Ear, Nose and Throat - U.S.A.  (ENT USA) Facial Paralysis - Bell's Palsy
Function and Anatomy of the Facial Nerve
Function and Anatomy
Of the Facial Nerve
Function and Anatomy of the Facial Nerve

The facial nerve controls the muscles of facial expression, tearing of the eye and taste.  It does not control the muscles of mastication or chewing.  Injury to the facial nerve can cause facial paralysis producing an inability to close the eyelids and drooling due to loss of function of the lip muscles (obicularis oris).  Injury to the eye may occur due to loss of the protective function of the eyelids and drying of the eye due to the loss of tearing.   







The Facial Nerve and Facial Paralysis - Bell's Palsy

Facial paralysis can be caused by infections such as herpes zoster (Ramsey Hunt Syndrome), trauma, and tumors.  Patients with Ramsey Hunt Syndrome may have hearing loss and dizziness and viral blebs on their ear canal and eardrum.  Treatment with acyclovir and steroids has been shown to be beneficial with a recovery rate of 82.6%   

Most often no cause is found and Bell's Palsy is diagnosed.  An MRI scan to visualize the facial nerve and an audiogram to test the hearing nerve (runs along with the facial nerve) may be ordered by your doctor.  The facial paralysis from Bell's Palsy is rapidly progressive over 24 to 48 hours, that from a tumor is usually slowly progressive, over many weeks or months.  Treatment may include use of steroid and anti-viral medications Surgical decompression of the nerve is debated in medicine.  Many feel that in order for surgery to be of benefit, the facial nerve must be decompressed at the entrance of the internal auditory canal, deep within the inner ear (middle fossa decompression).  This is a very difficult operation, which in itself carry significant risks.   Smouha et al. reported that a survey of 86 neurotologists that 2/3 would recommend surgery if electrophysiologicc criteria is meet but only half believed that surgical decompression should be the standard of care and only half would use a middle fossa decompression.   View Abstract

Axeisson et. al reported that valacyclovir and prednisone produced complete recovery in 10 of 10 treated patients as compared to a complete recovery rate of 50% in untreated patients.   View Abstract

Up to 90% of cases of Bell's palsy will have full or partial recovery of facial function, with over 50% of the cases having close to 100% recovery.  Recovery may be rapid over a few weeks or take several months to up to one year.  The longer the time of recovery, the more sever the injury and the more likely some residual weakness or synkinesis will be present.   ALL PATIENTS WITH BELL'S PALSY NEEDS TO CONSULT A HEALTH CARE PROVIDER FOR PROPER DIAGNOSIS AND TREATMENT !!!!

Search PubMed for Bell's Palsy       Search PubMed for Facial Paralysis         Go to Other Web Links

Eye care in Patients with Facial Paralysis

One of the most important aspects in the treatment of facial paralysis is care of the eye.  If the eye dry out the cornea may become damaged and vision may be lost.  Use of liquid tears during the day, lacrilube during the night and at times taping the eye shut at night will help to prevent damage.  Also, protective glasses should be worn when exposed to dust since the eye cannot blink to protect itself.

Determining the Extent of the Facial Paralysis

The Neely and Cheung Rapid Grading System
Copyright 1998 by Gail J Neely MD and John Y Cheung

This program will grade the degree and stage of facial paralysis using all or any one of 10 different grading systems.  The physician enters the patient's physical findings and the program calculates the degree of facial function impairment.

To start the program: 

  • Click on the New File Box. 

  • Enter the patient's demographic data

  • Select the RGS Grading System to be used.

  • Then enter the patient's physical findings. 

  • Select the "Evaluate" button at the bottom of the screen.

Download Program 118 K

Reference: Ahrens A, Skarada D, Wallace M, Cheung  JY,  Neely JG. Rapid simultaneous comparison system for subjective grading scales grading scales for facial paralysis.  Am J Otol. 1999 Sep;20(5):667-71.

Note:  The RGS program is provided free of charge with permission of the author.


House Brackman Facial Nerve Grading System     ** GO TO Top **

Reference:  House JW, Brackman DE.   Facial nerve grading system.  Otolaryngol  Head Neck Surg.  1985:93,146-147.

Grade Description Measurement* Function % Estimated
Function %
I Normal 8/8 100 100
II Slight 7/8 76 - 99 80
III Moderate 5/8 - 6/8 51 - 75 60
IV Moderately
3/8 - 4/8 26 - 50 40
V Severe 1/8 - 2/8 1 - 25 20
VI Total 0/8 0 0

* "Measurement" is determined by measuring the superior movement of the mid-portion of the superior eye brow and the lateral movement of the oral commissure.  A scale point of 1 is assigned for each 0.25 cm of motion up to 1 cm. for both eye brow and commissure movement.  The points are then added together.  Thus, a total of 8 points can be obtained, if each structure moves 1 cm.  

** "Description" is defined as follows: 

Grade Description Characteristics
I Normal

   Normal facial function in all nerve branches

II Slight
  • Gross:  Slight weakness on close inspection, slight synkinesis.
  • At Rest:  
    Normal tone & Symmetry.
  • Motion:  
    Forehead:  Good to moderate movement.
    Eye: Complete closure with minimum effort.
    Mouth: Slight asymmetry.
III Moderate
  • Gross:  Obvious but not disfiguring facial asymmetry. Synkineisi is noticeable but not severe.  May have hemi-facial spasm or contracture. 
  • At Rest:  
    Normal tone & Symmetry.
  • Motion:  
    Forehead:  Slight  to moderate movement.
    Eye: Complete closure with effort.
    Mouth: Slight weakness with maximum effort.  
IV Moderately 
  • Gross:  Asymmetry is disfiguring and/or obvious facial weakness.
  • At Rest:  
    Normal tone & Symmetry.
  • Motion:  
    Forehead:  No movement.
    Eye: Incomplete eye closure.
    Mouth:  Asymmetrical with maximum effort.  
V Severe
  • Gross:  Only slight, barely noticeable, movement.
  • At Rest: 
    Asymmetrical facial appearance.
  • Motion:
    Forehead:  No movement.
    Eye: Incomplete closure.
    Mouth:  Slight movement.
VI Total    No facial function





The Following Websites are Searched:  www.entusa.com, www.waent.org , www.ear-anatomy.com,
www.occupationalhearingloss.com, www.cme-usa.org and www.tobaccofacts.info

Subscribe to a Mailing List for Ear, Nose & Throat Health Care Providers.  Be Notified of updates on  https://www.entusa.com  &

Copyright 2001,2002, 2003,2004, 2008, 2009 
Kevin T Kavanagh,  All Rights Reserved

Page Last Updated 08/24/2023 
( Site Map )


( Site Map )

Google Ad space finances and sponsors ENT USAtm Websites.  ENT USAtm, Cumberland Otolaryngology or Dr Kevin Kavanagh, MD do not endorse, recommend, referrer to or are responsible for the Advertisements or for the content or claims made in the Advertisements.