August 2008, Bells Palsy by Dr Gonzalez

A recent case last week gave me the opportunity of writing about this topic which looks dramatic but normally has a very good prognosis.

Bell’s Palsy is a sudden weakness or paralysis on one side of the face that makes it hard for a person to move the mouth, nose, or eyelid and can make that side of the face droop or look stiff. It occurs when one of the facial nerves is not functioning properly, often after a virus.

When the facial nerve is working properly, it carries a host of messages from the brain to the face. These messages may tell an eyelid to close, one side of the mouth to smile or frown, or salivary glands to make spit. But if the nerve swells and is compressed, as happens with Bell’s Palsy, these messages do not get sent correctly. The result is weakness or temporary paralysis of the muscles on one side of the face.

Bell’s Palsy is most often connected with a viral infection. It is also associated with ear infections, bad colds, the infectious agent that causes Lyme disease, trauma to the head or face and severe stress.

In a few people, the immune system’s response to a viral infection leads to inflammation of the facial nerve. Because it is swollen, the nerve gets compressed as it passes through a small hole at the base of the skull and stops sending the correct messages from the brain to the face — messages that, among other things, tell one eyelid to blink, and tell the front of the tongue to taste things.

Often the virus or infection that causes Bell’s Palsy is so mild that some patients do not even feel ill. Usually the virus or infection has passed before the symptoms of Bell’s Palsy start to appear.

Bell’s Palsy tends to happen quickly. Some patients may feel pain behind or in front of their ears for a few hours or even days before the facial weakness sets in.

Because Bell’s Palsy only happens to one facial nerve at a time it only affects one side of the face. Some patients have only slight weakness; others may not be able to move that side of their face at all. This may make one half of the patient’s face, especially the mouth, seem to droop or sag.

Other symptoms may include:

Bell’s Palsy affects only the facial muscles, so if other parts of the body are stiff or paralyzed, talk with your doctor right away, as it may be a sign of a different condition.

There is not a specific test for Bell’s Palsy, so to eliminate other possible causes, your doctor will evaluate how long it took for the symptoms to develop and where the weakness or paralysis is.

The doctor will ask you about whether you are experiencing weakness or paralysis in other parts of the body, and other problems, like double vision or trouble swallowing. The doctor will also want to know about any head injuries.

If the facial paralysis lasts more than a few months, the doctor is likely to recommend further tests, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) to rule out other problems. The doctor might also recommend that you have an electromyography (EMG), which tests how well the muscles are responding to the nerves’ signals.

Because the virus or infection that leads to Bell’s Palsy has usually passed, there is usually no treatment for Bell’s Palsy. In some cases, medications that help reduce the swelling faster can be used.

Typically, there is nothing that a doctor can do to treat Bell’s Palsy. It goes away once the swelling of the nerve goes down and the nerve recovers from any damage that the swelling caused. The nerve has to renew itself and that can only happen with time.

In some cases doctors can offer medications to help reduce the swelling or prescribe an eye patch or eye drops if the eye is dry.

Most people recover fully within 1 to 3 months, whether or not the condition is treated, although some will have permanent weakness in their face afterwards. It is very unusual for anyone to get Bell’s Palsy twice.

Making sure you eat well and get plenty of sleep is important for healing. Activities and sports participation do not have to be limited as long as you can close the eye (to protect it). If the eye cannot be closed, talk with the doctor about using protective glasses or a patch to prevent eye damage.