Facial Nerve Paralysis

An Alarming Symptom That Has Many Potential Causes

Facial nerve paralysis is impaired function of the facial nerve. It causes weakness on one side of the face. Bell’s palsy is the most common cause of isolated facial nerve paralysis when there aren’t other symptoms.

Facial weakness can also be one of the symptoms of other conditions, such as Ramsay Hunt syndrome (a complication of shingles), stroke (a blockage of blood flow or bleeding in the brain), facial trauma, dental infections, or meningitis (inflammation of the meninges that protect the brain).

This article will discuss facial nerve paralysis, potential causes, diagnostic tests, and potential treatments.

Woman getting a neurological examination

Antonio_Diaz / Getty Images

Symptoms of Facial Nerve Paralysis 

When facial nerve paralysis occurs due to Bell’s palsy, it causes trouble moving the face, a droopy appearance on one side of the face and mouth, and a droopy eyelid that won’t fully close. 

Depending on the cause, other symptoms can be present with facial nerve paralysis too, such as:

  • A rash and pain with shingles 
  • Pain or numbness with Ramsay Hunt syndrome 
  • Dizziness, blurred vision, trouble speaking, weakness of one side of the body, or confusion with a stroke 
  • Photophobia (light sensitivity), neck stiffness, and a fever with meningitis 
  • Severe head pain with a migraine episode 

Facial nerve paralysis is never something to be ignored. If you or someone else develops this problem, it’s crucial to get medical attention right away.

Types of Facial Nerve Paralysis

Facial nerve paralysis is often described as central or peripheral. Central facial nerve paralysis is caused by a problem affecting the brain. It causes weakness in the lower part of the face. Peripheral facial nerve paralysis is caused by a problem affecting the nerve. It causes weakness in the whole face, including the forehead.

Causes of Facial Nerve Paralysis 

There are several medical conditions that can cause facial nerve paralysis. 

Causes of peripheral facial nerve paralysis include:

  • Bell’s palsy: A common idiopathic (without a known cause) facial nerve paralysis that is believed to be associated with inflammation
  • Ramsay Hunt syndrome: A rare complication of shingles, which is a reactivation of the virus that causes chicken pox
  • Nerve damage from an injury: Can occur due to trauma or surgery
  • An infection of the mouth or face: Can develop due to trauma, a weak immune system, or extension from a dental infection
  • Cancer growing near the nerve: Can occur as a primary cancer, or may metastasize (spread) from elsewhere in the body

Causes of central facial nerve paralysis:

  • Stroke: Brain damage due to inadequate blood supply due to a blockage or bleeding
  • Migraine episode: A neurological condition that causes recurrent head pain, often with other symptoms
  • Head trauma: Can damage the area of the brain that controls the facial nerve 
  • Meningitis: Inflammation or infection of the meninges (covering around the nerves in the brain and spinal cord) 
  • Encephalitis: Inflammation or infection of the brain tissue  
  • Brain cancer: Can develop anywhere in the brain, including the areas that control the facial nerve

How Facial Nerve Paralysis Happens 

The facial nerves are controlled by the motor regions in the brain. These regions include the motor strip of the cerebral cortex, as well as areas of the brain stem. 

The facial nerves exit from the brain stem on each side and divide into branches that control different muscles throughout the face. The forehead muscles receive motor control from both sides of the brain, which is why the forehead can still move when a condition affecting the brain causes facial nerve paralysis. 

When the nerve is damaged, the corresponding side of the face becomes weak. Sometimes only one branch of the facial nerve is injured, which can lead to weakness in just a small area of the face.

How to Treat Facial Nerve Paralysis 

The treatments of facial nerve paralysis vary widely because the right therapy depends on the cause. This is one of the reasons that diagnosis of the underlying condition is so important. 

Treatments include:

  • Steroids may help speed the natural recovery of Bell’s palsy. 
  • Antibiotics are required for the treatment of bacterial meningitis.
  • Surgery may be necessary to repair a nerve that’s injured or to remove a tumor. 
  • Drainage of an infected abscess or facial infection may be needed. 
  • Blood thinners and other stroke-directed treatments may help treat a stroke. 
  • Migraine medication can treat an ongoing migraine.

Treatment must be specific to the cause because any therapy for facial nerve paralysis will not be helpful unless it targets the underlying problem.

In addition to these specific interventions, physical therapy can speed recovery from facial nerve paralysis of any cause.

Sometimes recovery is complete, but often there is only partial recovery after facial nerve paralysis. Muscles can begin to atrophy (shrink) when they aren’t used. Rehabilitation can help you rebuild your facial muscle strength after facial nerve paralysis.

Are There Tests to Diagnose the Cause of Facial Nerve Paralysis? 

The diagnosis of facial nerve paralysis is based on a medical examination. Your healthcare provider will discuss your symptoms and medical history. They will examine your facial movements and vision and do a comprehensive physical examination, which includes a neurological exam

Depending on the findings, you might need additional testing. 

For example, further tests can include: 

  • A face or mouth X-ray to identify an abscess 
  • Brain imaging, such as computerized tomography (CT) or magnetic resonance imaging (MRI) if there is concern about a stroke, meningitis, or encephalitis 
  • Lumbar puncture to identify an infectious organism that could be causing meningitis 
  • Electrodiagnostic studies that use electrical stimulation to define the type and location of facial nerve damage
  • Facial imaging tests for surgical planning to repair an injured nerve 

Often, with facial nerve paralysis, tests are not needed or do not show anything abnormal. For example, Bell’s palsy, Ramsay Hunt syndrome, and migraine are not associated with abnormal diagnostic testing. 

When to See a Healthcare Provider 

Facial nerve paralysis is distressing. Sometimes it might be caused by a serious condition, like a stroke. But the most common cause is Bell’s palsy, which is not life-threatening. It can be extremely difficult to know whether facial weakness is due to a dangerous condition, so it’s crucial to get prompt medical attention. 

See a Provider

If you develop facial weakness, with or without any other symptoms, it’s important that you see a healthcare provider.


Facial nerve paralysis occurs when there is weakness on one side of the face. Bell’s palsy is a common cause. It can also occur due to nerve damage from trauma, infection, cancer, stroke, inflammation of the brain, and migraine,

When this symptom occurs, a person needs an examination by a healthcare provider to determine the cause. Treatment will be based on the cause.

A Word From Verywell 

Losing control of your facial movements can be frightening. Fortunately, most cases of facial weakness are not caused by a dangerous or life-threatening problem. However, prompt medical attention is necessary to determine whether there is a serious issue that has to be treated.

After the acute phase of facial nerve paralysis, rehabilitation exercises are an important aspect of recovery.

Frequently Asked Questions

  • What does facial nerve paralysis look like?

    In general, facial nerve paralysis is an uneven appearance of the face. It looks like one side of the face is droopy, with a flattened nasolabial fold. This fold is the deep crease that runs diagonally at the side of the nose and above the cheek and mouth. The eyelid might appear almost closed, but it often won’t fully shut. Sometimes facial wrinkles look smoother on the affected side. 

  • Is Bell’s palsy the same as a stroke?

    Two different conditions that can have similar effects on facial appearance are:

    • Bell’s palsy is an inflammatory weakness of the facial nerve that usually doesn’t have an identifiable cause, and it gets better on its own.
    • A stroke is a serious problem that occurs when an area of the brain is damaged due to impaired blood flow. It can cause many symptoms, and facial weakness is one of the potential effects of a stroke.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Guntinas-Lichius O, Volk GF, Olsen KD, et al. Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline. Eur Arch Otorhinolaryngol. 2020;277(7):1855-1874. doi:10.1007/s00405-020-05949-1

  2. UT Southwestern Medical Center. Facial paralysis.

  3. Wamkpah NS, Jeanpierre L, Lieu JEC, Del Toro D, Simon LE, Chi JJ. Physical therapy for iatrogenic facial paralysis: A systematic review. JAMA Otolaryngol Head Neck Surg. 2020;146(11):1065-1072. doi:10.1001/jamaoto.2020.3049

  4. Thakar A, Gupta MP, Srivastava A, Agrawal D, Kumar A. Nonsurgical treatment for posttraumatic complete facial nerve paralysis. JAMA Otolaryngol Head Neck Surg. 2018;144(4):315-321. doi:10.1001/jamaoto.2017.3147

  5. Madhok VB, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2016;7(7):CD001942. doi:10.1002/14651858.CD001942.pub5

  6. Centers for Disease Control and Prevention. Bacterial meningitis.

  7. Centers for Disease Control and Prevention. Treat and recover from a stroke.

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.