Facial paralysis after injury or surgery

The facial nerve travels through a narrow bony tunnel in the skull, which makes it vulnerable: a head injury, a fracture of the temporal bone, surgery near the ear or parotid gland, a tumor pressing on the nerve, or a serious infection can all disrupt it.

Unlike Bell’s palsy, where the cause is inflammation that usually settles, trauma-related paralysis depends heavily on what happened to the nerve — bruised, compressed, or cut are very different situations with different paths forward. That’s why this type gets more testing.

Facial weakness after any injury deserves prompt medical evaluation. Whether the weakness started immediately after the injury or developed over the following days is a key detail — try to pin that down, because it guides decisions.

Go to the emergency department if facial weakness follows a significant head injury, or if symptoms are getting worse quickly.

Imaging — usually a CT scan or MRI — lets doctors see the nerve’s path and what might be pressing on or interrupting it.

Electrical tests (you may hear “ENoG” or “EMG”) measure how much signal is getting through the nerve. They help predict recovery and, in some cases, whether surgery is worth considering. None of them are as scary as they sound — they mostly involve small sensors on the skin.