Bell’s Palsy

General Illness Information

Common Name: BELL’S PALSY

Medical Term: Acute Peripheral Facial Palsy

Description:

A form of acute paralysis of one side of the face, without an obvious acquired cause, in an otherwise healthy patient.

Causes:

Unknown- but it may involve swelling of the facial nerve secondary to a viral infection, compression or to lack of blood supply.

Prevention:

Cannot be prevented at present.

Signs & Symptoms

  • Pain behind the ear on the affected side (sometimes);
  • Sudden paralysis or weakness on one side of the face, including muscles to the eyelid;
  • Flat expressionless features on one side of the face;
  • Distorted smiles and frowns;
  • Drooling;
  • Changes in taste, salivation or tear formation (sometimes).

Risk Factors

Exposure to cold.

Diagnosis & Treatment

General Measures:

  • Computed tomography (CT) or magnetic resonance (MRI), and laboratory studies may occasionally be recommended to rule out other causes of pressure on the facial nerve.
  • The extent of nerve involvement can be assessed by diagnostic tests such as evoked electromyography or electoneuronongraphy.
  • Eye care is of paramount importance. Lubricating eye drops, used every few hours are recommended. At night, apply an eye patch to shut the lid so the eye stays moist and protected. Occasionally, a patch will be necessary during the daytime.
  • As muscle strength returns, use facial massage and exercises. Massage muscles of the forehead, cheek, lips and eyes using cream or oil. Exercise the weak muscles in front of a mirror. Open and close the eye, wink, smile, and bare your teeth. Perform the massage and exercise for 15 to 20 minutes several times a day.
  • Brush and floss teeth more often to keep the mouth healthy.
  • Surgery on the facial nerve (rare). If paralysis persists for more than 6 to 12 months or longer , then surgery may be performed to graft a healthy nerve ( usually taken from the tongue) into the paralyzed facial muscle

Medications:

  • Methylcellulose eye drops (artificial tears) for comfort and protection of the exposed eye.
  • Cortisone drugs for up to 2 weeks to reduce swelling and inflammation of the affected nerve are usually beneficial.
  • Other medications may be prescribed.

Activity:

Maintain your normal activities. Rest does not help Bell’s palsy.

Diet:

A soft diet is often necessary.

Possible Complications:

  • Eye irritation or injury because the eye does not close properly and is exposed to dust. If unprotected, the eye may develop ulcers on the cornea.
  • Tooth decay and gum disease due to reduced saliva and impairment of chewing.
  • Psychological and self-esteem problems.

Prognosis

Bell’s palsy is distressing, but it is not dangerous. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery time varies, sometimes requiring many months.

Patients with mild facial paralysis usually recover completely within 1-2 months. Patients with severe facial paralysis recover completely in 80%-90% of cases but may take several months.

Surgery can sometimes improve facial appearance and muscle function in patients who do not recover fully. Unexpected movements of some facial muscles or spontaneous watering of the eyes occasionally occurs, as the facial nerve heals forming abnormal connections.