Neck & Face

Facial Nerve Disorders & Bell’s Palsy

Facial Nerve Disorders

Disorders of the facial nerve can afflict adults and children, but they are more common among people over 40 years old, people with diabetes, weak immune systems, and pregnant women. Cases of facial paralysis can be permanent or temporary, but in all circumstances there are treatments designed to improve facial function.

The facial nerve is one of twelve cranial nerves.  For the most part, any of the cranial nerves are taken for granted until a problem develops.  These nerves, as a group, have a number of functions that are involved in our special senses including vision, smell, taste, hearing and balance as well as sensation of the nose, mouth, eyes, ears, and face.   They also control many voluntary and involuntary movements and reflexes.  The facial nerve is important in our ability to raise our eyebrows, close our eyes (opening the eyes is governed by other nerves), blow our nose, smile, and even purse our lips to blow a kiss.

Some of the symptoms that either precede or accompany a facial nerve disorder include facial twitching, disturbance of taste, dryness of the eye and mouth, difficulty speaking, dribbling when drinking or brushing teeth, and earpain.

Facial nerve disorders can arise deep in the brainstem, anywhere along the lengthy, convoluted nerve course, or close to the muscles and organs it innervates.  Depending on the location of the problem all or some branches may be affected.  For example, a stroke will cause your mouth to droop but your upper face is spared while an infection along the course of the nerve close to the brainstem may result in the whole side of your face drooping.

Bell’s Palsy

Bell’s palsy is the name given to a specific disorder of the facial nerve. This disorder, which often comes on suddenly and reaches its peak within 48 hours, is believed to be due to the body’s response to a virus causing the facial nerve within the skull to swell.  Pressure on the nerve within the narrow space it occupies in the bone causes damage to the nerve. The paralysis usually affects only one side of the face, but in rare cases it affects both sides of the face at once. Bell’s palsy may last from two to three weeks or longer. An early sign of improvement, such as getting a sense of taste back, is often a good indication that there will be a complete recovery.

Otolaryngologists are very well trained in facial nerve disorders.  They are the highly qualified to perform an in-depth evaluation of abnormal movement or paralysis of the face.  An evaluation will include an examination of the head, neck, and ears, as well as a series of tests to try to locate the site of injury which will determine what additional tests and treatment are best.  Treatments range from antibiotics, antivirals, steroid anti-inflammatory drugs, and in select cases, surgery to decompress a swollen nerve or reconstruct a physically traumatized nerve.  Early on in a facial nerve paralysis, one of the most important strategies is protection of the involved eye.  Because of the loss of closure of the eye, it is susceptible to drying and scratches.  Your doctor should go over guidelines for proper care for your eye that should include appropriate use of artificial tears and lubricants and physical protection with taping, patching or protective eyewear.

Patients with permanent facial paralysis may be rehabilitated through a variety of procedures.  Placement of a weight or spring in the eyelid can help with lid closure.  Facial retraining is a form of physical therapy that has been employed.  Advanced surgical procedures are also available to help restore facial form and sometimes even function.

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Coronavirus Update:

Our office is open to serve patients' needs on a case by case basis. We offer tele-visits either on your computer with a webcam or on a mobile device. Doxy.me is a secure video interface that gives you a chance to discuss your concerns with Dr Lait. She will determine if your problem can be handled in the safety your home or if you should be seen urgently. Medications, labs, and xrays can be ordered without an in person visit.
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