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Bell's Palsy Information - Symptoms & Treatment

Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face. The disorder results from damage to one of a pair of facial nerves that runs beneath each ear to the muscles in your face.

This neurologic disorder affects the seventh cranial (facial) nerve, producing unilateral facial weakness or paralysis. Onset is rapid. While it affects all age groups, it occurs most often in persons under age 60. In 80% to 90% of patients, it subsides spontaneously, with complete recovery in I to 8 weeks; however, recovery may be delayed in older adults. If recovery is partial, contractures may develop on the side of the face. Bell's palsy may recur on the same or opposite side of the face.

What causes bell's palsy

The seventh cranial nerve is responsible for motor innervation of the facial muscles. In Bell's palsy, the nerve is blocked by an inflammatory reaction around the nerve (usually at the inter­nal auditory meatus). This is often associated with infections and can result from hemorrhage, tumor, meningitis, or local trauma.

What Are the Signs and Symptoms of Bell's Palsy?

Bell's palsy usually produces unilateral facial weakness, occasionally with aching pain around the angle of the jaw or behind the ear. On the weak side, the mouth droops (causing the patient to drool saliva from the comer of his mouth), and taste perception is distorted over the affected anterior portion of the tongue. In addition, the forehead appears smooth, and the patient's ability to close his eye on the weak side is markedly impaired. When he tries to close this eye, it rolls upward (Bell's phenomenon) and shows excessive tearing.

Although Bell's phenomenon occurs in normal persons, it's not apparent because the eye closes completely and covers this eye motion. In Bell's palsy, incomplete eye closure makes this upward motion obvious. In addition to paralysis, other symptoms include:

• Dizziness
• Drooling
• Dry mouth
• Facial twitching
• pain behind or in front of one ear
• loss of taste at affected parts of the tongue
• changes in the amount of saliva in the mouth
• hearing sounds louder in one ear

Bell's palsy is self-limiting. Symptoms do not spread beyond the face and do not worsen once they "peak." Between 60% and 80% of patients experience complete recovery within a short time, whether or not they receive treatment. Others are left with varying degrees of facial disfigurement, paralysis, or muscle spasms.

Diagnosis

Clinical presentation in Bell's palsy includes distorted facial appearance and inability to raise the eyebrow, close the eyelid, smile, show the teeth, or puff out the cheek. After 10 days, electromyography helps predict the level of expected recovery by distinguishing temporary conduction defects ftom a pathologic interruption of nerve fibers.

Treatment

In Bell's palsy, treatment consists of prednisone, an oral corticosteroid that reduces facial nerve edema and improves nerve conduction and blood flow. After the 14th day of prednisone therapy, electrotherapy may help prevent atrophy of facial muscles.

Alternative treatment

Practitioners of traditional Chinese medicine have historically used acupuncture to treat Bell's palsy. There are also some indications that facial massage and chiropractic manipulation may help treat the symptoms and improve the outcome. There are also claims of therapeutic value for local injections or ingestion of vitamin B 12 supplements.

Bell's Palsy Prevention

Use of safety measures may reduce the incidence of head injury. Many of the other factors associated with this disorder are not readily preventable.

You'll need to protect your eye from damage to its outer layer (cornea) because of the absence of blinking on the side of your face with weakness. An excessively dry eye can result in clouding of the cornea and lead to a corneal ulcer, which can interfere with vision. You can protect your eye with artificial tears (a special eye lubricant generally used at night), an eye patch or a transparent eye shield attached to your face with tape.