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Facial nerve palsy
Facial nerve palsy causes a sudden weakening of the facial muscles. Symptoms include one-sided drooping of the corner of the mouth, difficulty closing the eye, and smoothing of wrinkles on the forehead, nose and around the mouth. Early assessment and trea
Specialist in the article
Fysioterapeutti
Revised 1/7/2026
Physiotherapist’s recommendation
- Facial nerve palsy results from a disturbance in the function of the facial nerve, leading to one-sided weakening or loss of muscle activity in the face.
- Early cortisone treatment can promote recovery. In the case of shingles, an antiviral medicine is also used. Eye protection is essential if the eyelid does not close.
- Facial physiotherapy supports recovery, helps restore symmetry and reduces synkinesis (involuntary linked movements) – even months or years after symptom onset.
Causes and symptoms of facial nerve palsy
The most common cause of peripheral facial nerve palsy is Bell’s palsy, in which the facial nerve’s function is disturbed along its route outside the brain without a clear single cause. Inflammation leads to swelling that compresses the facial nerve. Other causes include Ramsay Hunt syndrome related to shingles, Lyme disease, tumors and trauma.
A central facial palsy may be caused, for example, by a stroke, in which only the lower half of the face is weakened while forehead and eye function is preserved. It is usually accompanied by other stroke symptoms.
The palsy starts abruptly and reaches its peak within 72 hours. Facial nerve palsy may be partial or complete, and it typically affects one side of the face.
The most common symptoms of facial nerve palsy include:
- one-sided facial weakness/drooping
- difficulty closing the eye, dry eye, tearing
- pain around the ear, sound sensitivity
- taste disturbances
- difficulties with speaking and eating
- nasal discharge
Treatment and rehabilitation of facial nerve palsy
Facial nerve palsy always requires immediate medical attention. At the appointment, the physician confirms the diagnosis and rules out causes requiring urgent care. A course of cortisone started early can support recovery. If shingles is the cause, an antiviral medicine is added.
In most cases of facial nerve palsy, the outlook is good and symptoms improve over time. Most people recover fully. Nerve recovery takes time and requires patience. Eye protection is crucial in the early phase: lubricate the eye regularly and tape the eye closed at night. To prevent synkinesis (involuntary linked movements), avoid exaggerated facial expressions and electrical stimulation of the face.
Facial physiotherapy is an important part of rehabilitation. Specialist facial physiotherapy includes soft tissue techniques, relaxation, controlled movement exercises (Facial Neuromuscular Retraining) and guidance for home exercises. The aim is to support facial nerve recovery, restore facial symmetry and prevent or reduce synkinesis. Incorrect training may worsen symptoms, so seek guidance from an experienced professional.
Prevention of facial nerve palsy
There are no known preventive measures for Bell’s palsy, but risk management helps with other causes. The shingles vaccine reduces the risk of Ramsay Hunt syndrome in older adults. Facial palsy related to Lyme disease can be prevented by treating the infection promptly after a tick bite if it is detected immediately. In the acute phase, good eye protection prevents corneal damage. Early initiation of treatment and guided facial physiotherapy reduce the risk of permanent symptoms and synkinesis.
When should you see a specialist?
Go to the emergency department or a doctor the same day if one-sided facial weakness or paralysis begins suddenly. Prompt treatment increases the chances of recovery. Seek emergency care immediately if facial symptoms are accompanied by difficulty speaking, limb weakness, pain, balance problems, severe headache or blurred vision – these may indicate a more serious cause such as a stroke.
Expert tips – living with facial nerve palsy
In the acute phase, eye protection, rest and early treatment are key. Everyday activities, such as eating, speaking and making expressions, may be more difficult for a while. Most people recover well, but some may have lingering facial muscle weakness or synkinesis that can be treated with facial physiotherapy and botulinum toxin. Gentle, individualized practice under professional guidance is the safest way forward.
- Protect your eye: use lubricating drops during the day and gel or ointment at night. If the eyelid remains open, lightly tape it closed with skin-friendly tape.
- Eating and drinking: eat calmly, choose soft foods and drink from a thin-rimmed cup (avoid drinking from a bottle or using a straw).
- Speaking: a calm pace helps speech.
- Exercise: start under the guidance of a professional specialized in facial physiotherapy, preferably early. Rehabilitation is beneficial even months or years after onset. Gently massage and stroke the face. Avoid exaggerated facial expressions and electrical stimulation of the face, which can increase tightness and synkinesis.
- Mental well-being: recovery can be demanding. Talk to a professional and make use of peer support if needed.
If everyday life feels overwhelming or symptoms worsen, book an assessment. Start with Digital Clinic 24/7 or book an appointment for facial physiotherapy.
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Frequently asked questions about facial nerve palsy
Bell’s palsy is the most common cause of peripheral facial nerve palsy, in which the facial nerve’s function is disturbed along its route outside the brain without a clear single cause. Inflammation causes swelling that compresses the facial nerve. Other causes include shingles (Ramsay Hunt), Lyme disease, tumors and injuries. In central palsy, the cause is in the brain, often a stroke.
The speed and extent of recovery depend on the cause of the palsy and the degree of facial nerve injury. Symptoms often ease over weeks, with significant recovery occurring in 3–6 months. In partial palsy, most recover completely. In complete palsy, recovery may be slower and some may have mild residual symptoms or synkinesis.
Typical symptoms include one-sided facial weakness or drooping, difficulty closing the eye, taste disturbances, and difficulties with speaking and eating. With shingles, ear pain and a blistering rash may occur.
Yes. Most patients recover fully or almost fully, especially if treatment is started early and the eye is well protected. Facial physiotherapy facilitates recovery and reduces lasting harm.
In peripheral palsy due to facial nerve dysfunction, the forehead does not wrinkle and the eye does not close because the entire side of the face is weak. In brain-origin central palsy, the forehead and eye usually function normally, but other stroke symptoms may be present, such as limb weakness or speech disturbance.
Use preservative-free lubricating drops during the day and protective glasses if needed. Assist blinking with a finger. At night, use a long-acting gel or ointment. If the eyelid remains slightly open, close it at night with skin-friendly tape.
