Facial palsy

An Overview

Bell’s palsy or facial palsy temporary weakness or lack of movement affecting 1 side of the face. Most people get better within 9 months. The symptoms of Bell’s palsy include sudden weakness in your facial muscles. In most cases, the weakness is temporary and significantly improves over weeks. The weakness makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.

Bell’s palsy, also known as acute peripheral facial palsy of unknown cause, can occur at any age. The exact cause is unknown. It’s believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. Or it might be a reaction that occurs after a viral infection.

The person may find that they suddenly cannot control their facial muscles, usually on one side. The affected side of the face tends to droop. The weakness may also affect saliva and tear production, and the sense of taste.
Many people are afraid they are having a stroke, but if the weakness or paralysis only affects the face, it is more likely to be Bell’s palsy.

Symptoms of Bell’s palsy

Bell’s palsy is marked by a droopy appearance on one side of the face and the inability to open or close your eye on the affected side. In rare cases, Bell’s palsy may affect both sides of your face.
Other signs and symptoms of Bell’s palsy include:
• Drooling
• Difficulty eating and drinking
• Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days
• Facial droop and difficulty making facial expressions, such as closing your eye or smiling
• An inability to make facial expressions, such as smiling or frowning
• Facial weakness
• A loss of taste
• Changes in the amount of tears and saliva you produce
• Muscle twitches in the face
• Dry eye and mouth
• Headache
• Sensitivity to sound
• Irritation of the eye on the involved side

Causes of Bell’s palsy

The facial nerve controls most of the muscles in the face and parts of the ear. The facial nerve goes through a narrow gap of bone from the brain to the face.

If the facial nerve is inflamed, it will press against the cheekbone or may pinch in the narrow gap. This can result in damage to the protective covering of the nerve.
Although the exact reason Bell’s palsy occurs isn’t clear, it’s often related to having a viral infection. Viruses that have been linked to Bell’s palsy include viruses that cause:
• Cold sores and genital herpes (herpes simplex)
• Chickenpox and shingles (herpes zoster)
• Infectious mononucleosis (Epstein-Barr)
• Cytomegalovirus infections
• HIV, which damages the immune system
• sarcoidosis, which causes organ inflammation
• herpes zoster virus, which causes chickenpox and shingles
• Respiratory illnesses (adenovirus)
• German measles (rubella)
• Mumps (mumps virus)
• Flu (influenza B)
• Hand-foot-and-mouth disease (coxsackievirus)
• herpes simplex, which causes cold sores and genital herpes
• Epstein-Barr virus, which causes mononucleosis
• Lyme disease, which is a bacterial infection caused by infected ticks

Diagnosis

There’s no specific test for Bell’s palsy. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
Your doctor will first perform a physical examination to determine the extent of the weakness in your facial muscles. They’ll also ask you questions about your symptoms, including when they occurred or when you first noticed them.

Your doctor can also use a variety of tests to make a Bell’s palsy diagnosis. These tests may include blood tests to check for the presence of a bacterial or viral infection.

Other conditions such as a stroke, infections, Lyme disease and tumors — can cause facial muscle weakness that mimics Bell’s palsy. If the cause of your symptoms isn’t clear, your doctor may recommend other tests, including:

• Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
• Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture

Treatment

Most people will recover from Bell’s palsy in 1-2 months, especially those who still have some degree of movement in their facial muscles.
Treatment with a hormone called prednisolone can speed up recovery. A studyTrusted Source found that prednisolone, if administered within 72 hours of onset, can significantly reduce symptom severity and incidence after 12 months.

Eye lubrication. If the patient is not blinking properly the eye will be exposed and tears will evaporate. Some patients will experience a reduction in tear production. Both may increase the risk of damage or infection in the eye.
Antivirals. In some cases, an antiviral, such as acyclovir may be taken alongside prednisolone; however, evidence that they can help is weak.
Medication
• Corticosteroid drugs, which reduce inflammation
• Antiviral or antibacterial medication, which may be prescribed if a virus or bacteria caused your Bell’s palsy
• Over-the-counter pain medications, such as ibuprofen or acetaminophen, which can help relieve mild pain

Lifestyle and home remedies

• Protecting the eye you can’t close. Using lubricating eyedrops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.

Exercises. The Bell’s Palsy Association in the United Kingdom recommends the following exercises:

Facial workout
• Sit relaxed in front of a mirror
• Gently raise the eyebrows, using the fingers to help, if needed
• Pull the eyebrows together and frown
• Wrinkle the nose
• Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help ease your pain.
• Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist’s advice may help relax your facial muscles.

Risk factor

Bell’s palsy occurs more often in people who:
1. Are pregnant, especially during the third trimester, or who are in the first week after giving birth
2. Have an upper respiratory infection, such as the flu or a cold
3. Have diabetesRecurrent attacks of Bell’s palsy are rare. But in some of these cases, there’s a family history of recurrent attacks — suggesting a possible genetic predisposition to Bell’s palsy.

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