Droop Symptoms, Meaning, Calling 911

Facial palsy/paralysis is a common sign of a stroke. A stroke is a sudden interruption or severe reduction of blood supply to part of your brain. It can occur from a blood clot or bleeding.

A stroke deprives your brain tissue of necessary oxygen and nutrients. This can cause brain cells to die within minutes of a stroke onset. Facial drooping occurs when a stroke interferes with blood flow to areas of your brain that control facial muscles. It can also result from other conditions unrelated to a stroke.

Why Facial Droop Is a Stroke Symptom

Facial droop is a common stroke symptom. Research indicates that facial droop occurs in up to 60% of people with first-time ischemic stroke.

A stroke is when blood flow to a certain part of your brain is stopped or reduced so much that the affected area does not receive the oxygen and blood supply it needs to function. When the disruption in blood flow occurs, one of the following types of stroke can occur:

• Ischemic stroke: A stroke that occurs due to a blocked blood vessel and represents the most common type of stroke
• Hemorrhagic stroke: A stroke that occurs due to a ruptured blood vessel
• Transient ischemic attack (TIA) or ministroke: Occurs due to a temporarily blocked blood vessel

Without sufficient blood flow, brain cells start to die, and the functions the affected area of your brain manages become lost or damaged. This can have the following impact on your face:

• The right side of your face can twist or droop if blood flow to the left side of your brain is compromised.
• The left side of your face can twist or droop if blood flow to the right side of your brain is compromised.
• You may have trouble smiling if blood flow to the frontal lobe, the forward-most part of your brain, is affected.

How Stroke Face and Changes Look

Stroke face can look slightly different for everyone due to individual facial characteristics. Stroke face can involve the following changes:

• Drooping in half of your face
• One side of your face slightly twisting downward
• Uneven smile that droops on one side
• General facial muscle dysfunction in the lower part of your face, the region below your eye clefts
• Dribbling or drooling from the corner of the mouth on the affected side

In addition to physical changes, stroke face can also trigger the following long-term responses:

• Dysphagia (difficulty swallowing)
• Dysarthria (motor speech disorder that affects the voice box and tongue)
• Higher risk of anxiety and depression
• Negative impact on training motivation, which can affect the success of treatment

Emergency Stroke Treatment

Emergency stroke treatment can save someone’s life or prevent long-term brain damage and other dangerous effects. You can facilitate emergency stroke treatment by learning stroke symptoms and calling 911 at the first sign of symptoms. This is the best way to get to the hospital safely as soon as possible. All types of stroke can benefit from emergency stroke treatment.

The type of emergency stroke treatment you receive depends on the type of stroke that occurs. Treatments include:

Ischemic stroke treatment:

• Tissue plasminogen activator (tPA): Also known as alteplase IV r-tPA, this drug is the main treatment for an ischemic stroke, which represents 87% of strokes in the United States. It is administered as an injection to dissolve the blood clot blocking blood flow to your brain. To be effective, tPA must be given within three hours after stroke symptoms start, though some people may benefit from treatment even after 4.5 hours. The earlier you receive tPA, the better your chances of recovery.
• Antithrombotics: These drugs, which include antiplatelet and anticoagulant drugs called blood thinners, prevent the formation of new blood clots. They may be taken when tPA is not appropriate. Two common antithrombotics include aspirin and Plavix (clopidogrel).
• Clot retrieval system: This corkscrew-shaped mechanical device passes a microcatheter through the clot, where it lodges itself within the clot. As the device is slowly withdrawn, it brings the clot with it.
• Thrombectomy: This medical procedure removes the clot from the blood vessel. It involves the insertion of a catheter (a long, flexible tube) into your upper thigh. The catheter is threaded to the blocked artery. This allows the surgeon to position a stent (a small mesh tube) across the narrowed area of the blocked blood vessel. The stent is released and then dilated with an angioplasty balloon that is gently expanded to open the blocked artery. The stent remains in place permanently to keep the blocked blood vessel open.

Hemorrhagic stroke:

• Medication: Depending on your condition, you may receive medication to lower your blood pressure and reduce pressure on the affected blood vessels. You may also be given vitamin K.
• Endovascular procedures: Endovascular procedures aim to stop bleeding in the brain and reduce the risk of a blood vessel rupture by repairing a weak spot or break in a blood vessel. These procedures are performed using a catheter passed through an incision in your groin or wrist.
• Surgical treatment: When bleeding is caused by a ruptured aneurysm, a surgical procedure inserts a tiny metal clip at the base of the aneurysm to stop blood loss.
• Craniectomy or hemicraniectomy: A procedure in which a portion of the skull is temporarily removed in the operating room to prevent pressure on the brain from swelling. The bone is replaced when the pressure is relieved in another surgery.

Rehabilitation for Facial Drooping After Stroke

Rehabilitation for facial drooping after a stroke can help you regain control of facial muscle groups to restore function and expression. Though spontaneous recovery of facial drooping after stroke has been reported in up to 67% of cases at six months post-stroke, about 33% of those affected have persistent facial drooping after six months post-stroke.

When facial drooping remains after a stroke, rehabilitation that uses active therapy, passive therapy, or a combination of both may help:

Active therapy, called facial neuromuscular retraining, is performed under the guidance of a physical therapist. It involves highly specialized treatment to help you relearn basic facial expressions and movements. This nonsurgical treatment can support optimal recovery from facial paralysis or facial nerve damage. Active therapy can include:

Passive therapy, which involves treatments performed without your active participation, can include:

Rehabilitation results and recovery time depend on many factors unique to your situation. The severity of the brain damage, age, and the management of other physical health conditions can impact your progress.

When physical rehabilitation is ineffective, you may benefit from one of the following surgical treatments to treat facial drooping:

• Nerve repair or grafts: This surgery reconnects or repairs injured facial nerves to restore movement. A graft (a small piece of nerve from another part of your body) may be used to make the connection.
• Nerve transfer: This procedure connects healthy nerves to injured nerves by moving a nerve from a different part of your fact to the affected area.
• Muscle graft: This procedure transplants a small piece of the gracillis muscle (a muscle in your thigh) to your face. It replaces the action of a paralyzed face muscle. 
• Temporalis tendon transfer: This procedure connects a tendon in your jaw to the corner of your mouth to create a smile when you clench your jaw. Training and practice are required to get your face movement to look more natural.
• Injections: Botox (onabotulinumtoxinA) can reduce twitching or uneven facial movements to make your face appear more natural. Facial fillers can replace facial volume lost in paralysis. The restored volume can make your face look more even and help you hold food and liquid in your mouth.

Follow-Up When Home After Stroke

Follow-up care when you return home after a stroke can be different for each person depending on the physical and mental impact of the stroke. Rehabilitation takes advantage of neuroplasticity, your brain’s ability to rewire some of the circuits lost after a stroke. Depending on your condition, rehabilitation can take months to years to achieve improvement.

Follow-up care at home after a stroke can involve:

• Physical therapy to help relearn motor skills such as walking, standing, and sitting
• Occupational therapy to help you relearn how to perform daily activities such as eating, drinking, bathing, and using the toilet.
• Speech therapy to help relearn language and speaking skills
• Cognitive behavioral therapy and emotional therapy with a mental health specialist to address changing emotions about your condition

People who have had a stroke have a high risk of having another stroke. Know the signs of a stroke to alert others about your condition. Look for symptoms associated with BE FAST. Call 911 immediately if you or a companion has any of the following symptoms:

• Sudden numbness or weakness in the face, arm, or leg—especially on one side of the body
• Sudden problems seeing in one eye or both eyes
• Sudden confusion, trouble speaking, or understanding speech
• Sudden severe headache with no known cause
• Sudden dizziness, loss of balance or coordination, or trouble walking
• Double vision
• Drowsiness
• Nausea or vomiting

Summary

Facial droop is viewed as a medical emergency because it is a common symptom of a stroke. It most often affects only one side of your face. In addition to paralysis, it can involve slurred speech, drooling, or problems with normal eyelid opening and closing.

Facial droop from stroke often resolves on its own without treatment. When this does not occur, physical rehabilitation or medical treatments may improve appearance and restore function.

Facial paralysis, even for a short time, should not be ignored. Call 911 if you or anyone near you has sudden facial paralysis. Learn to recognize signs of a stroke with the BE FAST system. This can help ensure that you and others receive prompt stroke treatment, which can support the best outcomes.