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About Facial Nerve Paralysis

Facial nerve paralysis (partial or complete) may be caused by a variety of disorders, many of which are listed below.  Common findings include eyebrow drooping, inability to close the eye, blunting or disappearance of the nasolabial fold, and drooping at the affected corner of the mouth.  Our team can help diagnose the cause of your facial nerve paralysis and provide you with the most appropriate treatment options.


Bell's palsy

Acute peripheral facial palsy of unknown cause, though activation of herpes simplex virus is believed to be the likely cause of most cases.


Herpes zoster (shingles)

Herpes zoster or shingles is caused by reactiviation the varicella-zoster virus (responsible for chicken pox) and is often implicated if facial nerve paralysis is accompanied by vesicles in the ear, though in some cases, dematomal pain and dysethesia (preherpetic neuralgia) may be the only indication that herpes zoster is the cause. Ramsay Hunt syndrome refers to herpes zoster complicated by facial paralysis or by auditory or vestibular symptoms.



Facial paralysis can result from damage to the facial nerve as a result of temporal bone fracture, barotrauma, or even birth trauma..


Otitis media

Facial paralysis is a potential complication of bacterial infection of the middle ear, which is usually diagnosed by simple inspection of the external meatus and tympanic membrane.


Lyme disease

Facial nerve palsy can be a manifestation of Lyme disease. Involvement of the facial nerve can be unilateral or bilateral, and usually lasts less than two months. Findings suggestive of possible Lyme disease include the development of facial palsy in a young patient (with or without a known history of tick bite or prior skin rash), heart block, arthritis, vertigo, and hearing loss.


Guillain-Barré syndrome

The primary feature of Guillain-Barré syndrome (GBS) is progressive, mostly symmetric muscle weakness and absent or depressed deep tendon reflexes. Facial weakness occurs in more than half of patients with GBS, and is typically bilateral and symmetric.



Facial nerve palsy is not an uncommon manifestation of neurosarcoidosis. The facial nerve palsy can be unilateral or bilateral and recurrent. Neurosarcoidosis is an important diagnostic consideration in patients with known sarcoidosis who develop neurologic findings.


Sjögren syndrome

Sjögren syndrome can cause multiple cranial neuropathies, and the facial nerve is one of the most commonly affected cranial nerves. However, isolated facial nerve palsy due to Sjögren syndrome is unusual.



Mass lesions associated with the temporal bone or parotid gland can compress or infiltrate the facial nerve and cause an unilateral facial weakness. A prolonged, slowly progressive, or relapsing course of facial weakness suggests a tumor as the cause, though tumor can also cause sudden-onset or recurrent facial weakness. Active middle ear disease or a parotid mass suggests that the palsy is associated with that finding.



Ischemic and hemorrhagic stroke can present with unilateral facial weakness, which in most cases spares the forehead muscles, but limited evidence suggests that a substantial proportion of cases misdiagnosed as Bell’s palsy are due to ischemic stroke.


Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome is a rare condition characterized by recurrent episodes of facial paralysis, episodic facial swelling, and a fissured tongue. The cause is unknown.








Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist