Bell’s Palsy: Causes, Symptoms and Treatment

Facial Nerve Paralysis (Bell’s Palsy)
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Bell’s Palsy Overview

The term Bell’s palsy refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve. Damage to the Bell’s palsy that controls muscles on one side of the face causes that side of your face to droop. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.

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When a facial nerve is nonfunctioning or missing, the muscles in the face do not receive the signals to function properly. This results in paralysis of the affected part of the face which can affect the movement of the eye (s) and/or the mouth, and other areas. But a sudden weakness that occurs on one side of your face should be checked by a doctor right away to rule out these more serious causes.

Bell’s Palsy Causes

Bell’s palsy is idiopathic (no definite cause has been identified). The cause of Facial palsy is not clear. Most cases are thought to be caused by the herpes virus that causes cold sores. In most cases of Facial palsy, the nerve that controls muscles on one side of the face is damaged by inflammation.

Many health problems can cause weakness or paralysis of the face. If a specific reason cannot be found for the weakness, the condition is called Facial Palsy.

However, research has shown that it is often caused by viral infections such as herpes simplex. Facial palsy is more common in people with diabetes mellitus and in pregnant women. Patients with facial palsy often give a history of exposure to cold prior to the onset of symptoms (such as a direct exposure of AC wind, going out at night or early morning, or long road journey with open windows), but their role in causing facial palsy has not been proven.
Other causes of facial palsy may include brain stroke (decreased blood supply to the brain), tumors, other infections, trauma, infections or ear, etc. Although the most commonly known cause of facial paralysis is Bell’s palsy, there are actually many causes of facial palsy, and treatment and prognosis vary depending on the cause. Some main causes of facial palsy are listed below:
  • Viral infections such as Bell’s palsy and Ramsay Hunt syndrome.
  • Surgical causes: for example during removal of the acoustic neuroma or facial nerve tumor, or when operating on the parotid gland.
  • Bacterial causes such as Lyme disease or following a middle ear infection
  • Traumatic injury such as fractures to the brain, skull or face.
  • Birth trauma: for example caused by forceps or facial presentation delivery.
  • Congenital conditions such as abnormal development of the facial nerve or muscle in the womb.
  • Rare genetic syndromes such as Moebius syndrome or CHARGE syndrome.
  • Stroke: although a stroke can cause facial palsy it is slightly different in that the problems are not caused by direct damage to the facial nerve. The paralysis, in this case, is caused by brain damage and the messages not being transferred properly to the facial nerve.

Bell’s Palsy Symptoms

The Facial Palsy Symptoms starts abruptly over hours and is alarming for the patient. The patient may have pain behind the ear, in the neck, or the head on the side of paralysis. Symptoms are minor in the beginning, so, they often get noticed first by others or maybe noticed on looking into a mirror.

Symptoms of facial palsy include:

  • Difficulty in closing the eye, so, the eye on the affected side may look bigger.
  • Difficulty in frowning, leading to the absence of wrinkles over the forehead on the affected side.
  • Difficulty in blowing out cheeks (air leaks out on the affected side).
  • Difficulty in chewing food, food may get stuck within the mouth on the affected side.
  • Facial asymmetry, the face may seem to get pulled to the normal side.
  • Loss of taste on the affected side.
  • Headache or facial pain on the affected side.

Bell’s Palsy Treatment

Most people suffering from Bell’s palsy recover completely — with or without treatment. However, it is important to consult your doctor for faster recovery as they may suggest medications or physical therapy.

Medications

The medication for Bell’s palsy includes oral corticosteroids (prednisolone) and antiviral drugs. However, despite this, valacyclovir (Valtrex) is sometimes given in combination with prednisone in people with severe facial palsy.

  • Corticosteroids, such as prednisone, are a powerful anti-inflammatory agent that minimize the swelling of the facial nerve, it will fit more comfortably inside the bony corridor that surrounds it. Corticosteroids work best if they’re started within a few days of when your symptoms began.
  • Antiviral drugs. The role of antivirals remains disrupted. Antivirals alone have shown no advantage compared with placebo. Antivirals added to steroids are perhaps beneficial for certain individuals with Bell’s palsy, however, this is still unproven.

Physical therapy

Paralyzed muscles may shrink and shorten which may cause permanent contractures. A physical therapist can show you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery

Previously, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve goes through. These days decompression surgeries are not suggested. Facial nerve damage and permanent hearing loss are the potential danger related to this surgery. Infrequently, plastic surgery may be required to correct lasting facial nerve issues.

Bell’s Palsy Diagnosis

Neuro doctor will diagnose Facial palsy by asking you a question, such as about how your symptoms developed. The doctor will also give you a physical and neurological exam to check facial nerve function.

If the cause of your symptoms is not clear, a patient may need other tests, such as blood tests, an MRI, or a CT scan.

Bell’s Palsy Risk Factor

Bell’s Palsy occurs irrespective of age, gender and race however, the condition more commonly affects:

  • People aged 15 to 60 years
  • People suffering from diabetes or upper respiratory diseases
  • During pregnancy
  • Family History

What should you expect from your doctor

Your doctors may ask you below questions to identify the real cause and understand the symptoms to treat you better.

  • When did you have symptoms?
  • Are your symptoms frequent or occasional?
  • How severe are your symptoms?
  • What seems to improve your symptoms?
  • What appears to worsen your symptoms?
  • Do you have any family history of Bell’s palsy or problems with facial paralysis?
  • Did you have any symptoms of a more generalized infection?

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Author:

Dr. Srikanth Reddy

  • M.S(GOLD MEDALIST), M.Ch(Neurosurgery, NIMS)
  • Consultant Neuro & Spine Surgeon
  • Medical Registration No: 68934
  •   Mon – Sat: 10 AM – 4 PM*
  •   Hitech city, Madhapur

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