What are the types of facial paralysis?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Facial paralysis has many causes, which may be conveniently divided into the following 5 categories:

  • Congenital

  • Idiopathic

  • Traumatic

  • Neoplastic

  • Inflammatory

Congenital facial paralysis, as in the well-described although poorly understood Möbius syndrome, is uncommon.

Idiopathic facial paralysis (Bell palsy) is the most common type. It is often thought to be due to virally induced inflammation of the nerve that results in functional compromise, swelling, and vascular compromise. Facial nerve repair is infrequently required, because most of these patients regain function spontaneously. When paralysis is permanent, some advocate facial nerve decompression in selected cases. This article focuses on cases requiring various nerve grafting techniques, rather than procedures of decompression.

Traumatic facial paralysis (from blunt and penetrating trauma or intraoperative iatrogenic injury) is the next most common type. The site of facial nerve injury may be intracranial, intratemporal, or external to the stylomastoid foramen. Acoustic neuroma surgery is an example of a procedure that puts the facial nerve at risk (in the cerebellopontine angle, in this case). Any injury sites may be amenable to facial nerve repair, except for sites near the nerve’s root entry zone, where the available facial nerve stump may not be long enough to allow repair.

Neoplastic causes of facial paralysis include tumors of the parotid gland, typically malignant. Facial nerve schwannomas, acoustic neuromas, and neoplasms of the brain are among the less common causes of facial paralysis.

Inflammatory and infectious causes of facial paralysis can occur. Infectious agents implicated include virally mediated conditions such as herpes zoster (eg, Ramsey Hunt syndrome), mumps, Coxsackie virus, and mononucleosis. Bacterial infections include sequelae of otitis media and Lyme disease. Inflammatory causes of facial paralysis include sarcoidosis.

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