Causes of Facial Nerve Palsy with Dr. Tarek Amer – The Middle East’s Leading Expert in Facial Nerve Surgery

Facial nerve palsy occurs when the seventh cranial nerve (facial nerve), responsible for controlling facial muscles, is impaired. The result can be partial or complete paralysis, affecting expressions, eye closure, speech, and eating.

Common symptoms include:

• Drooping of one side of the face

• Difficulty blinking or smiling

• Altered taste and changes in saliva or tear production

• Sound sensitivity or facial twitching

• Immediate evaluation is critical, as symptoms may mimic those of life-threatening conditions like stroke.

A. Idiopathic – Bell’s Palsy

• Bell’s palsy is the most frequent cause of facial nerve palsy, often appearing suddenly and typically affecting one side of the face.

• While the exact cause remains unknown, it’s widely believed to stem from viral-induced inflammation or nerve compression within the narrow bony stylomastoid foramen.

• Many cases resolve spontaneously within weeks to months; corticosteroids and physical therapy can aid faster recovery.

B. Infections & Inflammatory Conditions

• Ramsay Hunt syndrome—due to herpes zoster—affects the facial nerve and can involve pain and hearing loss, often with lower recovery rates compared to Bell’s palsy.

• Lyme disease, meningitis/encephalitis, and other infections can directly damage the nerve.

• Systemic disorders like sarcoidosis or Heerfordt syndrome (uveoparotid fever) may manifest with facial palsy.

C. Trauma & Iatrogenic Injury

• Physical trauma, especially fractures of the temporal bone, frequently injures the facial nerve. Transverse fractures pose higher risks (%40–50) compared to longitudinal ones.

• Surgical procedures—such as parotidectomy, ear surgery, facelifts, or skull base operations—carry risks of inadvertent nerve damage if not expertly performed.

D. Neoplastic Causes (Tumors)

• Tumors—like schwannomas, cholesteatomas, hemangiomas, acoustic neuromas, or parotid gland neoplasms—may compress or infiltrate the facial nerve, causing gradual or sudden palsy.

• Central tumors (brain-based) can similarly disrupt nerve function, sometimes alongside additional neurological signs.

E. Autoimmune & Systemic Disorders

• Conditions such as diabetes, Guillain–Barré syndrome, multiple sclerosis, and neurosarcoidosis may include facial nerve involvement.

• These cases often require multidisciplinary management.

F. Congenital & Rare Syndromes

• Moebius syndrome, a rare congenital condition, involves bilateral facial paralysis and eye movement impairment, often diagnosed at birth.

• Birth trauma—e.g., forceps delivery—can also injure the facial nerve in neonates.

Given the varied causes—from idiopathic to serious systemic disease—accurate diagnosis is vital. Diagnostic tools include:

• MRI, CT scans, neuromuscular EMG

• Complete neurological and physical exams

• History-taking to differentiate central (stroke) vs. peripheral (nerve) causes

Dr. Amer’s dual academic and surgical mastery supports:

• Microsurgical precision in nerve grafting, reanimation, and transfer

• EMG-guided rehabilitation to optimize recovery

• Deep understanding of topographical nerve anatomy and injury mechanisms

• A track record of restoring natural expressions and dignity through tailored treatment

Treatment depends on the cause:

• Bell’s palsy: corticosteroids, antivirals, physical therapy

• Ramsay Hunt & infections: antivirals, pain management

• Tumors or malignancy: surgical intervention, sometimes with radiotherapy

• Trauma-related injuries: nerve decompression or grafting if indicated

• Synkinesis: Botox, physiotherapy, reanimation surgery

Dr. Amer’s approach incorporates free functional muscle transfer, cross-facial grafts, and advanced reconstructive strategies to restore symmetry and function.