Bell’s palsy is a facial paralysis can occur suddenly.
What is Bell’s Palsy?
Bell’s palsy is a weakness or paralysis that involves one side of the face. With this condition, there is damage to the nerve that is in charge of the muscles on that side of the face, leading to the face drooping. The nerve damage also could impact tear and saliva production, as well as the sense of taste. The condition might develop overnight, or suddenly, but it usually resolves on its own within weeks. Bell’s palsy has nothing to do with TIA (transient ischemic attack) or stroke, even though those medical conditions may cause facial paralysis as well. Of course, if a sudden one-sided facial weakness occurs, it is important to consult a healthcare professional to make sure there is not a more serious underlying condition than Bell’s palsy. The causes of Bell’s palsy are unclear, but most of the cases may be due to the same virus that causes cold sores (herpes). In patients who have the condition, inflammation causes damage to the nerve in charge of the muscles on one half of the face. In general, “if a specific reason cannot be found for the weakness, the condition is called Bell’s palsy”.1 The facial nerve affected is otherwise known as “the 7th cranial nerve”, and it runs “through a narrow, bony canal…in the skull beneath the ear, to the muscles on each side of the face”. Disruption to the nerve’s messages leads to the weakness and paralysis. Because the nerve is in charge of facial expressions, blinking, taste, tear and saliva production, and the stapes in the ear, all of these bodily functions could be affected by Bell’s palsy. The condition was named after Sir Charles Bell, a Scottish surgeon who described the facial nerve’s connection to the condition, in the 19th century. It is rare for Bell’s palsy to affect both sides of the face. It is “the most common cause of facial paralysis.”2
Diagnosis and Bell’s Palsy Symptoms
Symptoms of this condition, besides sudden paralysis or weakness that makes one side of the face droop, include drooling, dry eye or too much tearing, pain behind or in the ear, numbness on one side of the face, sound sensitivity, and possibly the loss of taste. Because of the weakness in the face, it is hard to close the eye on the affected side. Doctors will diagnose the condition based on taking a history of how symptoms developed, and neurological and physical exams to determine the functioning of the facial nerves. MRI/CT scans or blood tests may also be recommended.3 The facial nerve is complex, and Bell’s palsy symptoms can vary between people in type and in severity. Some other symptoms include twitching and facial distortion, ringing in the ears, headache and dizziness, impaired speech, and trouble drinking and eating. The condition affects “approximately 40,000 Americans each year”, impacting women and men equally. While Bell’s palsy can occur at any age, it is not as common prior to 15 or after 60. Those with diabetes and upper respiratory conditions (including flu and cold) are attacked disproportionately. Aside from the herpes virus, it is thought that a viral infection, including viral meningitis, may also cause Bell’s palsy. This is because the facial nerve can inflame and swell in a reaction to infection, leading to pressure and a restriction of oxygen and blood needed in the nerve cells. In the mild cases, recovery is swifter, and the nerve’s myelin sheath (insulating fatty covering) may only be affected. Bell’s palsy has also been associated with “headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma”.4 In “4-14% of the cases”, there has been “familial inheritance” found, and Bell’s palsy is actually “three times more likely to occur in pregnant women” and “four times more likely to occur in diabetics”. While people may assume facial weakness is due to stroke, the stroke would also have numbness in legs and arms, and patients having a stroke can generally “control the upper part of their faces”, including “wrinkling of their forehead”.5
Bell’s Palsy Treatment
In the mildest cases, patients can recover in only a couple of weeks. If infection is found to be the cause, then that is generally treated as well. Patients may find relief with NSAID medications, acetaminophen, or aspirin. Physical therapy, acupuncture, and massage could also provide relief from pain and improve nerve function. Decompression surgery is rarely recommended, and it is also rare for patients to need reconstructive or cosmetic surgery. The prognosis is good for most of the patients, although for some Bell’s palsy may recur on either side of the face.6 Most patients recover from Bell’s palsy with no treatment at all, within two months, especially if they have partial movement of the facial muscles. Some people, however, could have permanent weakness or problems on that one side of the face. One of the treatment options is prednisone, or other types of corticosteroid medications. They are best used as soon as symptoms arise. It is possible that acyclovir, or another antiviral medication, will be added to the treatment regimen, but while “they may help in some cases…in general they do not affect recovery”. Corticosteroid medications are not for every patient, either, and it is necessary to remember the fact that “most people with Bell’s palsy recover completely without any treatment”. In terms of self-care, patients can do facial exercises to relax and tighten the muscles. Massaging the cheeks, lips, and forehead could also be beneficial. Dry eye is a real problem for patients who can’t close their eye, and permanent vision problems may result. Artificial tears and ointments may be useful, especially if they contain methylcellulose. Drops are helpful during the day, and ointment is useful at night. Patients may need to sleep with an eye patch and wear goggles or glasses otherwise. Mouth care is also necessary for patients with Bell’s palsy. This is because some patients may have little saliva or feeling in the mouth, leading to food getting stuck, tooth decay, or gum disease. Brushing and flossing, chewing food well, eating slowly, and soft foods could also be helpful.7
Besides massage and acupuncture, physiotherapy has some benefit for patients to maintain the facial muscle tone and stimulate the nerve. Treatments could include “muscle re-education exercises and soft tissue techniques”, and heat can reduce pain. Hyperbaric oxygen therapy might also have some effect in patients with “severe disease”.8 In one case study, a 47-year-old woman with Bell’s palsy was treated with chiropractic manipulation and muscle stimulation. Her symptoms included “right sinus pressure and congestion, lack of facial tone on the right, and intermittent tingling of the right side of her face”. Treatment resulted in reduced symptoms after the first visit and continued improvement over the subsequent nine weeks.9 In another case study, a 40-year-old male patient had left-side facial paralysis for ten days, and he was experiencing excessive tearing and an inability to close his eye. He drooled when brushing his teeth and could not make his left lip move up. While steroids did not provide resolution, chiropractic care produced “dramatic results”. He received low-level laser therapy (LLLT), cervical manipulation, and spinal manipulation. He had no further issues after three appointments.10
2, 4, 6 http://www.ninds.nih.gov/disorders/bells/detail_bells.htm