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LMN facial nerve palsy due specifically to varicella (herpes) zoster is Ramsay Hunt syndrome . Pain is often a prominent feature and vesicles are seen in the ipsilateral ear, on the hard palate and/or on the anterior two thirds of the tongue. It can include deafness and vertigo and other cranial nerves can be affected. When the rash is absent it is known as zoster sine herpete; 2-23% of people with Bell's palsy actually have Ramsay Hunt syndrome. [ 12 ] It should be suspected when pain is significant, especially in those aged over 60. Immunodeficiency - for example, HIV - is a risk factor.
When your face is not working as it should, it is very tempting to try and force the muscles back to work by doing facial exercises. Never attempt to carry out exercises without professional help as you may do more harm than good. Most people want to do something but trying too hard may lead to problems later on in your recovery. There is evidence to suggest that exercising the facial muscles too forcefully can lead to a miswiring of the nerves as they recover, leading to longer term complications known as synkinesis. Your facial nerve is no different to any other part of the body and will take time to heal. Gentle facial massage is preferable to forceful exercises, using the pads of your fingers gently massage the brow, temples, cheek, chin and neck. If you are concerned about how your recovery is going after two to three months, ask your GP to refer you to a physiotherapist or speech and language therapist for assessment and treatment. They should have specialist experience in the management and treatment of facial palsy. Our self-help videos demonstrate techniques to help with your facial nerve recovery. Read more information about facial nerve recovery here: Facial Nerve Recovery .