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Facial Paralysis

Dr. J. Gail Neely treats patients at

Center for Advanced Medicine
Ear, Nose and Throat Center
4921 Parkview Place, 11th Floor, Suite A
St. Louis, MO 63110

Phone:  314-362-7509     Fax: 314-747-8687

Question:  My mother woke up and the left side of her face was drooping. Could it be Bell’s palsy and are there any treatments?

Answer:  Bell’s palsy may not be the correct diagnosis. Not all facial paralysis is Bell’s palsy. It is a very specific type of facial paralysis that is a diagnosis of exclusion, determined after a thorough search for other causes. The nerve ultimately involved in facial paralysis is the seventh cranial nerve – the facial nerve.

The facial nerves (seventh) are one pair of the twelve pairs of cranial nerves that leave or return to the brainstem through the base of the skull and are the primary movement nerves for the face. Each side of the face is controlled by the facial nerve on that side. The nerve control centers in the central nervous system begin in the higher levels of the brain.

The cerebral motor cortex, as upper motor neurons, cross to the other side of the brainstem to stimulate the nerve cell bodies of the facial nerve. The lower motor neurons ultimately move the face on that side by actuating the peripheral (cranial) nervous system, the facial nerve per se. Most facial paralyses are on one side only (unilateral) and are lower motor neuron (peripheral) type. If both sides of the face are involved at the same time (bilateral), a quite different set of potential problems exist.

Diseases that cause unilateral lower motor neuron dysfunction, i.e. facial paralysis, may involve the nerve or the surrounding tissues close to the nerve, such as arteries, bone or salivary glands like the parotid. The diseases may originate in these tissues or come from distant tissues, like metastatic cancers.

Categories of diseases that may involve the nerve or surrounding tissues include mechanical trauma like gunshot wounds or car wrecks; metabolic diseases such as diabetes; medicinal or toxic uses from certain cancer drugs; congenital or developmental symptoms such as paralysis of the lower lip; collagen-autoimmune-allergic diseases such as Rosenthal-Melkerson disease; neoplasty or growth diseases such a facial nerve neuroma or parotid cancer; infections including acute middle ear infections; degenerative or idiopathic diseases like Bell’s palsy; or psychogenic diseases such as hysteria.

There is no doubt that Bell’s palsy is the most common cause of facial paralysis; however, a search for other causes is very important. If Bell’s palsy is the proper diagnosis, oral steroids are the treatment of choice – antiviral drugs have no effect.

In all cases of any kind of facial paralysis, care of the affected eye to avoid drying is very important. Early diagnosis and treatment within the first 24-48 hours may improve recovery.
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Copyright 2015 Washington University School of Medicine