Facial paralysis occurs due to dysfunction of the facial nerve, leading to weakness or loss of facial movement. Because facial nerve muscles impact everyday functions, including eating, speaking, smiling, and blinking or closing the eyes, facial paralysis can have profound functional, emotional, and social consequences for patients.

The most common cause of facial paralysis is Bell’s Palsy, however, this is diagnosed after other potential causes have been ruled out. Other underlying causes of facial paralysis include stroke, Lyme disease, Ramsay Hunt syndrome, brain tumor, head and neck tumor, trauma, surgery, and congenital abnormalities.

Symptoms of facial paralysis include:

• Facial weakness
• Facial asymmetry
• Difficulty making facial expressions such as smiling
• Difficulty blinking
• Difficulty closing eyes
• Changes in saliva and tear production
• Changes in taste on one side of mouth
• Sensitivity to loud sound
• Pain around the ear on the affected side of the face

Patients experiencing acute onset of facial paralysis should be evaluated within an urgent care center or emergency department in order to rule out other causes of facial weakness.  Patients are typically seen within the Michigan Medicine Facial Nerve Clinic following initial management by primary care, urgent care and/or emergency department providers.

Patients with facial nerve disorders such as facial paralysis require integrated, collaborative care from a multidisciplinary team including facial plastic surgeons, oculoplastic surgeons, ophthalmologists or optometrists, neurologists, otologists, skull base surgeons, and occupational therapists.

Some patients with chronic facial paralysis may be treated with facial reanimation procedures. These procedures can help restore facial symmetry, function, and movement. They include free tissue transfer, nerve transfer, muscle transfer, and nerve grafting.  Furthermore, there are additional procedures including selective neurectomy (selective neurolysis) that may be utilized for patients with facial nerve synkinesis.

Static surgical procedures such as sling procedures, and a variety of eyelid, brow, lip, and facial procedures, can also improve facial symmetry and movement.

Facial paralysis can cause reduced blink reflexes and eyelid closure, leading to corneal dryness, corneal scratches, or, in severe cases, even vision loss.

All patients with facial nerve disorders affecting their eyelids should seek care from an eye provider. Every such patient of the Facial Nerve Clinic is given a baseline eye exam (unless they have had a recent eye exam elsewhere). This helps determine the impact of facial paralysis on the health of the eye, and the information is used to develop the individualized treatment plan for patients.

While waiting for a clinic visit, patients should use preservative-free artificial tears at least 4-6 times a day, and preservative-free artificial tear ointment while sleeping.

Each case is different and there are a variety of factors that impact chance of recovery and extent of recovery following development of facial paralysis.  However, it is not uncommon for it to take up to one year or longer to observe full recovery.

Synkinesis is the development of spasms and abnormal movement of the face due to unusual healing of the facial nerve. One part of the face may begin to move abnormally with the intentional movement of another part of the face - for example, the eyelids may involuntarily close when a person is attempting to smile.

Synkinesis may be treated with facial nerve retraining therapy to teach the facial muscles to work in a more coordinated way. It can also be treated medically (with a botulinum neurotoxin injection) or surgically in some cases.