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If facial nerve paralysis occurs suddenly—within hours or days—the cause may be a virus, such as herpes simplex, which causes cold sores, or herpes zoster, also called shingles. Doctors theorize that a virus may be responsible for the temporary paralysis associated with Bell’s palsy.
A virus can cause inflammation in the seventh cranial nerve, which carries electrical signals between the brain and facial muscles. If the nerve swells, the narrow, bony space in the skull through which the nerve travels may constrict the nerve. Even a brief moment of constriction may cut off blood supply to the nerve and prevent it from functioning. As a result, signals from the brain cannot reach the facial muscles, preventing them from moving.
When facial nerve paralysis is caused by a virus, it usually affects one side of the face and is rarely permanent. As soon as the inflammation subsides and the nerve shrinks back to its normal size, blood flow is restored and the nerve recovers.
To accelerate the healing process, doctors at NYU Langone often prescribe antiviral and corticosteroid medications to combat the virus and relieve inflammation.
Starting treatment as soon as symptoms appear is crucial for ensuring a complete recovery from temporary facial nerve paralysis. Quickly reducing inflammation limits nerve damage. Our doctors encourage you to seek medical evaluation as soon as you experience symptoms of paralysis.
Full recovery can take months, however, so it is helpful to be patient as nerve function returns. Your doctor schedules periodic follow-up visits to monitor your recovery and provide emotional support.
Corticosteroid medications reduce swelling in the seventh cranial nerve. Medication is taken by mouth once a day for 10 to 14 days to ensure the nerve recovers.
If your symptoms indicate that the herpes zoster virus is causing inflammation, your doctor may recommend a stronger dose of corticosteroids. These medications are administered through a vein with intravenous (IV) infusion. This more aggressive approach to treatment may prevent the virus from causing long-lasting inflammation and permanent damage.
Typically, doctors prescribe a single dose of intravenous corticosteroids, which is administered over the course of 24 hours in the hospital. After you’re discharged, your doctor may prescribe corticosteroid medication by mouth for 7 to 10 days.
Corticosteroid medications may have side effects, though they are uncommon when medication is taken for a short time. These may include increased blood pressure, restlessness, and mood swings.
Doctors often prescribe antiviral medications in addition to corticosteroids to fight a viral infection that may be causing inflammation in the facial nerve. Antivirals stop the virus from multiplying and prevent it from spreading throughout the body.
The medication is taken by mouth once a day for 10 to 14 days. Side effects are rare but may include stomach upset.
Lubricating the eye on the paralyzed side of the face is a crucial part of recovery from facial nerve paralysis. If you can’t move your eyelid, blinking is impaired and your eye is always exposed to the air. As a result, it may dry out, a condition known as dry eye. Also, without an eyelid to protect it, the eye is vulnerable to injury from dirt and other airborne elements.
Doctors recommend using lubricating eye drops frequently throughout the day. At night, they recommend using a lubricant gel, then taping the eye shut.
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