Bell’s palsy is defined as one sided facial paralysis due to an inflammation of the 7th cranial nerve of the face, that results in weakness or paralysis of the muscle on the affected side. The inflamed and swollen nerve becomes so compressed that it becomes damaged.
Bell’s palsy has a rapid onset, there is a slower recovery in elderly patients. There is complete recovery in majority of patients. Partial recovery can occur if contractures (tightening) occur on the affected side of the face. It may recur, but this is rare.
Up to 40,000 Americans a year get Bell’s Palsy. It can affects any age. The most susceptible are pregnant women, those who have diabetes, the flu, and a cold or other respiratory conditions.
The cause is unknown, but may be related to vascular ischemia [decreased oxygen to tissue causing damage to tissue], a virus (herpes, chicken pox, Flu, Measles, Mononucleosis), Lyme’s disease, tumors, a bacterial infection, or autoimmune disease that cause inflammation to the nervous systems (Multiple Sclerosis).
Characteristics include tearing of the affected eye, painful sensation to the face, pain behind the ear, pain in the eye, difficulty speaking and eating on the affected side, drooping eye, difficulty opening and closing eyelid on the affected side (can cause corneal ulceration due to drying of the eye), drooping of face and lips on the affected side, change in taste, sensitive to sound, drooling, and headaches.
Diagnosis is based on the characteristics mentioned, MRI or CT scans to rule out a tumor or other pressure to the facial nerve as the cause. An Electromyography, a test for nerve damage and to test for severity, can also be performed.
The goal of treatment is to maintain facial muscle tone and prevent further nerve damage. This is not a stroke and recovery can take 3 weeks to several months, and in a few up to a year.
1. Corticosteroid (prednisone) help to reduce inflammation and swelling, which then reduces compression to nerves and blood vessels. This helps to decrease severity of the paralysis, decrease pain, and prevent permanent nerve damage.
2. Remove the cause of the damage to the nerve, such has a tumor.
3. Oral care is important to prevent cavities.
4. Protect eyes from dryness with sunglasses and natural tears eye drops
or wear an eye patch at night.
5. Take pain medication such as Acetaminophen or NSAIDS (Ibuprofen, Aleve).
6. It is rare but surgery may be necessary to decompress the nerve
7. Gentle facial massages, and facial exercises to maintain muscle tone.
Physical therapy can help return muscle functioning.
8. Apply moist heat to relieve pain
9. Emotional support due to change in body image
10. Alternative therapy: L-lysine 500-1000 mg daily, and Vitamin B12 5000
once a day, help to heal nerve damage
11. Antivirals can be prescribed by your doctor.
Seek immediate medical attention if you ever have paralysis to rule out stroke.