Treatments for Facial Paralysis
UW Health's Facial Nerve Clinic at UW Hospital and Clinics in Madison, Wisconsin, provides a multidisciplinary approach to diagnosing and treating facial paralysis in children and adults.
Bell’s palsy, facial paralysis without an identifiable cause, can often improve on its own, but should be carefully monitored by a health care provider. It is important to give your body time to heal. Specialists recommend that patients rest the affected area for at least three months after initial consultation as most patients will experience complete recovery.
In many cases of facial nerve weakness, providers may prescribe an oral steroid that will help to reduce inflammation (irritation) of the facial nerve. Multiple research studies have shown that high doses of medication, started within 72 hours of the paresis (weakness) or paralysis, will improve chances for recovery.
In many cases, an antiviral medication may be prescribed in addition to the steroid. Although the research studies have not established a definite benefit, many providers still believe antivirals provide some additional help. Not all patients are candidates for both therapies.
Medications are best started within 72 hours of facial weakness. If you cannot be seen by your doctor for new facial weakness, you should proceed to the nearest emergency room so that the emergency doctor can rule out other serious causes and discuss medications with you.
In general, surgery may be recommended:
- If the onset of paralysis was fewer than 14 days ago: If complete paralysis has been present for two weeks or less, talk to your primary care providers about seeing an otologist. These ear surgery specialists can perform electroneuronography testing (ENOG) to determine if you are a candidate for facial nerve decompression. This operation may be helpful for individuals whose facial nerve has become so inflamed that it is compressed in the tight space near the inner ear. Research suggests that releasing this nerve in a timely manner can lead to improvement in facial paralysis symptoms.
- If paralysis has been present for longer than 14 days but fewer than three months: Since most cases of Bell’s palsy have an excellent chance for recovery, specialists recommend that patients rest the affected area for at least three months after initial consultation and no therapies should be considered aside from oral medication. Certain precautions may be recommended if you have incomplete eye closure.
- You may be a candidate for a small procedure to insert a metallic weight into your upper eyelid to aid in eye closure. Since the weight can be removed at a later time, this can be placed in special circumstances of facial paralysis where there is a good chance of recovery but profound difficulty in eye closure.
- Botulinum (Botox) injections may also help with eyelid closure for up to three months. However, most patients use other methods of eye care and undergo these procedures only for continued difficulty with eye closure at three months. (See eyelid section under important patient information)
- If paralysis has been present for more than three months: If you are still experiencing facial weakness for more than three months, you should be seen for a comprehensive evaluation at the UW Health Facial Nerve Clinic. We may perform electromyography testing (EMG) in cases where it is not clear if the facial muscles are recovering or order other imaging tests. The facial nerve team may recommend surgery or physical therapy that can help alleviate the residual effects of paralysis both functionally and cosmetically.
For patients who have undergone parotid/acoustic/skull base tumor surgery, your surgeon may refer you to the Facial Nerve Clinic for evaluation sooner than three months.
Your doctor may recommend surgical placement of weights within the eyelid early on in the course of treatment. Preserving the eye is crucial when recovering from any type of facial paralysis and placement of eyelid weights, even if it is temporary, can greatly help to prevent damage or injury to the eye.