Bell’s Palsy

Facial paralysis also called as Bell’s palsy, is a condition where one of the sides of the face meets with paralysis. Bell’s palsy is a self resolving condition having partial or complete weakness of the facial muscles. Usually one side of the face is affected.

Two hundred years ago, Sir Charles Bell first detailed a condition which causes weakness or paralysis of the facial muscles.

The Facial Nerve originating in the brain (in the pons) controls the muscles of the forehead, neck and facial expressions. It is also responsible for the ‘perceived sound volume’. Besides, it also stimulates secretions of tears and saliva. Trauma of the Facial nerve in any form causes Bell’s palsy.

The condition affects men and women alike, has no age bar and has no particular affinity for any one side of the face.

One in every 65 people will suffer from Bell’s palsy once in their lifetime. It is the most common disorder affecting just one nerve (mononeuropathy) making it most common cause of acute facial paralysis.

Symptoms

Symptoms range in severity from mild weakness to total paralysis. They include:

• Mild to moderate to severe weakness of facial muscles (one of both sides)
• Paralysis of facial muscles
• Difficulty in drinking, chewing, eating and blowing
• Twitching
• Weakness
• Headache
• Giddiness
• Discomfort or pain in the jaw or behind the ear on the affected side
• Ringing in the ears
• Loss of taste
• Increased sensitivity to noises in the ear of the affected side
• Symptoms associated with paralysis
• Drooling of saliva
• Drooping eyelid or corner of the mouth
• Dryness of eye or mouth
• Impaired sense of taste
• Excess tear formation in one eye.

Facial distortion can be quite significant in Bell’s palsy.

Causes of Bell’s Palsy

The exact cause remains unknown. However, some of the following factors could cause or trigger Bell’s palsy:

• Viral infections: Herpes Simplex Virus-1 (HSV-1) is a virus considered causing 70% of all Bell’s palsy.
• Lyme Disease (a bacterial infection transmitted by tick-bites)
• Trauma or injury to facial nerve

Diagnosis

Bell’s palsy is a diagnosis of exclusion. All other known causes of facial palsy need to be eliminated before naming the condition as Bell’s palsy.

Facial palsies from other causes usually present a number of symptoms not seen in Bell’s palsy. They necessarily do not affect the muscles of the forehead. Besides, Bell’s palsy will not bring about paralysis, weakness or numbness in other parts of the body.

How Soon Will it Improve?

Most people improve after the first two weeks. Complete recovery is usually seen in 3 to 7 months. Some may take longer for complete recovery 9 months to a year.

Complications

If you suspect Bell’s palsy, its best to seek medical attention immediately. In majority of cases, the prognosis is very good. Complete facial paralysis or starting medications very late are commonly associated with complications.

• Permanent contractures and spasms of the facial muscles
• Persistent loss in taste sensations
• Chronic eye (corneal) infections
• ‘Crocodile tear syndrome’ in which tears are involuntarily shed while eating

Treatment

Good news is that most people with Bell’s palsy recover completely within 3 to 9 months. Yet, the most important factor in treatment is to eliminate the source of the condition.

Conventional Treatment for Bell’s Palsy

• Antiviral therapy with acyclovir is the treatment of choice.
• Steroids (prednisolone) are given to prevent further damage from nerve inflammation.
• Pain killers (ibuprofen, acetaminophen and aspirins) are given to minimize pain and discomfort.
• Lubricating eye-drops -> artificial tears, eye ointments and gels – prevent the eyes from dryness and irritation.
• Electrical stimulation of the facial nerve will prevent further muscle degeneration and speed up recovery.
• Active physiotherapy sessions with facial muscle exercises strengthen the muscles, prevent permanent contractures and help gain control over facial expressions.

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