The facial nerve controls the muscles of expression and emotion in the face and caries taste sensations from the front of the tongue to the brain. In facial palsy, one of the two facial nerves is damaged, compressed, or inflamed, and this results in weakness of the facial muscles, causing the eyelid and corner of the mouth to droop on one side of the face. People with facial palsy are often concerned that they have had a stroke, but this is unlikely if only the face is affected because a stroke is usually also associated with muscle weakness in other parts of the body.

Facial palsy is usually temporary, but a full recovery may take several months. The disorder affects about 1 in 4,000 people in the UK each year.

What are the causes?

The most common form of facial palsy is Bell’s palsy. This type of palsy occurs for no known reason, although a viral infection is believed to play a part.

In order types of facial palsy, there are known causes of damage to the facial nerve. These include the viral infection shingles and the bacterial infection Lyme disease. In addition, the facial nerve sometimes becomes inflamed as a result of middle-ear infection. In rare cases, the facial nerve may be compressed by a tumour called an acoustic neuroma. Facial palsy can also result from damage to the nerve from a tumour of the paroid salivary gland.

What are the symptoms?

In some cases, such as in Bell’s palsy, the symptoms of facial palsy appear suddenly over about 24 hours. In other cases, including facial palsy caused by an acoustic neuroma, symptoms may develop slowly. The symptoms include:

- Partial or complete paralysis of the muscles on one side of the face.
- Pain behind the ear on the affected side of the face.
- Drooping of the corner of the mouth, sometimes associated with drooling.
- Inability to close the eyelid on the affected side and watering of the eye.
- Impairment of taste.

If facial palsy is very severe, you may have difficulty in speaking and eating, and, occasionally, sounds may seem unnaturally loud in the ear on the affected side. If the eyelid cannot be closed, the eye may become infected, leading to ulceration of the cornea, the transparent front part of the eye. In facial palsy due to shingles, you will also have a rash of crusting blisters on your ear.

How is it diagnosed?

Your doctor will probably be able to diagnose facial palsy from your symptoms alone. A rapid onset over about 24 hours suggests Bell’s palsy. Symptoms that develop more slowly usually indicate another cause.

If your doctor suspects a tumour may be compressing the facial nerve, he or she may arrange for you to have CT scanning or MRI. Nerve and muscle electrical tests may also be arranged to assess nerve damage. If you live in a part of the UK where Lyme disease is common, you may have a blood test to look for evidence of this disorder.

What might be done?

If your symptoms have appeared in the last 48 hours, your doctor may prescribe corticosteroids for up to 2 weeks to reduce inflammation of the nerve. He or she may also recommend that you take painkillers. To prevent damage to the cornea, you may be given artificial tears, and you will probably be advised to tape the affected eye shut when you go to sleep.

Bell’s palsy usually clears up without further treatment. If facial palsy has an underlying cause, it will be treated if possible. For example, if facial palsy is due to shingles, antiviral drugs, such as aciclovir, will be prescribed. To be effective, treatment with acyclovir should begin as soon as the rash appears. If you have an acoustic neuroma, it will be removed surgically to relieve compression of the facial nerve.

If muscle paralysis persists, plastic surgery may be used to reroute another nerve to the face. Facial exercises and massage may help to maintain tone.

What is the prognosis?

With appropriate treatment, facial palsy usually improves within about 2 weeks. However, a full recovery may take up to 3 months. Some people are left with weakness, and facial palsy may recur.

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The carpal tunnel is the narrow space formed by the bones of the wrist (carpal bones) and the strong ligament that lies over them. In carpal tunnel syndrome, the median nerve, which controls some hand muscles and conveys sensation from nerve endings in part of the hand, is compressed where it passes through the tunnel. This compression causes painful tingling in the hand, wrist, and forearm. Carpal tunnel syndrome is a common disorder, especially in women aged 40-60, and often affects both hands.

What are the causes?

In some cases, the underlying cause of nerve compression is not known. In others, it occurs because the soft tissue within the carpal tunnel swell, compressing the median nerve at the wrist. Such swelling may be due to diabetes mellitus, or it may occur during pregnancy. The carpal tunnel may also be narrowed by a joint disorder, such as rheumatoid arthritis, or by a wrist fracture. The syndrome is associated with work that involves repetitive hand movements, such as typing, which can result in inflammation of the tendons in the wrist.

What are the symptoms?

Symptoms mainly affect specific areas of the hand, such as thumb, the first and middle fingers, and the palm of the hand. Initially, symptoms may include:

- Burning and tingling in the hand.
- Pain in the wrist and up the forearm.

As the condition worsens, other symptoms may gradually appear including:

- Numbness of the hand.
- Weakened grip.
- Wasting of some hand muscles, particularly at the base of the thumb.

Symptoms may be more severe at night, and pain may interrupt sleep. Shaking the affected arm may temporarily relieve symptoms, but the numbness may become persistent if left untreated.

What might be done?

Your doctor may suspect carpal tunnel syndrome from your symptoms. He or she will examine your wrists and hands may tap the inside of your wrists to check if a tingling sensation occurs. Nerve conduction studies may be carried out to confirm the diagnosis. If pregnancy is the cause of carpal tunnel syndrome, the symptoms usually disappear after childbirth. In other cases, treating the cause, if it can be identified, usually relieves symptoms.

The symptoms of carpal tunnel syndrome may be relieved temporarily by nonsteroidal anti-inflammaroty drugs or by wearing a wrist splint, particularly at night. In some cases, a corticosteroid injection under or around the ligament may reduce swelling. If symptoms persist or recur, you may have surgery under local anaesthesia to cut the ligament and release pressure on the nerve. After surgery, there are usually no further symptoms.

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