Learn about facial palsy

Facial palsy happens when the facial nerve can't send signals to the muscles in your face the way it should. This causes weakness or loss of movement, usually on one side of your face. It can make it hard to close your eye, smile, or drink from a cup.

Facial palsy can be hard on you both physically and emotionally. If it isn't treated, it can lead to problems that last a long time. That's why it helps to get checked early.

There are several possible causes:

• Bell's Palsy: Doctors aren't fully sure what causes Bell's palsy. It's often linked to a virus called herpes simplex, or to swelling in the body. People often use "Bell's palsy" as a general term for facial palsy. See how it's different from Ramsay Hunt syndrome →
• Ramsay Hunt Syndrome (RHS): Caused by the herpes zoster virus — the same virus behind shingles. Think of it as shingles affecting the facial nerve. It can cause sores in the ear or mouth, sensitivity to sound and light, balance trouble, ongoing pain, changes in taste, and headaches.
• Zoster Sine Herpete (ZSH): Also caused by the zoster virus. It looks a lot like Ramsay Hunt Syndrome, but without the rash.

Other causes include:

• Nerve damage from surgery, such as removing an acoustic neuroma (a growth on the hearing and balance nerve near the facial nerve) or a tumor near the parotid gland
• Cancerous tumors in the face, head, or neck
• Bacterial infections, like Lyme disease or a middle ear infection
• Nerve conditions such as Guillain-Barré syndrome
• An injury to the facial nerve
• Being in the third trimester of pregnancy or the first week or two after giving birth — facial palsy is more common during this time
• Injury during birth
• Conditions a person is born with

Common signs include weakness or paralysis on one side of the face, dizziness, a dry mouth or eye, and trouble tasting food. These signs can show up fast, often within 24 to 48 hours.

Many people feel bad pain behind the ear or at the back of the head before the facial weakness starts. This early pain often shows up a day or two before the weakness does.

Because these signs can also point to other serious health problems, it's important to see a doctor or nurse practitioner right away.

Pam treats facial palsy at every stage — from the first days after it starts to cases that have lasted a long time.

Getting help early matters. Early care includes teaching you how to protect your eye, helping you understand your condition, starting exercises you can do at home, and referring you to a specialist if needed.

Every treatment plan is built around you. This can include working closely with your other doctors, managing medication, Botox (a treatment that relaxes tight or overactive muscles), eye care support including fitted lid weights for those who can't fully close their eye, and exercises that retrain your facial muscles and nerves.

Synkinesis usually shows up 3 to 6 months after facial palsy starts, once the nerve begins reconnecting. There isn't one fixed time when Botox should begin — it depends on how your synkinesis is affecting you and how your face is healing.

We'll talk through timing together at your visit, based on your specific situation, rather than following a set schedule that may not fit your recovery.

Recovery time is different for everyone. It can take anywhere from a few weeks to a few years, depending on what caused it. Some people notice steady improvement early on; others have a slower start with progress that builds over time. It's normal for recovery to feel uneven.

Getting the right diagnosis early on is key, since it shapes your whole treatment plan. To find the cause, we may use tools like an MRI, a CT scan, blood tests, hearing and vision tests, balance testing, and a full physical exam.

Nurse Practitioners can order tests and medical imaging, prescribe medication, and refer you to specialists.

According to the Nurse Practitioner Association of Canada, NPs are autonomous, licensed health professionals who provide comprehensive care across all stages of life. NPs care for the whole person, not just the illness — that means paying just as much attention to your overall health, preventing disease, staying well, and teaching you about your condition.

You can learn more at the British Columbia College of Nurses and Midwives (BCCNM).

Many extended health plans and health spending accounts will cover Nurse Practitioner visits. Your visit may also count as a medical expense on your income tax return — ask your accountant or tax preparer.

Check with your insurance provider to see if your visit is covered. We'll give you a detailed receipt so you can submit a claim.

Yes. Research shows Bell's palsy is about 2.6 times more common in pregnant women than in non-pregnant women of the same age, with risk highest in the third trimester and the first weeks after delivery.

Possible reasons include changes in blood pressure and fluid retention, hormone shifts, and other pregnancy-related factors. If you're pregnant or postpartum and notice facial weakness, get checked promptly rather than waiting.

There's a growing body of research suggesting a link. High psychological stress can raise stress hormones that temporarily weaken the immune response responsible for keeping dormant viruses, like the one behind shingles and some cases of facial palsy, in check. Several published studies have found higher stress linked to a greater risk of viral reactivation.

It's also worth knowing that facial palsy itself often affects mental health afterward — anxiety, low mood, and social withdrawal are common, even in mild cases. If you're struggling emotionally after a diagnosis, that's a recognized and normal part of many people's experience, not something to manage alone.

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