Weakness of facial expression on one side of the face that persists for months is a reason to investigate what is happening with the facial nerve. Facial nerve neuritis, or Bell's palsy, is the most common cause of such asymmetry. Let us explain what is called advanced neuritis and what consequences are possible.
What facial nerve neuritis is and what is called advanced
Facial nerve neuritis is an idiopathic, that is, without a clearly established cause, form of facial nerve neuropathy. Scientists believe that a viral infection causes the nerve to swell and become inflamed. Weakness appears suddenly and reaches its maximum after approximately 48 hours.
When facial weakness does not resolve within the usual recovery periods (most people recover within 3–6 months), it is described as a prolonged course. In some people, the weakness remains persistent.
Why neuritis may become prolonged or go unnoticed
Recovery depends on the condition of the nerve fibers. Electromyographic signs of denervation after 10 days indicate axonal degeneration: regeneration then occurs with delay and may be incomplete. This explains why weakness persists in some patients.
Neuritis may go unnoticed, for example, because 1–2 days before the weakness a person may feel pain behind the ear, and it is not linked to the future facial asymmetry. Meanwhile, treatment is more effective if started early. With incomplete paralysis in the first week, the prognosis is more favorable.
What complications are possible with advanced facial nerve neuritis
With persistent weakness, permanent facial weakness, pain in the face, around the jaw and behind the ear, a constantly watering eye, difficulty eating and drinking, taste changes, and intolerance to loud sounds are possible. If the eye does not close, protection is needed to avoid damaging vision.
- Persistent weakness of one side of the face
- Pain in the face, around the jaw and behind the ear
- Constant tearing and dry eye
- Difficulty eating and drinking, taste changes
- Increased sensitivity to loud sounds
Living with such asymmetry can cause low mood, stress, and anxiety — it is worth telling the doctor about this.
How the doctor assesses the degree of damage: examination and testing
The diagnosis is made based on the clinical picture. To rule out other causes of nerve damage, CT and MRI of the brain are performed. With slow progression of symptoms, it is differentiated from diabetes, middle ear infections, sarcoidosis, Lyme disease, temporal bone fractures, chronic meningitis, and tumors.
Electromyography helps distinguish a temporary conduction defect from an anatomical interruption of nerve fibers. If sarcoidosis is suspected, chest X-ray or CT is performed and the ACE level in the blood is determined.
When to seek medical help urgently
See a doctor at the first signs: weakness of half the face, drooping eyelid or corner of the mouth, drooling, dry eye or mouth, loss of taste. If there is no improvement within 3 weeks, a repeat examination is needed.
On its own, it is not a reason to call an ambulance; 103 or 112 — if the face is drooping on one side, the person cannot raise both arms and hold them up, and speech is difficult or slurred: these may be signs of a stroke.
This material is for reference and does not replace consultation with a doctor: only the doctor will assess your situation and suggest further steps.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer