Medical Oncologist
CION Cancer Clinics
Facial nerve risk in skull base surgery: what it means for your face | CION Cancer Clinics
Skull base and temporal bone surgery can weaken the facial nerve, which moves the muscles of your face. The risk is small for some operations and much higher when the cancer surrounds the nerve. Weakness can be temporary while the nerve recovers, or lasting if part of the nerve had to be removed. This page explains why the risk differs, how the eye is protected and what can be done. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Can skull base surgery damage the facial nerve?
- When is the facial nerve most at risk?
- What happens if the face is weak after surgery?
- Which everyday changes might you notice?
- What do families often get wrong about facial weakness?
- What should you ask, and what can this page not tell you?
- Common questions about facial nerve risk
The short answer
Can skull base surgery damage the facial nerve?
Yes. The facial nerve runs through the temporal bone, close to the ear and the skull base, so operations in that area can stretch, bruise or cut it. How likely that is depends mostly on where the tumour sits in relation to the nerve.
What the facial nerve does
It controls the muscles that close your eye, raise your eyebrow, make you smile and keep food and drink in the side of your mouth. It also carries taste from the front of the tongue and helps the eye make tears. Each side of the face has its own nerve, so a problem is almost always on one side only.
Why the risk is not the same for everyone
A tumour growing near the nerve but not into it can often be removed while the nerve is kept, with the surgeon watching it closely. A cancer that has grown into or around the nerve is different. To remove the cancer fully, part of the nerve may have to come out with it. Your surgeon can usually tell from the scans, and from how your face moves before surgery, which situation is more likely.
If your face is already weak before surgery, the cancer may already involve the nerve. Tell the team how long it has been weak.Where the risk is higher
When is the facial nerve most at risk?
These are the situations surgeons discuss most often. Your own risk comes from your scans, not from this list.
Ear canal and temporal bone cancer
The nerve runs through the bone that is removed. In a smaller lateral resection it can often be kept. In deeper operations it is at much greater risk.
Parotid cancer reaching the skull base
The nerve branches through this saliva gland in front of the ear. Cancers here that spread back towards the skull base can involve the nerve directly.
Tumours at the side of the skull base
Tumours near the inner ear or the openings where large veins and nerves leave the skull bring the facial nerve close to where the surgeon is working.
Repeat surgery or earlier radiotherapy
Scar tissue from earlier operations or radiotherapy makes the nerve harder to see and to separate from the tumour.
Tell your surgeon about every earlier treatment near the ear, however long ago.Not sure whether this applies to you?
Ask an oncologist
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An eye that will not close and turns red or painful
If your eye does not close fully after surgery, its clear front surface can dry out and become damaged quickly. Redness, pain, a gritty feeling, blurred vision or light hurting the eye need attention the same day. Call your surgical team or go to an eye emergency service. Keep using the drops and night-time eye protection you were given until you are seen.
After surgery
What happens if the face is weak after surgery?
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On waking
The team checks whether you can close your eye, raise your eyebrow and smile. Weakness can be there straight away, or appear a day or two later from swelling around a nerve that was kept.
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Protecting the eye
This comes first. You may be given lubricating drops for the day, a thicker ointment at night and advice on taping the eyelid closed while you sleep. Some people later need a small weight placed in the upper eyelid to help it close.
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Waiting for a nerve that was kept
If the nerve was kept but bruised or stretched, movement often returns slowly over weeks to months. Recovery can be partial. Facial physiotherapy helps the muscles work together as the nerve recovers.
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Repairing a nerve that was removed
If part of the nerve had to come out with the cancer, the surgeon may bridge the gap with a nerve graft, a piece of nerve from the neck or leg, during the same operation. Movement, if it returns, takes many months.
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Other options later
Where the nerve cannot recover, operations can lift the corner of the mouth or the eyebrow, or borrow a nearby nerve or muscle to give some movement and a more even resting face. Radiotherapy afterwards can slow nerve recovery, and your team will allow for that.
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Day to day
Which everyday changes might you notice?
What you may notice
What usually helps
The eye does not close fully and waters or feels dry
Drops, night ointment, eyelid taping and regular eye checks
Food collects in the cheek and drinks dribble
Small mouthfuls, chewing on the stronger side, a mirror at first
Some sounds in speech are less clear
Speaking slowly; speech therapy if it does not settle
Taste changes on one side of the tongue
Often settles; well-flavoured food helps in the meantime
The face looks uneven, especially when smiling
Facial physiotherapy and, for some people, surgery later
Commonly believed
What do families often get wrong about facial weakness?
"If the face droops after surgery, the surgeon made a mistake."
Facial weakness is a known risk of these operations, and sometimes it is the planned cost of removing a cancer that has grown into the nerve. That is why it should be discussed before surgery, not only afterwards. If it was unexpected, ask the team to explain what happened.
"It must be a stroke."
Weakness after surgery near the ear usually comes from the facial nerve on that side, not from the brain. It typically affects the forehead too. New weakness of an arm or leg, slurred speech or confusion is different and needs emergency care.
"Once the face is weak, nothing more can be done."
Eye protection, physiotherapy, nerve grafts and later facial surgery can all help, depending on whether the nerve was kept. Improvement can continue for a long time. Ask for a referral to someone experienced in facial nerve rehabilitation.
"Hard massage or an electric stimulator at home will speed things up."
Some specialists advise against strong electrical stimulation and forceful exercise, because they may encourage the face muscles to move together in unwanted ways. Gentle, guided facial physiotherapy is more useful. Check with your team before trying any device bought outside the hospital.
Being straight with you
What should you ask, and what can this page not tell you?
This page cannot tell you your own risk. That depends on where the tumour sits against the nerve, whether your face is already weak and what the operation needs to remove. Only your surgeon, looking at your scans, can give a fair estimate.
Questions to ask before surgery
Ask whether the nerve is expected to be kept, at risk or removed. Ask whether nerve monitoring, equipment that warns the surgeon when the nerve is close, will be used. Ask what happens if the nerve has to be removed, and whether a graft is planned. Ask who will look after your eye afterwards.
Who faces a harder recovery
Recovery is often slower in older people, after radiotherapy and where a long section of nerve was removed. That is not a reason on its own to accept or refuse surgery. It is information to weigh with your treating team, alongside the reason the operation is being offered.
Questions we are asked
Common questions about facial nerve risk
How common is facial weakness after skull base surgery?
It varies too much between operations to give one figure. When the tumour lies away from the nerve, lasting weakness is uncommon. When a cancer has grown into the nerve, weakness may be expected. Ask your surgeon how often it happens with the operation planned for you, in their own experience.
Will my face recover if the nerve was kept?
Often it improves, sometimes fully and sometimes partly. A bruised or stretched nerve recovers slowly, over weeks to months, and improvement can carry on beyond that. Facial physiotherapy helps, and your team will check your movement at each follow-up visit.
What is a nerve graft?
A short piece of nerve, usually taken from the neck or lower leg, used to bridge a gap where part of the facial nerve was removed. It gives the nerve a path to regrow along. Movement, if it returns, takes many months and is rarely as good as it was before.
Why does my eye water if it is also dry?
When the eyelid does not blink and close properly, tears do not spread across the eye or drain normally. The middle of the eye dries while tears overflow at the edge. Lubricating drops and keeping the eye closed at night usually help more than wiping the tears away.
Can I drive with facial weakness?
Facial weakness on its own does not usually stop driving, but a dry, blurred or taped eye can, and so can dizziness after ear surgery. Ask your team when it is safe. Do not drive if your vision is blurred or your eye is uncomfortable.
Will steroids help the nerve recover?
Steroid medicines are sometimes used around surgery to reduce swelling, but whether they are given, and for how long, is decided by your surgeon. Do not start, stop or change any medicine on your own. Ask the team what they have prescribed and why.
Does the weakness affect eating and speaking?
It can. Food may gather in your cheek, drinks may dribble and some sounds may be less clear. Eating slowly on the stronger side and checking your mouth after meals helps. A speech and swallowing therapist can give exercises if the problems carry on.
Is facial rehabilitation covered by schemes or insurance?
Eye care and physiotherapy linked to your cancer surgery may be part of the treatment package, but later surgery to restore movement is often assessed separately. Aarogyasri, CGHS, ECHS, EHS and cashless insurers each have their own rules. Call the helpline with your card details to check.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Vajja Sandeep Kumar
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Sources
- NHS — Bell's palsy
- National Cancer Institute — Head and Neck Cancers
- Cancer Research UK — Head and neck cancers
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Temporal bone resection for ear canal cancerThe operation where the facial nerve is most often at riskHearing after temporal bone surgeryThe other change to plan for after ear surgeryVision and eye movement after skull base surgeryThe nerves that move the eye, and what to watch forComplications and red flagsSigns after any cancer operation that need a callSkull Base and Temporal Bone ResectionEvery page in this guide
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