Facial Palsy (Bell’s palsy)
Bell’s palsy is a neurological disorder that affects the cranial nerves of the face. This causes weakening and drooping of the facial muscles towards one side, thus making it difficult for the person to smile and blink the eye.
Bell’s palsy also known as facial palsy is assumed to occur due to inflammation of a nerve that controls the facial muscles. This condition may also occur in diabetic people recovering from viral infections. Facial palsy may affect people of any age group. However, the exact cause of the condition is not known.
Signs and Symptoms
The signs and symptoms of Bell’s palsy may include:
- A sudden onset of facial muscle weakness or paralysis that affects one side of the face
- Difficulty in smiling
- Difficulty in closing or blinking the eye
- Pain around the affected area
- Decreased tasting ability
- Decreased salivary secretion
In rare cases, Bell’s palsy is known to affect the cranial nerves of both sides of the face. Complete paralysis and Bell’s palsy differ from each other, as the former cause’s neuronal impairment of one side of the body, while the later causes neuronal impairment of only the face.
The exact cause of Bell’s palsy is not known, however, swelling or compression the facial nerve can lead to weakened or paralyzed facial muscles. It is also said that viral infections may be a cause for the inflammation of the nerve that control the muscles of the face. The cause of Bell’s palsy is linked to the following viral infections:
- Flu (Influenza B virus)
- Mumps (mumps virus)
- German measles (Rubella)
- Respiratory infections (Adenovirus)
- Mononucleosis (Epstein-Barr)
- Chickenpox (Herpes zoster)
- Genital herpes and cold sores (Herpes simplex)
The incidence of risk factors is greater in the following individuals suffering from:
- Upper respiratory tract infections
- A family history of Bell’s palsy
- Women in their third trimester of pregnancy
- Women immediately after childbirth
The complications of Bell’s palsy may vary from mild to severe conditions such as:
- Irreparable damage to facial nerves
- Partial or complete blindness caused due to difficulty in blinking the eye, thereby impairing production of tears
- Excessive dryness in the eye, which may lead to the development of eye infections and ulcers
- Involuntary contraction of facial muscles caused due to damaged nerve fibres
Bell’s palsy is usually diagnosed through physical findings of the facial movement of the eyes, cheek, jaw and the eyebrows. However, there is no special marker or test for the diagnosis of Bell’s palsy.
- Electromyography (EMG): The test is performed to diagnose the nerve impulses of the face produced by the skeletal muscles and the nerves. The nerve impulses produced are recorded that helps detect any damage caused to the cranial nerves.
- Imaging scan: Image scan such as magnetic resonance imaging (MRI) scan or computed tomography (CT) scan is performed to detect any underlying cause of nerve damage caused due to trauma, tumor or skull fracture.
- Blood test: A blood test is also performed to check for the presence of bacterial or viral infections.
Bell’s palsy can be treated either through medication therapy or through surgery. However, most people recover normally without the use of any medicines.
The medication therapy may include the use of corticosteroid and antiviral drugs.
- Corticosteroid agents: The corticosteroid agents work by reducing pain and inflammation of the affected area. They act by reducing the swelling or inflammation of the facial nerves, thus helps in reducing the symptoms of Bell’s palsy. Corticosteroid agents work best when used within few days of the onset of symptoms of Bell’s palsy. This helps in preventing the condition.
- Anti-viral agents: The use of anti-viral agents in treating Bell’s palsy is rarely reported. However, in chronic conditions, it is administered in combination with corticosteroids to treat Bell’s palsy.
- Facial nerve decompression: The surgery is performed to relieve the pressure of the facial nerves. However, the surgery may be recommended in patients suffering from chronic Bell’s palsy who have not been responding to any medicines. The surgical procedure is usually limited as it may cause nerve damage and hearing impairment.
- Direct brow lift: The surgery is performed to treat brow ptosis that helps in eye lift. Care should be taken to prevent corneal decompression as it may cause further health complications.
- Eye implants: Gold or platinum implants are inserted into the eye that helps restore dynamic lid closure. The implants are inserted into the upper eyelid, which helps in the closure of the eyelid with gravity. The implants can be removed once the nerve function of the facial nerves is restored.
Physical therapies such as massage and facial exercises help in treating the symptoms of facial palsy. This therapy is usually recommended along with surgery or medication therapy to provide complete cure from the condition.
Coping and Management
Bell’s palsy is curable and the recovery period is usually about six months. However, in rare cases, the condition may recur.
Bell’s palsy can be effectively managed by use of eye drops and eye ointments that help in maintaining the lubrication of the eye. It can also be managed by using moist heat around the affected area that helps in relieving pain and inflammation. Regular facial exercise, facial massages help in faster recovery from the condition. Also, visiting the doctor regularly may prevent worsening of the condition.