Bell’s palsy

Bell’s palsy: Non-Progressive Neurological Disorder

Bell's palsy is a non-progressive neurological disorder of one of the facial nerves. Facial muscles are referred to as craniofacial muscles that comprise a group of 20 flat skeletal muscles. In the case of Bell’s palsy people experience a temporary weakness or paralysis of the muscles in the face. This can occur when the nerve that controls your facial muscles becomes inflamed, swollen, or compressed leading to paralysis.

Bell’s palsy is named after Scottish anatomist Charles Bell (who first described the condition). This will lead the face to droop or become stiff. People might face difficulty in smiling or closing their eye on the affected side. This can happen suddenly and people feel they are not able to control their facial muscles. The symptoms may be temporary and usually cure in a few weeks.

Although Bell’s palsy can occur at any age, it commonly affects people between ages 16 and 60. Approximately 40,000 individuals as per the National Organization of Rare Diseases (NORD) are diagnosed with Bell's palsy in the United States each year.

What Causes Bell’s palsy?

Bell’s palsy occurs due to the swelling and compression of the seventh cranial nerve. This results in facial weakness or paralysis. If the facial nerve is inflamed, and gets sandwiched between cheekbone and skin, or may pinch in the narrow gap of bone from the brain to the face. This might lead to the protective covering of the nerve being damaged and the signals from the brain to the muscles in the face are interrupted. This leads to weakness in the facial nerves or paralysis.

The swelling of the facial nerve could be linked to viral or bacterial infections such as:

• Herpes simplex, which causes cold sores on the affected nerve.
• HIV causes damage to the immune system.
• Sarcoidosis causes organ inflammation.
• Herpes zoster virus causing chickenpox and shingles.
• Epstein-Barr virus, which causes mononucleosis,
• Lyme disease, which is a bacterial infection caused by infected ticks.

Stress is also a major reason to weaken the immune system of the body that may affect the functions of various nerves and muscles of the body. The affected functions of the facial muscles may cause Bell’s palsy due to stress.

A mild case of Bell's palsy would usually disappear within a month with in-home treatments. But, recovery from a severe case involving total paralysis may include various complications:

• Irreversible damage to your facial nerve.
• Abnormal regrowth of nerve fibers - This may result in the involuntary contraction of certain muscles. Especially, when you're trying to move others or synkinesis such as, when you smile, the eye on the affected side may close.
• Partial or complete blindness of the eye – The eye won't close due to excessive dryness and scratching of the cornea (the clear protective covering of the eye). This condition leads to dryness of the eye known as exposure keratitis.

What are the Symptoms of Bell’s palsy?

The severity of the symptoms of Bell’s palsy can vary from mild weakness to total paralysis. In a more severe cae the facial nerve is exposed to more inflammation and often leads to paralysis. The more severe the case, the longer it takes for the nerve to heal and regain function.

Sometimes, you may develop symptoms of Bell’s palsy 1 to 2 weeks after you have a:

• Cold
• Ear infection
• Eye infection

The initial symptom usually is pain behind one of the ears later causing the weakness or paralysis of that side of the face. Other symptoms include:

• Sudden paralysis or weakness of one side of the face
• Droopy Mouth
• Difficulty eating and drinking
• Inability to use facial muscles for smiling or frowning
• Facial weakness
• Difficulty pronouncing certain words
• Muscle twitches in the face or closing the eyelid
• Dry eye and mouth
• Headache
• Sensitivity to sound and taste
• Drooling
• Irritation of the eye on the affected area

You are at a high risk of developing Bell’s palsy if you:

• Are pregnant
• Have diabetes
• Have a lung infection
• Have a family history of the condition

Doctors may run various tests to check for viral or bacterial infection as well as use MRI, Electromyography (EMG), X-rays, or CT scans to check the nerves in your face. Doctors will also check if any other facial nerve is damaged apart from the facial nerve.

How to treat Bell’s palsy?

In mild cases, the symptoms of Bell’s palsy may improve without treatment. But, it is important to treat Bell’s palsy within 3 days of the onset of the symptoms for quick recovery. Usually, the symptoms subside even without treatment but it can take a few weeks or months for the muscles in your face to regain their normal strength. Medical professionals follow a strict regime for quick recovery.

• Medication to relieve inflammation (corticosteroid drugs), antibacterial or antiviral drugs (acyclovir (Zovirax) or valacyclovir (Valtrex)), pain killers, or eye drops depending on the severity of the symptoms. These medications help reduce the swelling of the facial nerve and they will fit more comfortably in the bony corridor. People use eye patches for dry eyes. The affected area should not be kept dry by using eye drops during the day and ointment during the night to protect the cornea from scratching.
• Home treatment – using an eye patch for your dry eye, placing a warm & moist towel over your face to relieve pain, facial massage, and physical therapy exercises to stimulate your facial muscles. Food should be soft like rice and lentils, yogurt, khichdi which is easy to chew and swallow.
• Exercise - Apart from medication it is important patients do facial exercise by tightening and relaxing facial muscles which helps in strengthening the facial muscles.
• Surgery - Decompression surgery may help to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Rarely but plastic surgery may be needed to correct lasting facial nerve problems. In severe cases, facial reanimation helps to make the face look more even and may restore facial movement
• Alternative Medicine – Acupuncture and biofeedback training help stimulate the affected facial nerves and muscles. Physical therapy helps quick recovery from facial paralysis.

Some useful exercises are:

• Facial Workout – Lifting eyebrows, smiling and frowning, wrinkling the nose and breathing in deeply, and flaring the nostrils.
• Eyes workout – Moving eyeballs to four directions, closing eyelids with pressure, and massaging along the browline to prevent stiffness.

Outlook

Many people confuse Bell’s palsy with stroke as the symptoms are similar. Various actors like Angelina Jolie have suffered from Bell’s palsy and have shared their experiences for better recovery. She received acupuncture treatment which helped in quick and full recovery. People suffering from Bell’s palsy recover in time and usually do not cause long-term complications. It is important to combine medication with regular exercise for a speedy recovery.

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