Facial Nerve Paralysis: A Simple Guide

Here is a comprehensive yet simplified guide to understanding facial nerve paralysis.

Common Names:

Facial nerve inflammation, facial palsy, Bell’s palsy, facial nerve paralysis, Abu Al-Wajih, Abu Wajh (regional terms).

1. What is Facial Nerve Paralysis?

Facial nerve paralysis, also known as Bell’s palsy, is a sudden weakness or paralysis affecting one side of the face. It occurs due to inflammation and swelling of the facial nerve (seventh cranial nerve), which controls facial muscle movements and expressions. This results in drooping of one side of the face and difficulty closing the eye on the affected side.

The condition is temporary and may take several months to fully recover. (1)

2. What Are the Symptoms of Facial Nerve Paralysis?

Symptoms of Bell’s palsy usually develop gradually over hours or days and peak within 72 hours. They include: (2)

• Sudden weakness or paralysis on one side of the face, either partial or complete.
• Drooping or sagging on one side of the face.
• Inability to fully close the eye on the affected side, leading to dryness or excessive tearing.
• Sharp pain inside the ear at the onset of symptoms.
• Altered or reduced sense of taste.
• Difficulty chewing on the affected side, with food possibly getting trapped between the gum and cheek, leading to drooling.
• Difficulty pronouncing certain sounds, such as "P" or "B".
• Increased sensitivity to loud noises.

3. What Causes Facial Nerve Paralysis?

The exact cause of Bell’s palsy is unknown, but it is believed to be linked to a viral infection, such as: (3)

• Herpes simplex virus (HSV-1), which causes cold sores and genital herpes.
• Chickenpox and shingles virus (Varicella-zoster virus).
• Epstein-Barr virus.
• Cytomegalovirus (CMV).
• Rubella (German measles).
• Influenza (flu virus).
• Mumps virus.
• Adenoviruses (which cause respiratory infections).
• Hand, foot, and mouth disease virus.

Some people are more prone to Bell’s palsy, including: (3)

• Pregnant women, particularly in the third trimester or within the first week after childbirth.
• Individuals with respiratory infections, such as flu or common cold.
• People with diabetes or high blood pressure.
• Individuals who are overweight or obese.

"Contrary to popular belief, exposure to cold air does not cause Bell’s palsy."

4. How is Facial Nerve Paralysis Diagnosed?

Diagnosing Bell’s palsy is primarily clinical, meaning the doctor will:

• Examine the face carefully and ask the patient to perform movements like:
• Raising the eyebrows.
• Closing the eyes.
• Smiling.

If facial nerve paralysis is present, the patient cannot raise their eyebrow, smile symmetrically, or fully close their eye on the affected side.

The doctor may also ask if there are numbness, weakness in other parts of the body, or walking difficulties. These symptoms are NOT associated with Bell’s palsy but help rule out other potential causes of facial weakness. (1)

If no other symptoms are present and only facial muscles are affected, a doctor can diagnose Bell’s palsy without additional tests.

However, in some cases, blood tests or imaging scans may be ordered to rule out other conditions such as stroke, tumors, or infections. (2)

5. How is Facial Nerve Paralysis Treated?

85% of Bell’s palsy patients recover completely over time without any treatment. However, 15% may experience lasting partial facial weakness to varying degrees. (1)

The primary treatment for Bell’s palsy is corticosteroids

• Prednisone (Prednisone) is commonly prescribed to reduce inflammation and swelling of the facial nerve, speeding up recovery.
• In some cases, an antiviral medication such as Acyclovir (Zovirax) or Valacyclovir (Valtrex) may be prescribed for 7 days.

Corticosteroids and antivirals are only effective if started within 72 hours of symptom onset. (1)

Additionally, it is important to keep the eye moist using lubricating ointments and eye drops.

6. How Long Does It Take to Recover from Facial Nerve Paralysis?

Improvement usually begins within two weeks of symptom onset, and most patients recover completely within six months. (1)

7. What Are Facial Nerve Rehabilitation Exercises?

Facial rehabilitation exercises help restore facial symmetry and improve muscle coordination in Bell’s palsy patients. These exercises are typically performed under the guidance of a specialist and include:

• Smiling exercises.
• Frowning movements.
• Nose wrinkling.
• Eye-closing exercises.

It is essential to follow a physiotherapist’s guidance to ensure proper technique and avoid complications. (2)

8. Can Bell’s Palsy Recur?

Most people experience Bell’s palsy only once, but 5-10% of cases may experience a recurrence. (4)

References

• Harvard Health Publishing - Bell's Palsy
• Facial Palsy UK - Bell’s Palsy
• Mayo Clinic - Bell's Palsy
• Cleveland Clinic - Bell’s Palsy