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Ask the Expert: What are the most common causes of facial paralysis?

Ask the Expert: What are the most common causes of facial paralysis?

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What are the most common causes of facial paralysis, and what treatment options are available?

Facial paralysis involves an interruption of the nerve that moves the muscles of the face. This can happen suddenly or slowly. Usually, just one side of the face is affected, but occasionally both sides are paralyzed. Facial paralysis can occur by itself or can be a sign of a serious underlying condition, such as stroke or cancer, so it’s critical to get immediate medical attention if you develop sudden facial paralysis.

The most common cause of facial paralysis is Bell’s palsy. This occurs rapidly over one to three days and can be preceded by an earache, cold-like illness or changes in hearing or taste. In severe cases, this causes complete paralysis of half of your the face, making you unable to raise your eyebrow, close your eye and move your mouth. Bell’s palsy also can cause difficulty with drinking liquids without drooling.

Bell’s palsy is caused by a reactivation of the herpes virus that causes cold sores. This can occur even in people without a history of cold sores. There is no definitive test for Bell’s palsy, so it’s important to have a complete medical evaluation when facial paralysis develops to rule out other potential causes, such as stroke, cancer, autoimmune conditions or other infections like Lyme disease and the shingles virus (Ramsay-Hunt Syndrome).

Treatment for severe Bell’s palsy should be started in the first three days after symptoms develop and often involves steroid medications to reduce swelling and anti-viral medication to fight off the virus. Recovery usually begins in the first few weeks, but can be delayed in some people — and full recovery can take up to one year. Additional treatment focuses on protecting your eye from drying out if you can’t close it completely. Most people recovery fully after Bell’s palsy, but up to 30% do not. In these cases, partial facial weakness may persist, or twitching and spasm of the face develop, which is called synkinesis.

If synkinesis develops, additional treatment can help, even if you’ve had this condition for years. Specialized physical therapy and massage can help you better control your muscles and targeted injections of Botox medication can help relax muscles that are overactive and relieve twitching.

There are also surgeries that can help reduce twitching and restore facial motion. Selective neurectomy is a surgery that carefully divides small facial nerve branches to reduce spasms or twitching in the facial muscles and improve facial symmetry. Nerve transfer surgery can help improve your smile by using a neighboring nerve in the cheek to increase the strength of weakened facial muscles. In more severe cases, a small piece of muscle called the gracilis can be transferred from the thigh to replace smile muscles that are permanently paralyzed to restore your smile.

Treatment for facial paralysis is different for every person, and many of these treatment options are available for any cause of facial paralysis. If you have issues with facial paralysis or spasm, it’s important to have these issues evaluated by an expert who can help you decided which treatment may be best for you.

For more information about facial paralysis, visit

Dr. Sam Oyer is a facial plastic and reconstructive surgeon at UVa Health who specializes in facial paralysis treatment.

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