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Facial Nerve Disorders

Facial nerve disorders occur when the nerve that controls facial movement and expression is damaged. They can occur as the result of a variety of factors. Viral infections, strokes, trauma, surgery, and tumors can all cause facial paralysis or weakness.

Bell’s Palsy

One of the most common facial nerve disorders is Bell’s palsy, which is caused by a viral infection of the facial nerve. Common symptoms of Bell’s palsy include:

  • Paralysis or weakness on one side of your face
  • Pain behind your ear on the same side as the weakness usually before the paralysis starts
  • Increased tearing of the eye on the affected side of the face
  • Altered taste sensation on the weakened side of the face
  • Increased sensitivity to sound on the affected side

In most cases, the infection goes away on its own within a few weeks to months. Approximately 80 to 90 percent of patients with Bell’s palsy recover to a completely normal function. Corticosteroids and antiviral medications can increase your chances of a successful recovery if treatment is started early.

Facial Spasms

Spasms of the facial muscles or eye can be the result of an irritated nerve or pressure from one of the blood vessels of the brain. Facial spasms are often treated using minimally invasive Botox® injections to relax the nerves and muscles of the face. In some instances, surgery may be required to remove the blood vessel causing the pressure on the nerve.

Ramsay Hunt Syndrome

Ramsay Hunt syndrome occurs when the shingles virus attacks the facial nerve. The condition typically causes pain and blisters in and around the ear and ear canal. The treatment for Ramsay Hunt syndrome is the same as for Bell’s palsy, although only 50 to 60 percent of patients are able to regain normal function.


Facial paralysis can also be the result of slow-growing tumors called neuromas. It is possible to restore facial tone and some movement using surgery to remove the tumor and replace the damaged nerve with one from elsewhere in the body. Usually a facial neuroma (also called facial schwannoma) is observed over time since the tumor may not grow or may not cause paralysis. Treatment may be initiated when paralysis occurs. The facial nerve tumor can sometimes be treated with stereotactic radiation (CyberKnife) to stop the growth of the tumor without the need for removal. This depends on the location of the tumor.


Accidents or other types of trauma can damage the facial nerve and the bones surrounding the ear, which can result in facial paralysis. In these cases, treatment depends on the type, location, and severity of the injury.

How are Facial Nerve Disorders Diagnosed?

Otolaryngologists use a variety of nerve function and imaging tests to diagnose and determine the extent of facial nerve disorders. An electroneuronography, also known as an ENoG test, can help your specialist identify the extent of the nerve damage if performed during the first 21 days following the injury or onset of paralysis. An electromyography, or EMG, can assess the progress of treatment and determine the prognosis for recovery. This test is typically performed more than 21 days after the injury or onset of paralysis. Sometimes, an EMG is performed early on after the onset of the injury as it provides valuable information. Depending on your circumstances, CTs and MRIs may also be used.

A Multidisciplinary Approach to Treatment

The treatment of facial nerve disorders typically requires coordination between various otolaryngology specialties and subspecialties. Depending on the specifics of your condition, your treatment team may include:

  • Head and neck surgeons
  • Neurotologists
  • Neurosurgeons
  • Facial plastic and reconstructive surgeons
  • Audiologists
  • Ophthalmologists