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Bell’s palsy is a condition characterized by the abrupt weakening or paralysis of facial muscles on one side of the face. Facial weakness can occur when a certain condition, such as a viral infection, leads to inflammation and swelling of the seventh cranial nerve, which is responsible for controlling the facial muscles. Fortunately, in the majority of cases, this weakness is temporary and shows significant improvement over a period of several weeks. When facial weakness occurs, the affected side of the face may exhibit a droopy appearance. Smiles become one-sided, and there is difficulty in fully closing the eye on the affected side.
The name came from the Scottish physician named Sir Charles Bell, he originally characterized the illness in the 19th century. Acute peripheral facial palsy of unknown cause is another name for Bell’s palsy. Any age can experience it.
In most cases, the symptoms of Bell’s palsy begin to improve within a few weeks, with complete recovery typically taking around six months. While a small percentage of individuals may continue to experience some Bell’s palsy symptoms throughout their lives, recurrence of the condition is rare. The likelihood of a recurrence is highest within a two-year period following the initial incident. It is possible for the facial nerve palsy to affect either the same side of the face or the opposite side. Individuals with a family history of Bell’s palsy are at a higher risk of experiencing a recurrence.
Symptoms
Symptoms of Bell’s palsy often occur suddenly and reach their peak severity within 48 to 72 hours. While some individuals may experience mild symptoms, others may suffer from complete paralysis of the affected facial muscles.
Bell’s palsy signs and symptoms may include the following:
- A sudden, hour-to-day development of mild weakness to full paralysis on one side of the face.
- Drooping facial muscles and trouble producing facial gestures like smiling or closing the eyes
- Drooling
- Pain in the ear or around the jaw
- Ringing in ears or tinnitus
- High sensitivity to sound
- Headache
- Loss of taste
- Changes in the saliva and tear production
- Difficulty to speak, eat, or drink.
In rare cases, Bell’s palsy can affect the facial nerves on both sides. It is important for individuals experiencing any form of paralysis to seek immediate medical assistance, as it could potentially indicate a stroke. Although Bell’s palsy is not caused by a stroke, its symptoms may resemble those of a stroke.
If an individual experiences facial weakness or drooping, it is advisable to consult a healthcare provider to assess the underlying cause and evaluate the severity of the condition. Seeking medical advice can help in obtaining a proper diagnosis and determining the appropriate course of action.
Causes
Bell’s palsy frequently has a connection to having a viral infection, even though its exact cause is unknown. A number of viruses can cause Bell’s palsy. The condition develops when swelling or inflammation suddenly presses against the nerve that regulates the muscles of the face.
As it travels towards the face, the nerve responsible for controlling facial muscles passes through a narrow bony corridor. Bell’s palsy is characterized by the swelling and inflammation of that nerve, which is typically brought on by a viral infection. Not only the facial muscles, the nerve also influences a tiny bone in the middle of the ear, tears, saliva, and taste.
Some viruses that have been connected to Bell’s palsy include those that:
- Herpes simplex (cold sores and genital herpes)
- Herpes zoser (chickenpox and shingles)
- Rubella (German measles)
- Mumps (mumps virus)
- Influenza B virus (Flu)
- Epstein-Barr virus (Infectious mononucleosis)
- Cytomegalovirus infections
- Coxsackievirus (hand-foot-and-mouth disease)
- Adenovirus (respiratory illnesses)
Risk factors
Bell’s palsy is more common in those who:
- Age: It is most common to people between the age of 15 and 60 years old.
- Family history: Rarely do Bell’s palsy attacks recur. But when they do, recurring episodes are frequently a family history. This shows that Bell’s palsy may have a genetic component.
- Gender: It typically affects male and female equally. It also increases the risk for pregnant mothers, especially in the third trimester, or within one week of giving birth.
- Other diseases: Patients with diabetes, high blood pressure, obesity, and upper respiratory infections like the flu or the common cold are more likely to develop Bell’s palsy.
Diagnosis
Bell’s palsy has no specific diagnostic test. Based on the symptoms, a healthcare provider can make a diagnosis. Facial paralysis can also be brought on by other illnesses, such as Lyme disease, sarcoidosis, and stroke. Patient might undergo one or more tests to rule out those causes.
- Physical examination: The healthcare provider will examine the face and may request that the patient make certain facial motions, such as frowning, showing teeth, elevating the brow, and closing their eyes.
- Blood tests: No specific blood test exists for Bell’s palsy. However, blood testing can be performed to rule out illnesses such sarcoidosis and Lyme disease.
- Imaging test: In some cases, it may be necessary to rule out additional potential sources of pressure on the facial nerve, such as a tumor or skull fracture, using magnetic resonance imaging (MRI) or computerized tomography (CT).
- Electromyography (EMG): The test can evaluate the extent of nerve injury and confirm its presence. A muscle’s electrical reaction to stimulation is captured by an EMG. A nerve’s ability to conduct electrical impulses is also measured, along with their nature and velocity.
Treatment
The majority of Bell’s palsy patients experience a full recovery, regardless of whether they receive treatment or not. While there is no universally effective treatment for Bell’s palsy, healthcare professionals may recommend medication or physical therapy to expedite the recovery process. Surgery is rarely effective in treating Bell’s palsy.
Taking measures to protect and care for the affected eye is crucial due to the inability to fully close it in Bell’s palsy. Maintaining adequate moisture can be achieved by using lubricating eye drops during the day and applying an eye ointment at night. To prevent accidental injury, wearing glasses or goggles during the day and an eye patch at night can help shield the eyes from being poked or scratched. In severe cases of Bell’s palsy, an eye doctor may need to closely monitor the eye’s condition.
- Medications: Medications frequently used to treat Bell’s palsy include:
- Corticosteroids: Example is prednisone. These anti-inflammatory medications work effectively. The facial nerve will fit more comfortably in the bone channel surrounding it if they can minimize the swelling. If corticosteroids are administered within a few days of the onset of symptoms, they may act more effectively. Early steroid administration increases the likelihood of a full recovery.
- Antiviral drugs: Antivirals’ role is yet unclear. Antivirals by themselves have not demonstrated any advantage over a placebo. Bell’s palsy patients may find some relief with antivirals combined with corticosteroids, but this has not yet been proven.
Nevertheless, in patients with severe facial palsy, a combination of prednisone and an antiviral medication, such as valacyclovir or acyclovir, may be administered.
- Eye care: The care of the eyes is important. Artificial tears and other eyedrops can relieve dry, itchy eyes. To protect the eye from irritants and injuries, patient might need to wear an eye patch if their eyelid won’t close.
- Physical therapy: Muscles that are paralyzed can become permanently shorter and smaller. A patient can learn how to massage and exercise their facial muscles from a physical therapist to help avoid this from happening.
- Surgery: Decompression surgery, which involves widening the bone channel that the facial nerve travels through, was once employed to release pressure on the nerve. Decompression surgery is not advised today. This operation may come with hazards like permanent hearing loss and facial nerve damage.
In rare instances, persistent facial nerve issues may necessitate correction by plastic surgery. Facial reanimation surgery can help achieve a more balanced facial appearance and potentially restore facial movement. Procedures such as brow lift, eyelid lift, face implants, and nerve grafts are examples of surgical interventions used in these cases. It is worth noting that certain treatments, like a brow lift, may need to be repeated after a few years.
