When the cause is a nerve: facial palsy and neurologists

Most of this site is about faces that are missing something: an ear, a nose, an eye socket, part of a jaw. A different group of changes involves a face that is all there but no longer moves as it did. A smile pulls to one side, an eye will not close, a cheek hurts. Those changes come from nerves, and sometimes from the brain, and they belong to a different branch of medicine. This page explains what the main sources say, with one rule above the rest: sudden facial drooping can be a sign of stroke and needs emergency help at once.

First, the emergency signs

The NHS describes the stroke check with the word FAST: Face, Arms, Speech, Time to call 999. In the face check, one side of the face sags and smiling may be difficult; in the arm check, one arm is weak or numb so both cannot be raised and held up; in the speech check, words are slurred or the person sounds confused. The NHS says to call 999 now even if the signs have stopped, and not to drive yourself to hospital. The US Centers for Disease Control and Prevention use the extended BE FAST version, adding Balance and Eyes, says to call 9-1-1 right away, and advises noting the time when symptoms first appear because this helps providers choose treatment.

A headache can be part of the picture. The NHS headache page says to call 999 or go to A&E if a headache comes with numbness or weakness in the body or face, if it started suddenly and is extremely painful, or if there is difficulty speaking, balancing or remembering things. If any of these apply to you or someone near you, stop reading and call emergency services.

The facial nerve

The National Institute of Neurological Disorders and Stroke explains that Bell's palsy results from a problem in the seventh cranial nerve, also called the facial nerve, which connects the brain to the muscles that control facial expression. When the nerve is injured or stops working properly, one side of the face becomes weak or paralyzed.

Bell's palsy

Bell's palsy is the most common cause of facial paralysis according to the same institute. The NHS describes weakness on one side of the face, or not being able to move it, developing over a few days, sometimes with a drooping eyelid or mouth corner, drooling, a dry mouth, loss of taste, and a dry or watering eye. The NHS tells people with these symptoms to see a GP urgently or call 111, because treatment works better when started early, ideally within 72 hours. Treatment is typically a 10-day course of steroid medicine, sometimes with an antiviral. NINDS likewise says oral steroids should in most cases be started within three days of onset.

The cause is not fully known. NINDS says inflammation and swelling of the nerve appear to be involved and lists possible triggers including an existing dormant viral infection such as herpes simplex or chickenpox, impaired immunity, and infections such as Lyme disease. Because the picture overlaps with other conditions, the diagnosis is made by a clinician, not from a web page.

Protecting the eye

When the eyelid will not close, the eye can dry out. The NHS says treatment may include eye drops and ointment and surgical tape to keep the eye closed at bedtime, and that if you cannot close your eye you may need treatment to prevent damage to your vision. NINDS says lubricating eye drops or eye patches can keep the eye moist and protect it from debris or injury, especially during sleep. These are general descriptions; what to use is for a clinician to say.

Seeing a neurologist

A neurologist is described in American Academy of Neurology materials as a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine. Stroke is the emergency case; the usual route in the NHS for suspected Bell's palsy is the GP or 111. Symptoms that persist, keep changing or do not fit a simple pattern are worth raising with a doctor, who can decide whether a specialist opinion is needed. Anyone who wants an expert consultation of this kind, for example a second opinion, could look at the services a neurology practice lists, such as Virgin Islands Neurology - St. Thomas, and then check with their own doctor whether a referral is needed.

Facial pain and headache

Pain in the face is a separate subject, though it can be confused with palsy. The NHS describes trigeminal neuralgia as sudden, severe facial pain, usually on one side, in attacks lasting from seconds to about two minutes, and tied to the trigeminal nerve, which carries sensation from the face, teeth and mouth to the brain. It says to see a GP for frequent or persistent facial pain and that dental causes should be ruled out first. A weak face and a painful face are different problems, although both can be reported together, and the NHS notes some people with Bell's palsy have facial pain around the jaw and behind the ear. New or severe headaches with any weakness in the face fall under the emergency advice at the top of this page.

Recovery and what lasts

The NHS says most people with Bell's palsy get better within 6 months, though some take longer, and advises seeing a GP if symptoms have not improved after 3 weeks. NINDS says people usually recover some or all facial function within a few weeks to six months. The NHS also notes some people have permanent facial weakness, and that long-term problems can include a constantly watering eye, difficulty eating and drinking, changed taste and sensitivity to loud sounds. It adds that Bell's palsy can affect mental health and that anyone feeling depressed, stressed or anxious should speak to a GP.

How this relates to prosthetics

A facial prosthesis replaces tissue that is missing, as explained on what a facial prosthesis is. Facial palsy is different: the parts are present but weak. The two can meet, though. Case reports in the oncology literature describe facial paralysis when a tumor surrounds the facial nerve and the nerve has to be removed, leaving the face changed by the paralysis; the page on prosthesis or reconstruction sets out how teams approach decisions about rebuilding and replacing facial parts. Day-to-day experience of living with an altered face is covered on living with a facial prosthesis.

Finding a specialist away from home

People sometimes need a neurologist while traveling or living abroad. A reader in the US Virgin Islands who is looking for the best St. Thomas neurologist could start there, then confirm credentials and whether a referral or insurance approval is needed with their own doctor. In an emergency, do not search; call local emergency services.

In brief

Facial weakness and pain can come from a nerve problem such as Bell's palsy, or from a stroke, and sudden drooping needs emergency help. Most Bell's palsy improves within months, protecting the eye matters, and persistent or unusual symptoms may lead to a neurologist. Your own doctor decides what applies to you.