nerve impulses for movement of the forehead and closing of the eyelids comefrom both halves of the brain
  • One-sided loss of nerve function is compensated by the healthy opposite half

Causes and treatment

Cause

Peripheral paralysis

• Idiopathic facial nerve paralysis (Bell's palsy)
  • Unexpected peripheral paralysis
  • No clearly discernible cause
  • Often occurs after a cold
• Mechanical damage
  • Compression (bruising) of the nerve at the base of the skull (tumours, fracture at the base of the skull)
• Infections
  • Local infection in the ear canal or the ear (direct damage to the nerve)
  • Often: chronic middle ear infection (otitis media)
  • Other infections: herpes zoster, poliomyelitis, Lyme disease, TBE, syphilis, HIV, tuberculosis
• Neurological disorders: multiple sclerosis, Parkinson’s disease
• Treatment by doctors: small risk, e.g. injections (conductive anaesthesia)

Central facial nerve paralysis

• Opposite side is affected by paralysis
• Impaired circulation in the brain
  • Cerebral apoplexy (stroke)
  • Cranial and brain injuries with bleeding inside the skull
• Multiple sclerosis
• Aneurysms
• Tumours (more rarely)

Further treatment by your doctor / in hospital

Possible tests

• Examination of mimic muscles
• Examination of ear canal (otoscopy) and outer ear
• MRI (magnetic resonance imaging)
• CT scan (computed tomography)
• Examination of cerebrospinal fluid if infection is suspected to be the cause
• Measurement of electrical muscle activity (electromyography, in particular if healing is delayed)

Possible therapies

• Cortisone preparations
• Treatment of possible causes
  • Virostatic agents (antiviral medication) if there are herpes or zoster blisters
  • Antibiotics for borreliosis
• Operation
  • If there is residual paralysis
  • Various plastic surgery measures (depending on muscle loss)

What can I do myself?

• If the eyelid can't close: protect the eye
  • Artificial tear fluid during the day (prevents drying out)
  • Eye ointment to keep the eye moist at night
  • Cover eye with an eye patch at night
• Movement exercises in front of the mirror (can promote residual function and contribute to rehabilitation)
  • Don't exercise too much, 20 to 30 minutes per day (in 3 to 4 sessions) is enough
• Wear a helmet when doing dangerous work and sports

When to see a doctor?

• Facial paralysis (e.g. impossible to close the eyelid, frown or whistle)
• Facial paralysis accompanied by severe earache (emergency)
• As medication works better in the early stages, don't lose time going to the doctor

Synonyms

facial nerve paralysis, facial nerve palsy, facial paralysis