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Date issued: August 2022

Review date: August 2024

Ref: C-425/LB/Physiotherapy/Paediatric Facial Palsy v2

PDF:  facial palsy children final August 2022 v2.pdf [pdf] 435KB

What is facial palsy in children?

Facial palsy is the weakness of the muscles in the face, mainly resulting from temporary or permanent damage to the facial nerve. It can affect any part of the face but usually affects one side. It occurs in around 25 children per 100,000 per year.

How do the facial muscles and nerves work?

The facial muscles are also called the muscles of facial expression.  The nerve to the facial muscles is called the facial nerve. It is the seventh cranial nerve which means it arises from a part of the brain called the brainstem. Each nerve leaves the brain through a tiny channel in the skull and enters the face in front of the ear. It then divides into 5 branches to supply different muscles for facial expression. It is also responsible for production of tears, saliva and taste for part of the tongue.

The diagram shows the 5 branches coming out of the ear and going to the muscles in the forehead, eye and cheek, lips, chin and neck. These branches are responsible for facial movement.

What causes facial palsy?

Inflammation, infection, compression, or injury to the facial nerve will result in weakness or occasionally complete paralysis, usually to one side of the face. In most cases a cause is not identified, and it tends to resolve spontaneously.

Most common causes include:

• Bell’s Palsy: most common cause but the exact cause of this damage is unknown, it is believed it is most likely triggered by a viral infection, most commonly Herpes Simplex Virus (the virus that causes cold sores).

• Ramsay Hunt Syndrome, Varicella Zoster Virus (the virus that causes chicken pox).

• Direct Injury: e.g., fractures of the skull, birth trauma.

• Facial nerve tumours.

• Guillain-Barré syndrome.

• Lyme disease

• Congenital syndromes e.g., Melkersson's syndrome

• Neoplasmic, Leukaemia or lymphomas.

• Mononeuropathy: e.g., due to diabetes mellitus or sarcoidosis.

Why are the muscles of the face so important?

• They enable us to demonstrate how we feel.

• They help us to communicate e.g., clear speech, looking interested in what is being said.

• Eat and drink without making a mess.

• Protect the eyes e.g., blinking and being able to close the eye when asleep.

Common problems seen include:

• Red sore eyes.

• Inability to blink or close eye voluntarily.

• Over production of tears.

• Visual problems.

• Dry mouth.

• Sore tongue/altered taste.

• Numbness.

• Tenderness/pain/increased sensitivity.

How is facial palsy managed?

Treatment depends on the cause of the problem, but it may consist of:

Medication: steroids, antiviral drugs, antibiotics. These are usually started soon after the onset of the problem i.e., within a few days

Surgical treatment: to take pressure off the nerve or repair damage that may have occurred to the nerve

Practical advice: Looking after the eyes, keeping the mouth clean, eating and speaking more easily

Emotional help and support: it helps to be able to discuss problems with someone who understands or has suffered with the same problem

Exercises: to help regain and improve the quality of movement

Massage: to relax the face

What can you do to help protect the eye?

• Keep the eye moist and clean.

• Try taping the eye closed at night.

• Use wraparound sunglasses.

• Wear an eye patch to help with double vision.

What can I do to help with any mouth problems?

• Use a mouthwash regularly (4-5 x daily).

• Take care when cleaning your teeth.

• Dry mouth oral lubricant can be prescribed.

What is the aim of an exercise programme?

• Preserve the quality of your facial muscles and skin while the face recovers from the weakness.

• Provide a sensation of movement to the muscles on the weaker side encouraging their recovery.

• Prevent overuse of the unaffected side.

How do I do the exercises?

• Use a mirror to monitor and maintain symmetry.

• Help the movement with your fingers on the affected side.

• Involve a parent, sibling or friend.

• Make sure you are in a comfortable position.

• Exercises should be prescribed individually but should be performed at least 3 x daily.

The Good News: Your Recovery

Bell’s Palsy: Whilst distressing, most people get better in a few weeks, without the need for any special treatment. 

Ramsay Hunt Syndrome: Again, improvement occurs over a period of time but usually takes longer than Bell’s Palsy to recover.

Injury to nerve: The speed of recovery depends on the degree of injury and whether a surgical repair is required.

You will have already been advised by your doctor what has caused your facial weakness, whether any further treatment is required and roughly how long it will take to get better.

If you have any further questions, please contact our department on the telephone number below.