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Facial paralysis is the total loss of voluntary muscle movement of one side of the face.

About 75% of all adult facial paralysis cases are due to Bell's palsy, a condition in which the facial nerve becomes inflamed.

Stroke may cause facial paralysis. When stroke is the cause of facial paralysis, the person may still be able to close the eye on the affected side, as well as wrinkle the forehead. People with Bell's palsy cannot do either of these. With a stroke, other muscles on one side of the body may also be involved.

Facial paralysis due to a brain tumor generally develops slowly and causes headaches, seizures, or hearing loss.

In newborns, facial paralysis may result from birth trauma.

• Bell's palsy
• Birth trauma (newborns)
• Brain tumor
• Infection
• Lyme disease
• Sarcoidosis
• Stroke

Treatment depends on the cause. Follow your health care provider's treatment recommendations. Sometimes steroids and acyclovir may be given depending on the cause.

If the eye cannot be fully closed, the cornea must be protected from drying out with prescription eye drops or gel.

Call your doctor if you have weakness or numbness in your face. Seek emergency medical help if you experience these symptoms along with a severe headache, seizure, or blindness.

The doctor will perform a physical exam and ask you questions about your medical history and symptoms, including:

• Are both sides of the face affected?
• Have you recently been sick or injured?
• What other symptoms do you have? For example, drooling, excessive tears from one eye, headaches, seizures, vision problems, weakness, or paralysis.

Tests that may be done include:

• Blood tests, including blood sugar, CBC, ESR, Lyme test
• CT scan of the head
• Electromyography
• MRI of the head

The doctor may refer you to a physical, speech, or occupational therapist. If facial paralysis from Bell's palsy persists for more than 6 - 12 months, plastic surgery may be recommended to improve eye closure and facial appearance.

Paralysis of the face

O'Handley JG, Tobin E, Tagge B. Otorhinolaryngology. In: Rakel RE. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 25.

Stettler B, Pancioli AM. Brain and cranial nerve disorders. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 103.

Updated by: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.