What Is Facial Nerve Paralysis? Early Signs and Common Causes

Have you ever wondered what would happen if one side of your face suddenly stopped working properly? It might sound scary, but facial nerve paralysis is more common than you think: and understanding it can help you know what to look for and when to get help.

Facial nerve paralysis happens when the nerve that controls your facial muscles gets damaged or stops working correctly. This can cause weakness or complete loss of movement on part of your face, usually just on one side. While it can feel overwhelming at first, many cases improve with time and proper treatment.

Let's break down everything you need to know about this condition, from how your facial nerve works to the early warning signs you shouldn't ignore.

How Your Facial Nerve Actually Works

Think of your facial nerve as the master controller for your face. This important nerve, also called cranial nerve VII, starts in your brain and travels through your skull before splitting into five main branches. Each branch has a specific job:

• One controls your forehead muscles

• Another manages your eyelid

• One handles your cheek and nose area

• Another controls your mouth and lips

• The last one manages muscles in your neck

When everything's working normally, these branches coordinate seamlessly to help you smile, frown, blink, chew, and make all those facial expressions that make you uniquely you.

But when something interrupts this nerve anywhere along its path: whether it's swelling, injury, or another problem: that's when facial paralysis can happen.

Early Signs You Shouldn't Ignore

Facial nerve paralysis usually develops suddenly, often over just a few hours. The key thing to remember? Make sure it's not a stroke! Remember the act FAST adverts. If not a stroke, you should see a doctor within 72 hours. Don't wait and hope it goes away on its own.

Here's what to watch for:

Facial Weakness You might notice that one side of your face feels weak or heavy. Maybe your smile looks lopsided, or you can't raise one eyebrow like you used to.

Drooping Features Your eyebrow, eyelid, cheek, or corner of your mouth might start to droop or sag on one side. This happens because the muscles lose their normal tone when the nerve isn't working.

Eye Problems You might find it hard or impossible to close one eye completely. This can lead to your eye feeling dry or producing too many tears. Some people also become sensitive to loud sounds in one ear.

Changes in Expression Smiling, frowning, or showing other facial expressions becomes difficult or impossible on the affected side.

Eating and Drinking Issues You might start drooling, or notice that food and drinks leak out of one side of your mouth when you eat.

Taste Changes Some people notice that food doesn't taste the same, or they lose their sense of taste on one side of their tongue.

Muscle Spasms Your facial muscles might twitch or spasm involuntarily, even when you're trying to keep your face still.

One thing that can develop later is something called synkinesis. This is when trying to move one part of your face causes another part to move unintentionally. For example, when you try to smile, your eye might close too. This usually starts a few months after the initial paralysis but can take up to two or three years to appear.

What Causes Facial Nerve Paralysis?

There are actually more than 100 possible causes of facial nerve paralysis, but don't let that number scare you. Most cases fall into just a few common categories that doctors are very familiar with treating.

Bell's Palsy - The Most Common Culprit Bell's palsy is by far the most common cause of facial paralysis. It causes sudden weakness on one side of your face, often appearing overnight. The good news? Bell's palsy is usually temporary, and most people recover completely within a year without any treatment. However, the longer the nerve is weak, the more likely there will be some level of asymmetry long term. Also it is more likely to develop synkinesis.  Doctors think it might be caused by swelling in the facial nerve that temporarily cuts off its blood supply.

Viral Infections Several viruses can trigger facial paralysis, including:

• Herpes simplex (the virus that causes cold sores)

• Shingles, which can cause Ramsay Hunt syndrome: you might notice fluid-filled blisters in or around your ear

Injuries and Trauma Any injury to your head or face can potentially damage the facial nerve. This includes:

• Car accidents or sports injuries

• Falls that involve hitting your head

• Fractures to the temporal bone (the bone around your ear)

• Birth injuries from difficult deliveries

Stroke When a stroke affects the brain stem, it can cause facial paralysis along with other symptoms like numbness. Stroke-related facial paralysis needs immediate medical attention.

Infections Various infections can affect your facial nerve:

• Lyme disease from tick bites

• Ear infections that spread

• Mastoiditis (infection of the bone behind the ear)

Tumors While less common, tumors can press on or grow around the facial nerve:

• Parotid gland tumors (in your saliva gland)

• Acoustic neuromas (benign tumors near the ear)

• Facial nerve schwannomas (slow-growing tumors on the nerve itself)

Neurological Conditions Conditions like Guillain-Barré syndrome, where your immune system attacks your own nerves, can cause facial paralysis: sometimes on both sides of your face.

Surgical Complications Sometimes facial nerve paralysis can happen as a rare complication of:

• Brain surgery

• Ear surgery

• Facial surgery

Conditions Present from Birth Some people are born with facial paralysis due to genetic conditions like:

• Möbius syndrome

• Hemifacial microsomia

• Various other developmental conditions

When Should You Get Help?

Here's the bottom line: if you notice sudden facial weakness or any of the symptoms we've talked about, don't wait. See a doctor as soon as possible, ideally within 72 hours.

This is especially important if your symptoms could be signs of a stroke. If you have facial numbness along with weakness, or if you're experiencing other neurological symptoms, head to the emergency room right away.

Your doctor will examine you and might order some tests to figure out what's causing your symptoms. The sooner you get proper diagnosis and treatment, the better your chances of recovery.

What Happens Next?

If you're dealing with facial nerve paralysis, remember that you're not alone, and there are treatment options available. Some cases resolve on their own, while others benefit from medications, physical therapy, or surgical interventions.

At Ullas Facial Plastic Surgery, we specialize in helping people with facial nerve conditions, including both static and dynamic facial nerve reanimation procedures. We also treat complications like synkinesis that can develop after facial paralysis.

The most important thing to remember is that facial nerve paralysis, while initially concerning, is often treatable. Many people go on to recover significant function and feel confident about their appearance again.

In our next post, we'll explore what daily life is like with facial weakness and share practical tips for managing the challenges. We'll also discuss the emotional side of dealing with facial changes and how to cope while you're on your recovery journey.

If you're currently experiencing facial weakness or have questions about your symptoms, don't hesitate to book a consultation with our team. We're here to help you understand your condition and explore your treatment options.