Facial Palsy and Bell’s Palsy

Facial palsy is weakness or paralysis of the muscles on one side of the face, caused by a problem with the facial nerve. The most common form is Bell's palsy, which comes on over a day or two with no other cause found.

About seven in ten people with Bell's palsy recover fully, mostly within three months. Those who do not may be left with weakness, tightness or unwanted linked movements, and these long-term problems are where specialist treatment has most to offer.

Symptoms

• Drooping of one side of the face, including the forehead
• Inability to close the eye fully
• A dry, gritty or watering eye
• Drooling and difficulty eating or drinking
• Pain behind the ear at onset
• Altered taste and sensitivity to loud sounds
• Later: tight cheek, eye closing when smiling (synkinesis)

Causes and risk factors

Bell's palsy is thought to result from swelling of the nerve inside its narrow bony canal, probably triggered by reactivation of herpes simplex virus. It is more common in pregnancy and diabetes. Other causes of facial palsy include shingles of the ear (Ramsay Hunt syndrome), Lyme disease, middle ear infection, skull fracture, surgery on the parotid gland or for acoustic neuroma, and tumours. Slow progression over weeks, or no recovery at all by four months, is not typical of Bell's palsy and needs imaging.

How it is diagnosed

• Clinical examination: Forehead involvement separates a facial nerve problem from a stroke, where the forehead is usually spared.
• Ear and parotid examination: Looks for blisters, infection or a lump.
• MRI: Requested when the course is atypical, recurrent or not recovering.
• Electrical tests (ENoG, EMG): Estimate the degree of nerve damage and whether muscles are still viable, which decides the surgical options.
• Blood tests: Lyme serology or glucose where relevant.

Treatment options

• Steroids within 72 hours: A short course of prednisolone improves the chance of full recovery in Bell's palsy. Antivirals are added for Ramsay Hunt syndrome.
• Eye protection: Lubricating drops, ointment and taping the lid shut at night prevent corneal damage.
• Specialist facial physiotherapy: Neuromuscular retraining, not electrical stimulation, for incomplete recovery.
• Botulinum toxin: Relaxes tight or overactive muscles and improves symmetry. It needs repeating every three to four months.
• Eyelid procedures: An upper lid weight or lower lid tightening protects the eye.
• Nerve transfer or cross-face nerve graft: Within about 12 to 18 months of paralysis, while the facial muscles can still be revived.
• Free muscle transfer: A strip of gracilis muscle from the thigh restores a smile in long-standing paralysis.

When it is urgent

Sudden facial droop with arm weakness, speech difficulty, or a forehead that still moves may be a stroke: call an ambulance. A painful red eye or blurred vision in the affected eye needs an eye doctor the same day.

Travelling to Türkiye for treatment

New facial palsy must be treated locally within three days, so travel has no role at that stage. It becomes relevant for palsy that has not recovered after 6 to 12 months. A visit can cover assessment by a facial nerve team, botulinum toxin with a physiotherapy plan, eyelid surgery, or reanimation surgery needing about two weeks. Results of nerve and muscle transfers appear over 6 to 12 months, and some are done in two stages, so plan for a return trip.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions