Seventy-five per cent of cases of facial paralysis in adults are caused by an inflammation of the facial nerve called Bell's palsy. This disorder (probably derived from a virus) is common, affecting 25 out of 100,000 individuals per year. It is more common in people with diabetes. It usually affects one side of the face (very rarely both sides at one time), causing a drooping mouth, drooling, and excessive tearing from one eye. Paralysis occurs within a few hours to a few days. There may also be a loss of taste on the front of the tongue on the affected side of the face. Sound may also seem louder on the affected side (hyperacusis).

While the facial distortion usually improves over time, there may be some permanent deformity in 20% of individuals. Full recovery is less likely in older people, as well as those with hyperacusis, loss of taste, and severe paralysis. Recurrence of paralysis on the same side or the opposite side occurs in 1 in 10 people.

In facial paralysis due to stroke, the eye on the affected side can be closed and the forehead can be wrinkled. This is not possible with Bell's palsy. Other muscles on one side of the body may also be involved with a stroke.

Facial paralysis due to a brain tumor generally develops gradually with accompanying headaches, seizures, or hearing loss.

In newborns, facial paralysis may result from birth trauma.

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

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.

• There is any facial paralysis. If it is accompanied by a severe headache, seizure, or blindness it may be an emergency situation!
• The muscles in the body are involved.

The medical history will be obtained and a physical examination performed.

Medical history questions you may be asked include:

• Are both sides of the face affected?
• Is there any recent history of illness or injury?
• What other symptoms are also present?
  • Is there a facial droop?
  • Is there drooling?
  • Are there excessive tears from one eye?
  • Are there headaches?
  • Are there seizures?
  • Are there any vision problems?
  • Is there weakness or paralysis elsewhere in the body?

The physical examination will include a detailed neurological examination.

Diagnostic tests that may be performed include:

• Blood studies such as a blood sugar, CBC, ESR, Lyme test
• MRI of the head
• CT scan of the head
• Electromyography

INTERVENTION

Arrangements may be made for physical therapy, speech therapy, or occupational therapy, if appropriate.

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.