Bell’s Palsy or Facial Paralysis

Bell’s Palsy or Facial Paralysis is characterized by severe weakness of muscles or paralysis on one side of the face. It is caused by damage to the seventh cranial nerve, the facial nerve that supplies the muscles of the face. It causes drooping of one side of the face or sudden, temporary weakness on one side of the face.

In most of the cases, Bell’s palsy is temporary and an individual can make full recovery within six months.  But in some cases, it may persist for a longer duration. Rarely, Bell’s Palsy can recur after a short duration.

Signs and Symptoms of Bell’s Palsy

Patients may experience symptoms slowly on one side of their face, such as:

  • Rapid onset of mild weakness on one side of the face
  • Drooping of eyelids on one side making one eye look slightly lower than the other
  • Drooping of lips on one side of the face causing spilling of saliva from that side
  • Drooling (hyper salivation and spilling of saliva)
  • Headache
  • Pain around the jaws and in the mandibular area around ears on the affected side
  • Complete loss or decreased ability to taste
  • Increased sound sensitivity on the affected side

Causes Of Bell’s Palsy

Bell’s Palsy is caused by a lesion or damage to the facial nerves and it is often correlated with viral infections.  The following viruses have been linked to Bell’s Palsy;

  • Chickenpox
  • Herpes zoster virus (Shingles)
  • Epstein-Barr virus (infectious mononucleosis)
  • Cytomegalovirus
  • Adenovirus
  • German measles (rubella), mumps, rabies
  • Influenza B virus (Flu)
  • Herpes simplex virus (genital herpes)
  • Coxsackievirus (hand, foot, and mouth disease)

Risk Factors for Bell’s Palsy

The following groups of people are more susceptible to develop Bell’s Palsy;

  • Pregnant women especially during their third trimester or in the first week following birth or miscarriage
  •  Individuals with upper respiratory tract infections such as allergy, cold, flu
  • Those that have been diagnosed with Diabetics
  • Other Genetic factors

Complications of Bell’s Palsy

As mentioned, in most of the cases, symptoms disappear within a few months and individuals fully recover. But in severe cases, the following complications can occur;

  • Irreversible damage to the facial nerve
  • Abnormal regeneration and growth of nerve fibers causing involuntary contractions of the facial muscles. For instance, when an individual tries to move one group of muscles, it causes involuntary contractions of the other group of muscles.
  • Partial or complete blindness of the eye
  • Inability to close one eye due to excessive dryness of the cornea

Diagnosis of Bell’s Palsy

Patients of Bell’s Palsy are diagnosed based on clinical evidence.  When a neurologist is seen due to symptoms, such as weakness on one side of the face around the forehead, eyelid and/or mouth, they perform a physical examination to understand the cause.

If you experience any of the above mentioned symptoms, visit a nearby medical practice and get yourself treated by certified neurologists.

Please note, there is no specific laboratory test to confirm the diagnosis. Electromyography (EMG) can indicate the presence of nerve damage and its severity. Imaging techniques such as an MRI and CT scan can indicate the cause of nerve lesions and other structural causes of excessive pressure to the nerve.

Treatment of Bell’s Palsy

Facial Palsy affects each individual differently. Some cases are very mild and patients do not require treatment as the lesion subsides on its own within a few weeks.  But in other cases, treatment and medication are required.

According to recent research carried out in Manhattan, NY, steroids such as steroid prednisone have been proven effective in reducing inflammation and swelling to treat the nerve damage.

Acyclovir is another effective drug that helps in early recovery from the disease.

Analgesics such as aspirin, ibuprofen, and paracetamol are prescribed to relieve the pain. A neurologist should take the necessary precautionary measures while prescribing medicines to prevent drug interaction and related complications.

Bell’s Palsy causes excessive dryness of the cornea and it can interrupt the blinking ability of the eye, and in severe cases, it can lead to blindness.  It is important to protect the eyes from dryness, debris, and injury and to keep them moist. Medicated eye drops and gels are effective in preventing dryness of conjunctiva of the eye.

Acupuncture, physiotherapy and facial massage may provide temporary relief from pain and improvement in nerve function.

Decompression surgery to relieve pressure on the facial nerve is controversial and seldom performed.

Cosmetic or reconstructive surgeries are effective to improve appearance if any permanent damage has been caused.

Prognosis

The extent of nerve damage determines the effectiveness of treatment and recovery. Some patients start recovering within two weeks, with a full recovery within 3-6 months. 

In some cases, the patient may take a longer time for recovery ranging from 6 months or longer. Occasionally the symptoms may never disappear completely. In addition, Palsy may attack the same person after their initial recovery, either on the same or opposite side of the face.

Home Treatment

  • A warm moist towel over the face to relieve pain
  • Facial massage
  • Physiotherapy
  • Eye patch for dry eye

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