Overview
Bell's palsy is a condition that causes sudden weakness in the muscles on one side of the face. In most cases, the weakness is temporary and significantly improves over weeks. The weakness makes half of the face appear to droop. Smiles are one-sided, and the eye on the affected side resists closing.
Bell's palsy is also known as acute peripheral facial palsy of unknown cause. It can occur at any age. The exact cause is unknown. Experts think it's caused by swelling and inflammation of the nerve that controls the muscles on one side of the face. It could be caused by a reaction that occurs after a viral infection.
Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy occurs more than once.
Symptoms
Signs and symptoms of Bell's palsy come on suddenly and may include:
1.Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days
2.Facial droop and difficulty making facial expressions, such as closing your eye or smiling
3.Drooling
4.Pain around the jaw or in or behind your ear on the affected side
5.Increased sensitivity to sound on the affected side
6.Headache
7.A loss of taste
8.Changes in the amount of tears and saliva you produce
In rare cases, Bell's palsy can affect the nerves on both sides of your face.
Causes
Although the exact reason Bell's palsy occurs isn't clear, it's often related to having a viral infection. Viruses that have been linked to Bell's palsy include viruses that cause:
1.Cold sores and genital herpes (herpes simplex)
2.Chickenpox and shingles (herpes zoster)
3.Infectious mononucleosis (Epstein-Barr)
4.Cytomegalovirus infections
5.Respiratory illnesses (adenovirus)
6.German measles (rubella)
7.Mumps (mumps virus)
8.Flu (influenza B)
9.Hand-foot-and-mouth disease (coxsackievirus)
The nerve that controls facial muscles passes through a narrow corridor of bone on its way to the face. In Bell's palsy, that nerve becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of the ear.
Risk factors
Bell's palsy occurs more often in people who:
1.Are pregnant, especially during the third trimester, or who are in the first week after giving birth
2.Have an upper respiratory infection, such as the flu or a cold
3.Have diabetes
4.Have high blood pressure
5.Have obesity
Recurrent attacks of Bell's palsy are rare. But when they do recur, there's often a family history of recurrent attacks. This suggests that Bell's palsy might have something to do with your genes.
Complications
A mild case of Bell's palsy typically disappears within a month. Recovery from a more severe case where the face was completely paralyzed can vary. Complications may include:
1.Irreversible damage to your facial nerve.
2.Irregular regrowth of nerve fibers. This may result in involuntary contraction of certain muscles when you're trying to move other muscles (synkinesis). For example, when you smile, the eye on the affected side may close.
3.Partial or complete blindness of the eye that won't close. This is caused by excessive dryness and scratching of the clear protective covering of the eye (cornea).
Treatment
Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy. But your health care provider may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.
Because the eye on the affected side doesn't close, it's important to take steps to protect and care for that eye. Using lubricating eye drops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched. In severe cases of Bell's palsy, an eye doctor may need to monitor the eye.
Medications
Commonly used medications to treat Bell's palsy include:
1.Corticosteroids, such as prednisone. These are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, the nerve will fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they're started within several days of when your symptoms started. Steroids started early improve the likelihood of complete recovery.
2.Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids may benefit some people with Bell's palsy, but this is still unproved.
Despite this, an antiviral drug, such as valacyclovir (Valtrex) or acyclovir (Zovirax), is sometimes given in combination with prednisone in people with severe facial palsy.
Physical therapy
Paralyzed muscles can shrink and shorten, which may be permanent. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.
Surgery
In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.
Rarely, plastic surgery may be needed to correct lasting facial nerve problems. Facial reanimation surgery helps make the face look more even and may restore facial movement. Examples of this type of surgery include an eyebrow lift, an eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.
Diagnosis
There's no specific test for Bell's palsy. Your health care provider will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
Other conditions — such as a stroke, infections, Lyme disease, inflammatory conditions and tumors — can cause facial muscle weakness that mimics Bell's palsy. If the cause of your symptoms isn't clear, your health care provider may recommend other tests, including:
1.Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation. It also measures the nature and speed of the conduction of electrical impulses along a nerve.
2.Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.
3.Blood tests. There is no blood test for Bell's palsy. But blood tests can be used to rule out Lyme disease and other infections.
Home remedies
Home treatment may include:
1.Taking pain relievers. Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) are available without a prescription and may help ease your pain.
2.Doing physical therapy exercises. Massaging and exercising your face according to your physical therapist's advice may help relax your facial muscles.
Alternative medicine
Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following:
1.Acupuncture. Placing thin needles into a specific point in your skin helps stimulate nerves and muscles, which may offer some relief.
2.Biofeedback training. By teaching you to use your thoughts to control your body, biofeedback training may help you gain better control over your facial muscles.
3.Botulinum toxin. This medication may help manage symptoms such as facial spasms and tearing. Injections of botulinum toxin may also help improve symmetry of the face.
How to manage Bell’s palsy
Beyond taking your medication, what else can you do to cope with Bell’s palsy while you wait for it to hopefully resolve?
1.Use artificial tears or eye drops during the day. If your eyelid doesn’t completely close, or you can’t blink, you can develop a pretty significant case of dry eye, also known as exposure keratitis. Without treatment, you might develop some damage to your cornea. Your eye doctor can give you more specific advice on how many times per day to use the drops. If you need to use lubricating eye drops more than four times a day, be sure to use preservative-free eye drops, which won’t irritate your eye.
2.Use a heavy lubricating ointment in your eye at night. This kind of thicker ointment will prevent moisture loss in your eye while you’re sleeping, but it can make your vision blurry. Apply right before you go to sleep.
3.Tape your affected eye shut at night. To prevent your eye from drying out during the night, use surgical tape to close your eyelid when you go to bed. Be gentle with removing the tape when you wake up so as not to damage your eyelid or the skin around your eye.
4.Consider using an eye patch. Some experts suggest placing a patch or moisture chamber over your eye to reduce moisture loss and prevent dry eye.
5.Use a straw. Sometimes it’s hard to drink from a glass when your mouth is droopy. To reduce the likelihood of dribbling water or other beverages down your chin, try using a straw.
6.Talk with someone. If you’re feeling down about your appearance, don’t hesitate to talk about your feelings with a trusted friend or even a counselor or therapist.
7.Consider alternative therapies. Complementary therapies won’t cure your Bell’s palsy symptoms, but they might help you feel better. For example, if you have a favorite relaxation technique or other stress-reduction strategy, consider putting it to use.
8.Try to rest as much as possible. Dealing with facial paralysis and the changes it brings can be stressful. Try to rest as much as you can, get plenty of sleep, and focus on eating nutritious, wholesome foods.
Can Bell's palsy be cured?
Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy. But your health care provider may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.
What is the fastest way to cure Bell's palsy?
Treating Bell's palsy
Your doctor might prescribe steroids if you have new-onset Bell's palsy. In most instances, oral steroids should be started within 72 hours of symptom onset if possible, to reduce inflammation and swelling and increase the probability of recovering facial nerve function.
Does Bell's palsy affect the brain?
In summary, this study provided significant evidence for abnormal brain activity between patients with early left and right Bell's palsy. In addition, the severities of the disease were closely associated with abnormal fALFF values in certain brain regions.
How long does Bell palsy last?
How long Bell's palsy lasts. Most people make a full recovery within 9 months, but it can take longer. In a small number of cases, the facial weakness can be permanent. Go back to see a GP if there are no signs of improvement after 3 weeks.
What is the best therapy for Bell's palsy?
Customized Facial Physical Therapy
Some evidence suggests customized facial exercises, or neuromuscular retraining therapy, may help Bell's palsy patients improve facial function. With customized facial exercises, a Bell's palsy patient will learn the proper the brain-to-nerve-to-muscle routine.
Can Bell's palsy cause permanent eye damage?
The inability to properly blink or close your eye, especially when sleeping, can damage the cornea and can cause permanent damage in your vision. At Palm Beach Eye Center, we offer specialized surgical and non-surgical treatment for Bell's Palsy covered by most medical insurances.
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