Employer’s guide to facial palsy

This information is intended to help employers and managers to understand what it means to have facial palsy and to appreciate some of the difficulties that your employee may have as as a result.  It is not intended to replace advice and guidance already available about returning to work after a long-term illness.

Losing a member of staff because of a long-term absence can be a strain on your business financially, through loss of skills and experience, or loss of morale of the remaining staff.

It will be an advantage to you as an employer and to your employee if a return to work is successful.

Understanding facial palsy

The term ‘facial palsy’ is an umbrella term which includes over 50 different medical conditions. It refers to a weakness of the facial muscles resulting from temporary or permanent damage to the facial nerve(s). The causes of facial palsy are varied but can include infections, tumours (and their treatment) and trauma.

When the facial nerve is non-functioning, damaged or cut, the muscles in the face do not receive the necessary signals from the brain in order to operate properly. This results in the paralysis of the affected part of the face. There are different degrees of facial paralysis: sometimes one whole side of the face is affected (unilateral facial paralysis) and in some cases both sides of the face are affected (bilateral facial paralysis ).

Some episodes of facial palsy last for weeks or months. Other instances may last much longer and may involve periods of pain and discomfort. The recovery from facial palsy can be slow and some people never fully recover. However, many people who have facial palsy are able to successfully return to work and fulfill their potential.

What are the difficulties of having facial palsy?

Facial palsy is a physical problem that can occur without warning and can be traumatic. No two cases are quite the same and the impact of it may affect individuals quite differently.

Physical symptoms

The problems experienced depend precisely on where and how significantly the facial nerve is affected. However, any of the facial nerves or muscles which control the eyes, ears, nose and mouth can be affected. This can sometimes make facial expressions difficult to read. A number of symptoms could be experienced, including:

Eye(s) – There may be a loss of eye closure and affected vision, increased sensitivity to light and dry eye which may be painful or watering excessively.

Ears – There may be hearing loss or an onset of tinnitus. In some cases, balance or vertigo may also be an issue.

Nose – Paralysis can affect the nose, causing dryness and irritation in the affected nasal passage. The person may experience a streaming nostril on the affected side.

Mouth – Where the paralysis affects the mouth, speech may be affected resulting in slurred words or difficulty in pronunciation. Smiling is compromised and this can lead to others receiving incorrect facial cues. Saliva production may be reduced, which can lead to a continual thirst and problems with chewing and swallowing. Additionally paralysis of some of the muscles needed to chew and swallow may cause difficulty when eating and drinking. Over time, and combined with a lack of saliva, teeth can decay.

Synkinesis (pronounced sink-eye-nee-sis) – This means that when intentionally trying to move one part of the face, another part automatically moves. For example, on smiling the eye on the affected side automatically closes. Similarly, on raising the eyebrows or closing the eyes, involuntary contraction of the cheek or neck muscles occurs. Some people find when they eat their eye waters or their nose streams.

General – Pain is a problem for many people. Many individuals will be challenged by periods of fatigue that may continue for longer than the facial palsy is visible. It is important to understand that this fatigue is part of the condition and does not reflect the motivation of the employee.

Remember that not all people with facial palsy will experience the same symptoms.

Mental health

People often feel uncomfortable and embarrassed talking about their face as they might feel that it can be seen as vanity. It is important to understand that facial palsy is not a cosmetic issue. Distress is caused by the loss of facial function and the loss of self. The level of distress is not always in line with the change that can be seen.

An employee may appear to be coping well with the symptoms and changes to appearance, but be prepared to monitor this. Research has shown that people who have a chronic condition that lasts for a long time or comes back are more likely to suffer from depression than the general population.

Returning to work

After facial palsy has been diagnosed and treatment has begun, many people gradually improve physically and emotionally. Recovery can be slow and unpredictable and the length of time needed can depend on the cause and extent of the facial nerve damage and any related symptoms.

The process and planning for an employee’s return to work can make a huge difference to their readjustment. Procedures put in place can help to make sure that your employee feels valued and well supported.

It is vital that a two-way trust is developed and your employee is assured of continued respect and confidentiality.

When you discuss goals around returning to work be as realistic as possible. Offer flexibility and schedule regular reviews to revise arrangements as necessary.

Take time to listen to how your employee feels about their condition, the impact it has on them and the implications of returning to work. Discuss all of the options available to make this easier for both of you.

Some people will need to attend regular hospital appointments when they return to work. These clinics usually run on specific days and times, appointments are organised by the hospital and are difficult to move.

The absence policy for your organisation may give guidance about this, but time off for appointments should be discussed as part of the agreed return to work schedule. This reduces stress on the employee and makes the responsibilities of both the employer and employee clear.

Does facial palsy affect the employee’s ability to do their job?

This is dependent on the individual with facial palsy, the severity and impact of their condition and the type of job they do. In many cases people who have facial palsy are able to work.

Key factors that help to overcome barriers at work include: reasonable adjustments, flexibility in working arrangements, knowledgeable support and team working.

Legal responsibilities

The Equality Act 2010 protects employees from discrimination, harassment and victimisation, because of disability. An employer must make ‘reasonable adjustments’ to ensure that workplace requirements or practices do not disadvantage employees or potential employees with a disability. Adjustments have to be reasonable, and need not be excessive.

Summary: How can an employer help?

To ensure a successful and speedy return to work after any illness it is essential that a carefully managed programme of support, reasonable adjustments and understanding of the complexities of individual circumstances is offered. This will enable an employee to return to work without risk and with the potential to increase confidence and general health and well-being.

Fit for Work offers free, expert and impartial advice to anyone looking for help with issues around health and work. Medical reports and the advice of Occupational Health should be carefully considered, with any anticipated problems or issues thoroughly discussed with a view to resolving them.

When your employee has returned to the workplace, a flexible approach to reviewing and revising arrangements will be necessary. Needs may change over time; some issues may have been wrongly identified and some areas may have later become a problem. It is essential that the employer, manager and employee all work together to resolve any difficulties and find mutually agreeable solutions.

For further information and advice see the External Links below.

Externally Linked Articles:

Gov.uk Employment Info (Ext. Link - opens in new window)

UK Government information about employment.

nidirect (Ext. Link - opens in new window)

nidirect brings together lots of information from government departments and agencies, written in language that is easy to understand.

Fit for Work (Ext. Link - opens in new window)

Fit for Work can help supplement the advice an employee receives from their employer’s occupational health provider or through their own private insurance.

Thriving at Work: the Stevenson/Farmer review of mental health and employers (Ext. Link - opens in new window)

Thriving at Work: the Stevenson/Farmer review of mental health and employers October 26th 2017

ACAS (Ext. Link - opens in new window)

ACAS provide information, advice, training, conciliation and other services for employers and employees to help prevent or resolve workplace problems

Definition of disability under the equality act 2010 (Ext. Link - opens in new window)

Equality and Human Rights Commission (Ext. Link - opens in new window)

– challenging discrimination and protecting and promoting human rights.

Last reviewed: 02-02-2021    ||    Next review due: 02-02-2023