Approximately 40,000 Americans are diagnosed with Bell’s palsy every year. Persons with diabetes have a higher risk (as much as 29% greater than persons without diabetes) of being affected by this disorder.
Bell’s palsy is caused by trauma to either of the seventh pair of cranial nerves (also known as the facial nerves) that control facial muscles and relay sensation from the taste buds located on the front of the tongue. Trauma to this nerve results in weakness or paralysis that in turn causes distortion of facial features and can interfere with routine functions, such as eating and eye movement.
The good news is that about 80 percent of patients who suffer from the disorder recover within weeks or months and for many the recovery is complete.
Basically, the quality and duration of recovery depends on the severity of the initial injury. When the initial trauma to the nerve is minor, recovery is likely to occur rapidly. However, more significant damage can lengthen the recovery period and necessitate surgical treatment to reduce distortion of facial features and help restore function.
Bell’s Palsy: Symptoms
The onset of paralysis is sudden with Bells palsy. In fact, many people affected by this disorder often report waking up in the morning to find that one side of their face is paralyzed.
Bell’s palsy symptoms typically peak within a few days, although it can take as long as two weeks.
Several hours before the onset of facial weakness or paralysis, many people experience pain behind the ear or in the back of the head. Other symptoms include:
- Dry mouth
- Facial twitching
- Heightened sensitivity to sound
- Inability to blink or close the eye, tearing, and dry eyes
- Impaired sense of taste
- Impaired speaking
There are many physical symptoms associated with facial paralysis, but the effects vary greatly between individuals. The nature of the symptoms depends largely on the extent of trauma to the seventh nerve, and the precise location of the damage.
Bell’s Palsy: Diagnosis
Bell’s palsy is diagnosed on the basis of a thorough history and physical examination, as well as further diagnostic testing such as an MRI of the brain, lumbar puncture, and electromyography (EMG) when appropriate.
Bell’s Palsy: Treatment
Since there is no cure for Bell’s palsy, treatment centers primarily on the management of symptoms, especially problems with eye movement and inflammation of the affected facial nerve.
Facial paralysis often impedes the patient’s ability to blink or close the affected eyelid completely. This can lead to eye problems and permanent damage, if the eye is not cared for properly.
Measures must be taken to protect the exposed eye from damage and drying out. The use of artificial tears, lubricants and protective eyewear (sunglasses) is recommended until the patient regains control of the muscle surrounding the eye.
In terms of medications, Prednisone and antivirals are the most commonly prescribed agents for patients diagnosed with Bell’s palsy. These medications have the best outcomes when administered shortly after onset of the disorder. Prednisone is used to quickly reduce the inflammation compressing the nerve. Antivirals such as Famciclovir (Famvir), acyclovir (Zovirax), and valacyclovir (Valtrex) are often prescribed to prevent the viral cells from replicating so that the virus will run its course in a shorter period of time.
Throughout the recovery period, patients may find relief through moist heat and regular massage therapy. A customized physical therapy program can prove beneficial as well. A certified facial NMR therapist can perform facial retraining, a specialized program designed to retrain facial muscles for improved movement and expression. It can also help Bell’s sufferers to minimize the asymmetrical appearance of the face that occurs when one side is weakened. Facial retraining has been proven to improve muscle mobility, even in cases of long-standing paralysis.
Acupuncture and other therapies, such as Botulinum toxin injections (BOTOX®), may provide relief of involuntary twitching (Hemifacial spasm). BOTOX can reduce spasms and the pain and discomfort associated with them. It can also effectively enhance a patient’s appearance.
For patients with permanent facial nerve injury, there are a number of surgical procedures that can improve facial function.
In the final analysis, the appropriate diagnosis and treatment of Bell’s palsy is vital to achieving the best possible recovery of facial nerve function.
Additionally, serologic testing may be used to determine the underlying cause for the onset of the disorder. For example, in recent years, Lyme disease has been identified as one of many possible causes of facial paralysis. Blood work may be used to attempt to confirm a diagnosis of Lyme disease.
Bell’s Palsy: Reources
National Organization for Rare Disorders (NORD)
P.O. Box 1968
(55 Kenosia Avenue)
Danbury, CT 06813-1968
Voice Mail: 800-999-NORD (800-999-6673)
National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Tel: (800) 352-9424 or (301) 496-5751
TTY (for people using adaptive equipment): (301) 468-5981
American Academy of Otolaryngology – Head and Neck Surgery
1650 Diagonal Rd.
Alexandria, VA 22314-2857