Bell's palsy

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Facial drooping

Ptosis, drooping of the eyelid

Facial palsy; Idiopathic peripheral facial palsy

Symptoms usually start suddenly, and range from mild to severe. They may include:

• Twitching in face
• Weakness in face
• Face feels stiff or pulled to one side
• Droopy eyelid or corner of mouth
• Drooling due to inability to control facial muscles
• Facial paralysis of one side of the face, makes it hard to close one eye
• Change in facial expression (for example, grimacing)
• Dry eye or mouth
• Loss of sense of taste
• Difficulty with eating and drinking
• Pain behind or in front of the ear, may occur 1-2 days before muscle weakness
• Sensitivity to sound (hyperacusis) on the side of the face affected
• Headache

Examination shows weakness in the upper and lower part of the face, usually on just one side. Weakness may affect the forehead, eyelid, or mouth. Blood pressure is normal.

Blood tests for sarcoidosis or Lyme disease may be considered. If there is no improvement in the facial paralysis after several weeks, an MRI is done to rule out other causes.

An EMG and nerve conduction studies may also be done to determine the severity of nerve damage.

Other causes of cranial mononeuropathy VII, such as head injury and tumor, need to be ruled out.

Review Date: 09/10/2006
Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.