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BELL'S PALSY

Bell’s palsy refers to paralysis on one side of the face caused by injury to the nerve supplying the muscles of the face (7th cranial nerve and facial muscles supplied by that nerve). The disorder is named after the Scottish surgeon and anatomist Charles Bell (left), who first described the function of the nerve, which for a time was referred to as the “respiratory nerve of Bell”. The onset of the paralysis may be sudden or may come on over several days. In a majority of patients, there is a preceding condition such as a common cold.. All ages are affected, but it occurs most commonly in adults.

Signs & Symptoms

-Sudden paralysis on one side of the face, including muscles to the eyelid.

-Pain behind the ear on the affected side (sometimes)

-Flat, expressionless features on one side of the face.

-Distorted smiles and frowns.

-Changes in taste, salivation or tear formation (sometimes).

Causes

The cause of Bell’s palsy is unknown. The paralysis is probably caused by inflammation of the nerve within the skull with associated swelling. There is some recent evidence that the majority of cases are related to a viral infection. There is no known effective preventative method.

Diagnosis

The diagnosis is often apparent from the medical history and physical exam done by your doctor, and may not require further investigation. MRI or CT scanning to rule out other causes of pressure on the facial nerve are sometimes ordered, if the symptoms are not typical. The extent of nerve involvement can be assessed by diagnostic tests such as  electromyography, which are sometimes done if there is a concern about recovery

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.

Probable Outcome

Bell's palsy is distressing, but it is not dangerous. The extent of nerve damage determines the extent of recovery, with the overall prognosis being very good for most people. Even those with severe facial paralysis recover completely in 80% to 90% of cases. Improvement is gradual and recovery time varies, but often takes many months.

Later on, surgery can, in selected cases, sometimes improve facial appearance and muscle function in patients who do not recover fully.

Treatment

General Measures

If you have pain, applying heat to the painful area twice a day will sometimes help. Make sure to cover or close the eye during heat treatments.

While waiting for recovery, it is extremely important to protect the affected eye, which can not easliy clear debris and tends to dry out. Artificial tears should be applied frequently during the day. If you cannot close your eye well protective goggles worn during the day may help shield your eye from dirt and dust 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 massaging the muscles of the face and exercising them in front of a mirror may help. Brush and floss teeth more often to keep the mouth healthy.

Maintain your normal activities. Rest does not help Bell's palsy. A soft diet is rarely necessary if there are problems with food sticking in the weak side of the mouth.

Medications used:

1. Methylcellulose eye drops frequently to the exposed eye if you are unable to close it.

2. Cortisone like drugs (usually prednisone) for 2 weeks to reduce swelling and inflammation of the affected nerve (effectiveness of this treatment is still controversial and if used must be taken within 10 days of onset of symptoms).

3. Antiviral agents are sometimes given if a viral cause is suspected

During treatment:

After your diagnosis and as treatment is underway call your doctor if:

-Your eye becomes red or irritated, despite treatment.

-Your pain worsens.

-You have a fever.

-Symptoms recur after treatment

R. O'Brien MD   

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This data is provided for informational purposes only. It does not substitute for individualized advice from a qualified physician. Although attempts have been made to ensure the material is accurate and up to date it is provided in an 'as is' state. Neither the author nor neurology BC assumes any liability for errors or omissions or any problems that might arise due to  them. Always consult your physician or qualified health professional before acting on information that concerns your health.