How does facial paralysis feel?

Facial Paralysis - Signs and Course

Facial paralysis develops within a few hours, and patients sometimes even wake up with it in the morning. The peak is usually reached after one to two days, at the latest after a week.

The symptoms depend on where the nerve is damaged. Doctors also divide the severity of the disease into six levels. In level I, the face appears normal and inconspicuous at rest and in movement. In stage VI there is no longer any discernible residual movement, in this case one speaks of paralysis.

In peripheral facial paralysis, all branches on the face are affected: the patient can no longer frown, and the eye on the affected side can never be completely closed. When trying, the eyeball turns upwards (Bell phenomenon). Sometimes pain behind the ear, in the temporomandibular joint, or a vague numb feeling in the cheek in the days leading up to paralysis are the first warning signs.

In contrast, with a central facial nerve palsy, the forehead can be frowned and the affected eye can usually still be completely closed. In addition, symptoms of paralysis can almost always be observed in the arm and hand on the affected side.

In both the peripheral and the central form, the paralysis is predominantly one-sided, but can affect both halves of the face as a result of an infection, particularly borreliosis.

Both types have in common the drooping corner of the mouth on one side, which does not move when speaking. This makes the pronunciation less clear and saliva trickles out of the corner of the mouth. The crease between the nose and mouth looks distorted.

There may also be dry mouth and eyes, problems with eating and tasting, and difficulty swallowing. The ear on the affected side is more sensitive to noise, the cheek can no longer be inflated to whistle.

The chances of a cure for idiopathic facial paralysis are good. In around 90% of patients, the paralysis heals completely after 4 to 10 weeks or sometimes only after a few months with appropriate therapy.

In the case of traumatic facial paralysis, the prognosis depends on the degree of damage at the start of therapy. An operation with reconstruction of the destroyed nerve may be recommended.

In around 10% of cases, facial expressions remain permanently distorted and plastic surgery may be necessary. Basically, the worse the prognosis, the more complete the paralysis.