Facial Paralysis Causes and Treatments

Facial paralysis physical therapist with patient

Here at the Facial Nerve Center, we provide evaluation and treatment options for children and adults experiencing facial paralysis. A team of specialists work closely to provide a comprehensive approach to managing facial paralysis caused by the following disorders:

Bell's Palsy

Patients with Bell’s palsy develop sudden facial weakness on one side of the face with no obvious cause. Bell’s palsy is thought to be caused by the activation of a virus along the facial nerve. Patients may experience ear pain, changes in taste, and tongue numbness.

Our specialists treat Bell’s palsy with a combination of steroids and antiviral medications. The majority of patients will begin to recover within three weeks and will go on to have a full recovery.

Some patients may take months to recover and may develop mild to severe long-term facial movement problems (see Synkinesis).

Facial Paralysis and Ear Disease

Patients with ear disease who develop sudden facial paralysis should be seen by an otolaryngologist (ear, nose, and throat specialist) immediately.

Facial paralysis may develop during an ear infection in children and is treated with antibiotics and ear tube placement.

Patients with chronic ear disease or cholesteatoma may also develop facial paralysis and are treated with surgery.

Benign Tumors of the Facial Nerve

Benign tumors along the facial nerve, called facial schwannomas, can cause sudden facial paralysis, slowly progressive facial paralysis, or fluctuating facial paralysis. In many cases, these tumors are watched closely by our team and do not always require surgical removal. Some patients may require facial reanimation if their facial function declines.

Vascular Malformations of the Facial Nerve

Vascular malformations or “geniculate ganglion hemangiomas” of the facial nerve can cause sudden facial paralysis, slowly progressive facial paralysis, or fluctuating facial paralysis. Vascular malformations are closely observed by our team and may require surgery or other forms of treatment, such as radiation therapy.

Facial Paralysis and Head Trauma

Temporal bone fractures can cause facial paralysis by creating swelling along the facial nerve or by directly crushing or cutting the nerve. Most patients are treated with steroids. Surgery is needed in some cases to repair the nerve or to relieve the pressure from nerve swelling.

Lyme Disease

Lyme disease is common in many parts of the country, particularly New England. The disease is transmitted through a tick bite and can cause facial paralysis on one or both sides of the face. The majority of patients do not see the tick and do not have the classic “Bull’s Eye” rash, therefore if you are experiencing symptoms related to Lyme disease, you must seek medical care.

At the Facial Nerve Center, Lyme disease-associated facial paralysis is diagnosed with a blood test and is treated with antibiotics.

Patients have worse recovery when compared to Bell’s palsy and may develop mild to severe long-term facial movement problems (see Synkinesis).

Melkersson-Rosenthal Syndrome

Patients with Melkersson-Rosenthal syndrome develop a combination of recurring facial paralysis, facial swelling, and cracks in the tongue. Patients who have multiple episodes of facial paralysis may undergo facial nerve decompression where the bone that surrounds the facial nerve is drilled to make more space for the facial nerve.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome is caused by the chicken pox virus. Patients with Ramsay Hunt syndrome develop painful lesions on the ear, facial paralysis, hearing loss, and dizziness.

Our specialists treat Ramsay Hunt syndrome with a combination of steroids and antiviral medications.

Patients have worse recovery when compared to Bell’s palsy and may develop mild to severe long-term facial movement problems (see Synkinesis).

Long-Standing (Chronic) Facial Paralysis

Facial paralysis and parotid tumors

The facial nerve runs through the parotid gland and can be damaged during removal of parotid tumors, or through direct growth of the tumor into the nerve branches. If the facial nerve is stretched but still intact, patients will have a good recovery. In cases where the parotid tumor is malignant, the facial nerve may be removed deliberately, causing complete paralysis. We offer many facial reanimation options for patients after parotid surgery.

Skull base and other brain tumors

Due to the location of the facial nerve, the facial nerve can be damaged during removal of vestibular schwannomas (acoustic neuromas) and meningiomas of the skull base. Facial reanimation procedures are chosen based upon whether the facial nerve is stretched or cut during removal of the tumor. Other brain tumors may lead to temporary or permanent paralysis. Facial reanimation options are available before, during, or after treatment of the tumor.


After facial nerve damage, some patients develop synkinesis. Synkinesis is the development of unwanted facial movement that occurs during voluntary facial movement; for example, eye closure (unwanted movement) occurs when a patient is smiling (voluntary movement).

Synkinesis is treated with a combination of two main interventions: (1) focused facial nerve physical therapy designed to retrain the facial muscles, and (2) botulinum toxin (Botox) injections to weaken the tight, overactive muscles.


Genetic causes of facial paralysis

There are several genetic syndromes that are associated with facial paralysis, including Mobiius Syndrome and Goldenhar’s syndrome. Isolated congenital facial paralysis, in the absence of any syndrome, is also commonly seen. We offer many options for facial reanimation in patients who are born with facial paralysis, including surgery for smile reanimation.

Birth trauma

Infants may develop facial paralysis after traumatic birth, and many infants will go on to recover completely. Infants who continue to have facial paralysis are followed closely and offered facial reanimation procedures when they are older.