Facial Nerve Disorders – Paralysis and Bell’s Palsy

Face injuries and disorders can cause pain and affect how you look. In severe cases, they can affect sight, speech, breathing and your ability to swallow. Broken bones, especially the bones of your nose, cheekbone and jaw, are common facial injuries.

Certain diseases also lead to facial disorders. For example, nerve diseases like trigeminal neuralgia or Bell’s palsy sometimes cause facial pain, spasms and trouble with eye or facial movement. Birth defects can also affect the face. They can cause underdeveloped or unusually prominent facial features or a lack of facial expression. Cleft lip and palate are a common facial birth defect.

Facial Paralysis

Facial paralysis is the total loss of voluntary muscle movement of one side of the face.

About 75% of all adult facial paralysis cases are due to Bell’s palsy, a condition in which the facial nerve becomes inflamed.

Stroke may cause facial paralysis. When stroke is the cause of facial paralysis, the person may still be able to close the eye on the affected side, as well as wrinkle the forehead. People with Bell’s palsy cannot do either of these. With a stroke, other muscles on one side of the body may also be involved.

Facial paralysis due to a brain tumor generally develops slowly and causes headaches, seizures, or hearing loss.

In newborns, facial paralysis may result from birth trauma.

Causes

• Bell’s palsy
• Birth trauma (newborns)
• Brain tumor
• Infection
• Lyme disease
• Sarcoidosis
• Stroke

Bell’s Palsy

Bell’s palsy is a disorder of the nerve that controls movement of the muscles in the face.

Damage to this nerve causes weakness or paralysis of these muscles. Paralysis means that you cannot use the muscles at all. Bell’s palsy affects about 30,000 – 40,000 people a year in the United States.

Bell’s palsy involves damage to the seventh cranial (facial) nerve. This nerve controls the movement of the muscles of the face.

Bell’s palsy is thought to be due to swelling (inflammation) of this nerve in the area where it travels through the bones of the skull.

The cause is often not clear. A type of herpes infection called herpes zoster might be involved. Other conditions that may cause 

Bell’s palsy include:

• HIV infection
• Lyme disease
• Middle ear infection
• Sarcoidosis

Sometimes you may have a cold shortly before the symptoms of Bell’s palsy begin.

Symptoms most often start suddenly, but may take 2 – 3 days to show up. They do not become more severe after that.

Symptoms are almost always on one side only. They may range from mild to severe.

The face will feel stiff or pulled to one side, and may look different. Other symptoms can include:

• Difficulty eating and drinking; food falls out of one side of the mouth
• Drooling due to lack of control over the muscles of the face
• Drooping of the face, such as the eyelid or corner of the mouth
• Hard to close one eye
• Problems smiling, grimacing, or making facial expressions
• Twitching or weakness of the muscles in the face

Other symptoms that may occur:

• Dry eye or mouth
• Headache
• Loss of sense of taste
• Sound that is louder in one ear (hyperacusis)
• Twitching in face

Exams and Tests

Often, Bell’s palsy can be diagnosed just by taking a health history and doing a complete physical exam.

If your health care provider is worried that a brain tumor is causing your symptoms, you may need:

• CT scan of the head
• Magnetic resonance imaging (MRI) of the head

Sometimes, you will need a test to check the nerves that supply the muscles of your face:

• Electromyography (EMG)
• Nerve conduction test