Facial Nerve Palsy

About Facial Nerve Palsy

Facial nerve palsy, often called Bell's palsy, causes sudden weakness or paralysis of one side of the face when the facial nerve fails to conduct signals normally. About four in five patients recover spontaneously within a few weeks, but a meaningful minority are left with lasting difficulty closing the eye, smiling or speaking clearly. For these patients, surgical reconstruction can restore symmetry and meaningful movement.

The facial nerve travels through a tight bony canal beneath the ear before fanning out across the face. Bell's palsy is most often linked to viral inflammation that swells the nerve within this narrow passage. Our team in Lucknow reviews potential triggers, examines residual movement, and uses electrophysiology and imaging when needed to decide whether observation, medical treatment or surgery is the right next step.

When the nerve is cut or compressed, direct repair, with or without a sural nerve graft from the calf, can rebuild continuity. Where one side of the face is paralysed but the other works normally, a cross-facial nerve graft connects healthy branches across the midline so that movement on the unaffected side eventually drives the paralysed side. Recovery is gradual but can be remarkably natural.

For patients with bilateral palsy or limited donor branches, we use nerve transfers, most commonly from the masseteric branch of the trigeminal nerve. This avoids the need for a graft and tends to deliver an earlier, stronger smile, often within four to six months. The procedure shares many steps with a standard facelift, with incisions hidden in the hairline and around the ear.

When the palsy has lasted longer than 12 to 24 months, the original facial muscles may no longer respond to nerve input. In these cases, Dr. Agarwal, FRCS Edinburgh, considers free functional muscle transfer, tendon transposition or static slings to restore resting symmetry and selected movement. Each plan is tailored to the patient's age, goals and overall health.

What to expect

• Detailed neurological and facial muscle assessment
• Electrophysiology and imaging where indicated
• Counselling on direct repair, grafts and nerve transfers
• Microsurgery under general anaesthesia
• Hidden incisions in the hairline and around the ear
• Staged plans for long-standing or bilateral palsy
• Coordinated physiotherapy and biofeedback rehabilitation

Recovery

• Hospital stay of one to two nights for most procedures
• Mild swelling and bruising for two to three weeks
• Movement returns gradually over four to twelve months
• Daily home exercises to retrain facial muscles
• Eye protection until blink mechanics improve
• Periodic follow-up to track functional gains