Facial nerve palsy

• Alternative Names

  Neuropathy - facial; Cranial mononeuropathy VII; Seventh cranial nerve palsy

• Causes, incidence, and risk factors

  Facial nerve palsy occurs when there is damage to the seventh cranial (facial) nerve. It is a type of mononeuropathy. The seventh facial nerve is located in the skull. It controls movement of the muscles of the face. It also affects feeling in the ear canal and the sense of taste.

  This type of nerve damage may occur with local growths, such as a tumor, that put pressure on the facial nerve.

  Facial nerve palsy may also be caused by:

  • HIV infection
  • Lyme disease
  • Sarcoidosis

  It also may have no obvious cause.

• Symptoms
  • Change in the appearance of the face
    • Difficulty closing one eye
    • Difficulty making expressions, grimacing
    • Difficulty with fine movements of the face
    • Facial droop
    • Paralysis of one side of the face
  • Difficulty eating (items fall out of the weak corner of the mouth)
  • Face feels pulled to one side
  • Face feels stiff
  • Headache
  • Impairment of taste
  • Increased loudness of sound in one ear
  • Pain behind the ear (for Bell's palsy)
  • Sensitivity to sound (hyperacusis)
• Signs and tests

  An examination will show facial drooping on one side of the face or just on the forehead, eyelid, or mouth. Examination of the eardrum may show fluid-filled sacs (vesicles).

  A blood test may be done to check for Lyme disease. Other tests may include:

  • Lumbar puncture
  • MRI of the head
  • Tests to rule out a stroke or other nervous system problems
• Treatment

  Finding and treating the cause (if it can be found) may relieve symptoms in some cases. The disorder may disappear on its own depending on the severity of nerve damage.

  Powerful anti-inflammatory drugs (steroids) may be used if the condition is caught early enough. The drugs may be used in combination with an antiviral drug called acyclovir.

  Your doctor may recommend lubricating eye drops or eye ointments to protect the eye if it doesn't close completely. You may need to wear a patch over the eye while you sleep.

  Your health care provider may recommend surgery to remove any tumors that are pressing on the facial nerve.

• Expectations (prognosis)

  The outlook varies. Some patients recover completely, while others permanently lose movement of the face.

• Complications
  • Changes to the appearance of the face (disfigurement) from loss of movement
  • Changes to taste
  • Damage to the eye (corneal ulcers and infections)
  • Nerves that grow back to the wrong structures (aberrant regeneration) -- for example, smiling causes the eye to close
  • Spasm of face muscles or eyelids
• Calling your health care provider

  Call your health care provider if your face droops or you have other symptoms of facial nerve palsy.

• Prevention

  Quickly treating tumors or other growths that press down on the facial nerve may reduce the risk of facial nerve palsy in some cases.

Review Date: 2/6/2008

Reviewed By: Daniel Kantor, MD, Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.