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Facial Nerve Problems and Bell's Palsy

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Medical Author:

Standiford Helm II, MD

Standiford Helm II, MD

Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is the facial nerve?

The facial nerve is a nerve which controls the muscles on the side of the face. It allows us to show expression, smile, cry, and wink. Injury to the facial nerve causes a socially and psychologically devastating physical defect; treatment may require extensive rehabilitation or multiple procedures.

The facial nerve is the seventh of the twelve cranial nerves. Everyone has two facial nerves, one for each side of the face. The facial nerve travels with the hearing nerve (the eighth cranial nerve) as it travels in and around the structures of the middle ear. It exits the front of the ear at the stylomastoid foramen (a hole in the skull base), where it then travels through the parotid gland. In the parotid gland it divides into many branches which provide motor function for the various muscles and glands of the head and neck.

What are symptoms of a facial nerve problem?

Facial nerve problems may result in facial muscle paralysis, weakness, or twitching of the face; dryness of the eye or the mouth; or alteration of taste on the affected side. However, the finding of one of these symptoms does not necessarily imply a specific facial nerve problem; your physician needs to make a careful investigation in order to make a precise diagnosis.

What conditions affect the facial nerve?

There are numerous causes of facial nerve disorder:

• Trauma: such as birth trauma, skull base fractures, facial injuries, middle ear injuries, or surgical trauma.

• Nervous system disease: including Opercular syndrome, Millard-Gubler syndrome.

• Infection: of the ear or face, or herpes zoster of the facial nerve (Ramsey-Hunt syndrome).

• Metabolic: diabetes mellitus or pregnancy.

• Tumors: acoustic neuroma, schwannoma, cholesteatoma, parotid tumors, glomus tumors.

• Toxins: alcoholism or carbon monoxide poisoning.

• Bell's palsy: Also called idiopathic facial nerve paralysis (see below).