Facial Nerve Paralysis

Author: Marisa Healy, BSN, RN
Last Reviewed: March 14, 2023

What is the facial nerve?

The facial nerve sends signals from your brain to the muscles of your face. This nerve helps you move the muscles in your face, change your expression, swallow, taste, blink, and speak. You have one facial nerve on each side of your head. Each nerve runs from the base of your skull, near your ear, and branches out near your parotid gland (found just in front of your ears and helps make saliva).

Each facial nerve has 5 branches. The branches control a different part of your face:

  • Frontal: Moves the forehead muscles.
  • Zygomatic: Closes your eyes.
  • Buccal: Moves your nose, blinks your eyes, moves your upper lip and corners of your mouth (smiling).
  • Marginal Mandibular: Moves your lower lip (frowning) and helps your ear respond to loud noises.
  • Cervical: Moves your chin and lowers the corners of your mouth.

What is facial nerve paralysis and what causes it?

Paralysis means you can’t move and sometimes feel one or many parts of your body. When your facial nerve is paralyzed, you may not be able to control or move parts of your face.

Paralysis of your facial nerve can be:

  • Present when you are born (congenital).
  • Caused by an injury or trauma.
  • Caused by disease or illness, such as a stroke, cancer, or Bell’s palsy.
  • Caused by treatment for cancer (surgery, radiation, etc.).

Signs and symptoms of facial nerve paralysis may include:

  • Feeling like your facial muscles are weak or not moving as they should, most often on the side of your face where you have had surgery.
  • Being unable to blink or close your eye, or there may be changes to how your eye makes tears. You may have dry eyes.
  • The affected side of the face may droop and your smile may be one-sided.
  • Drooling.
  • Twitching of muscles.
  • Being unable to raise your eyebrows.
  • Taste changes.

Facial nerve paralysis can be temporary (for a short time) or permanent (does not go away).

This article will focus on permanent facial nerve paralysis caused by cancer and/or its treatments.

How can cancer cause facial nerve paralysis?

Facial nerve paralysis can be caused by the cancer itself or the treatments used to treat your cancer.

  • Some types of cancer, like salivary gland cancer, can grow near or around the facial nerve, causing paralysis. Skin cancer that has spread (metastasized) can also cause damage to the facial nerve.
  • Surgery to treat cancer can lead to paralysis. The nerve may be damaged during surgery. It some cases it is removed while trying to take out as much of the cancer as possible.
  • Radiation therapy for head and neck cancers can damage the facial nerve.

How is facial nerve paralysis diagnosed?

Your provider will do a physical exam, asking you to move your face (smiling, frowning, scrunching your nose, etc.). You may also be sent for imaging tests, such as:

How is facial nerve paralysis treated?

Facial nerve paralysis is treated using surgery. There are also treatments that will not cure the paralysis but will help with the side effects it is causing.

Surgery used to treat facial nerve paralysis is called reanimation surgery. There are a few types of reanimation surgery depending on which part of the nerve is affected. Muscles, tendons, and/or nerves from other parts of your body are used to help you gain movement back in your face.

Other treatments that can help with symptoms but won’t cure facial nerve paralysis are:

  • Eye surgery to help with blinking.
  • Plastic surgery to help even out your face.
  • Ointments, drops, patches, and tape to help with dry eye and to help close the eye.

Talk with your provider about your treatment options.

There are a few reasons why you may be having facial nerve problems. If your cancer or its treatment might cause this, your provider will tell you what to look for. If you have any new or worsening signs or symptoms of facial nerve paralysis, call your provider right away.

Note: The signs and symptoms of facial nerve paralysis can look like a stroke. If you or a loved one are having signs or symptoms of a stroke (facial drooping, problems walking, slurred speech, weakness on one side of the body) that come on quickly, call 911 or go to the nearest emergency room right away. A stroke will often affect other parts of your body.

Alghamdi M, Strenger T, Thoelken R, Schaller T, Zenk J (2019) Facial Nerve Palsy, When Should We be Alarmed: A Case Report of Facial Nerve Paralysis Caused by Occult Malignancy and Review of the Literature. Clin Med Rev Case Rep 6:283. doi.org/10.23937/2378-3656/1410283

Chung, EJ., Matic, D., Fung, K. et al. Bell’s palsy misdiagnosis: characteristics of occult tumors causing facial paralysis. J of Otolaryngol - Head & Neck Surg 51, 39 (2022). https://doi.org/10.1186/s40463-022-00591-9

MacIntosh PW, Fay AM. Update on the ophthalmic management of facial paralysis. Surv Ophthalmol 2019; 64:79.

Mehta R. P. (2009). Surgical treatment of facial paralysis. Clinical and experimental otorhinolaryngology, 2(1), 1–5. https://doi.org/10.3342/ceo.2009.2.1.1

Nguyen, C. N., Mallepally, N., Tabilona, J. R., & Lu, L. B. (2021). Not So Benign Bell's Palsy: Malignant Peripheral Nerve Sheath Tumor of the Facial Nerve Involving the Temporal Bone. Journal of general internal medicine, 36(4), 1102–1105. https://doi.org/10.1007/s11606-020-06463-0

Terhaard C, Lubsen H, Tan B, et al. Facial nerve function in carcinoma of the parotid gland. Eur J Cancer 2006; 42:2744.

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