Facial palsy: when and why to refer for specialist care

Facial paralysis causes significant functional and psychological morbidity, including anxiety and depression. The muscles of facial expression play a critical role in protecting the eye, maintaining oral competence, and are essential for portraying emotions to facilitate social interaction. The management of patients with facial palsy can be challenging because there are over 50 aetiologies that can result in facial muscle paralysis, and measuring severity is challenging. Facial palsy encountered in primary care can fall into one of three broad groups that help guide the management in both primary and secondary care. These are acute flaccid facial paralysis (AFFP), longstanding flaccid facial paralysis (LFFP), and post-paralytic facial palsy (PPFP). This article aims to provide guidance on when and why to refer patients with facial palsy to secondary care.