🧠 Facial Nerve Paralysis Vet Guide 2025 by Dr Duncan Houston

Facial nerve paralysis (FNP) in horses is a serious condition that may resolve or become permanent depending on the cause and timing of treatment. In this comprehensive guide, we’ll explore how to recognize symptoms, determine causes—from trauma to infection—use diagnostic tools, apply effective treatments (including acupuncture), and support recovery with veterinary-led care. 🐴✨

1. What Is Facial Nerve Paralysis?

Facial nerve paralysis means loss of voluntary movement in facial muscles—ears, lips, eyelids, nostrils—due to dysfunction of the facial nerve (cranial nerve VII) :contentReference[oaicite:3]{index=3}. It can be partial or complete, unilateral or bilateral.

2. Recognizing Clinical Signs

• Lip droop on one side; food or saliva drips (“quidding”) :contentReference[oaicite:4]{index=4}.
• Muzzle deviation toward the normal side due to muscle tone loss :contentReference[oaicite:5]{index=5}.
• Ear droop and ptosis (eyelid droop); incomplete blink and absent palpebral reflex :contentReference[oaicite:6]{index=6}.
• Nostril collapse and airway compromise on the affected side :contentReference[oaicite:7]{index=7}.
• Excess saliva and feed loss; decreased tear production leading to corneal ulcer risk :contentReference[oaicite:8]{index=8}.

3. Common Causes 🎯

Trauma

Kicks, falls, tight halters (especially during anesthesia), facial surgery, and skull fractures often injure facial nerve branches :contentReference[oaicite:9]{index=9}.

Neurologic or Infectious

Guttural pouch disease (e.g., tympanic joint arthritis/fracture), middle/inner ear infections, EPM, neuroborreliosis, temporohyoid osteoarthropathy (THO) :contentReference[oaicite:10]{index=10}.

Neuropathic Conditions

Idiopathic/paralysis or nerve degeneration in rare cases :contentReference[oaicite:11]{index=11}.

4. Diagnostic Approach

• Clinical history & physical exam: Check for trauma, halter use under anesthesia, ear/deep throat infection :contentReference[oaicite:12]{index=12}.
• Neurologic exam: assess reflexes (blink, palpebral, menace), muscle atrophy, sensory deficits :contentReference[oaicite:13]{index=13}.
• Ophthalmic tests: Schirmer tear test, fluorescein stain to check corneal ulcer risk :contentReference[oaicite:14]{index=14}.
• Advanced imaging: Skull X-ray, CT/MRI for ear/joint lesions, guttural pouch endoscopy :contentReference[oaicite:15]{index=15}.
• Electromyography: Assess nerve-muscle function and injury severity :contentReference[oaicite:16]{index=16}.
• Lab tests: CBC/chemistry; EPM titers, CSF if other neurologic signs present :contentReference[oaicite:17]{index=17}.

5. Treatment Options

Supportive Care

• Eye protection: Lubricant eye drops, ophthalmic ointments, temporary tarsorrhaphy for missing blink :contentReference[oaicite:18]{index=18}.
• Soft feed/drinking aids: Provide water in deep buckets, soaked feeds, diet mash :contentReference[oaicite:19]{index=19}.
• Facial massage & warmth: Helps maintain muscle tone and blood flow :contentReference[oaicite:20]{index=20}.

Pharmaceuticals

• NSAIDs/steroids: Reduce swelling and inflammation.
• Antibiotics: Treat middle ear, guttural pouch, or THO infections :contentReference[oaicite:21]{index=21}.

Acupuncture & Electro‑acupuncture

Used in combination with meds and physiotherapy; clinical reports show improved nerve regeneration when started early :contentReference[oaicite:22]{index=22}.

6. Prognosis & Recovery Timeline

Most FNP cases in horses are traumatic and can improve with proper care :contentReference[oaicite:23]{index=23}. Recovery may take weeks to months:

• Neuropraxia: Temporary conduction block—often full recovery in 1–2 months.
• Axonotmesis: Axonal damage—recovery via regrowth (~1 mm/day) over several months :contentReference[oaicite:24]{index=24}.
• Neurotmesis: Severe injury with connective tissue disruption—regrowth unlikely after ~12 months :contentReference[oaicite:25]{index=25}.

Poor prognosis if no improvement after 6 months :contentReference[oaicite:26]{index=26}.

7. Nursing & Practical Care

• Monitor eye and corneal health daily.
• Provide comfortable eating setup and soaked diet.
• Massage and warmth to the affected muscles.
• Use acupuncture if available and safe.
• Reassess nerve function monthly with reflex exams.

8. Veterinary-Owner Collaboration

• Start treatment early—support can make a difference.
• Coordinate meds, nutritional changes, and physiotherapy.
• Use logs and photo/video tracking of facial symmetry and blink.
• Plan follow-ups at 1–3 month intervals to reassess nerve recovery.
• Consider imaging or referral if no progress after 3 months.

9. Quick Reference Table

🔚 Final Thoughts

Facial nerve paralysis in horses demands rapid recognition and care. While many cases recover with supportive therapy, early use of acupuncture, medication, and attentive nursing can improve outcomes. If you notice facial asymmetry or drooping in your horse, contact your veterinarian swiftly. For help designing a facial paralysis recovery plan, monitoring tools, or acupuncture guidance, reach out to our Ask A Vet team. Download the Ask A Vet app for 24/7 expert support, symptom tracking, and personalized rehab protocols. 🌟