Facial paralysis: causes, symptoms and treatment

Bell’s palsy is a condition that causes sudden weakness of the muscles on one side of the face. In most cases, the weakness is temporary and improves significantly over weeks. The weakness makes half of the face droop. The smile is seen on one side only and the eye on the affected side cannot close.

Bell’s palsy is also called acute peripheral facial palsy of unknown cause. It can occur at any age. The exact cause is not known. Experts believe it is caused by swelling and inflammation of the nerve that controls the muscles on one side of the face. This may be due to a reaction that occurs after a viral infection.

Symptoms usually begin to improve within a few weeks and full recovery is achieved in about six months. There are a small number of people who continue to have symptoms of Bell’s palsy for life. Rarely, Bell’s palsy occurs more than once.

Bell’s palsy signs and symptoms come on suddenly and can include:

Sudden onset of mild weakness to complete paralysis on one side of the face, which may occur within hours or days. Drooling on one side of the face and difficulty making facial expressions, such as closing an eye or smiling. or behind the ear on the affected side Increased sensitivity to sound on the affected side Headaches Loss of sense of taste Excessive or insufficient production of tears and saliva

Less commonly, Bell’s palsy can affect the nerves on both sides of the face.

Seek immediate medical attention if you develop any type of paralysis as it could be a stroke. Bell’s palsy is not caused by a stroke, but it can cause similar symptoms.

If you have facial weakness or drooping, see your healthcare provider to determine the underlying cause and severity of the condition.

Bell’s palsy is more common in people who have:

Pregnancy, especially in the third trimester or in the first week after giving birth Upper respiratory tract infection, such as the flu or cold Diabetes High blood pressure Obesity

Recurrent attacks of Bell’s palsy are rare. But when they do occur, there’s usually a family history. This suggests that Bell’s palsy might have something to do with our genes.

There are no specific tests to detect Bell’s palsy. The healthcare provider will check your face and ask you to move your facial muscles, such as closing your eyes, raising your eyebrows, showing your teeth, and frowning, among other movements.

Other conditions, such as strokes, infections, Lyme disease, inflammatory conditions, and tumors can cause facial muscle weakness, which can be confused with Bell’s palsy. If the source of your symptoms is unclear, your healthcare provider may recommend other tests, such as:

electromyography.

This test can confirm the presence of nerve damage and determine its severity. There

electromyography

measures the electrical activity of a muscle in response to a stimulus as well as the nature and speed of conduction of electrical impulses along a nerve.

Imaging scans.

Sometimes magnetic resonance imaging (MRI) or computed tomography (CT) is needed to rule out other possible sources of pressure on the facial nerves, such as tumors or skull fractures.

Blood test.

There is no blood test that detects Bell’s palsy. However, blood tests may be done to rule out Lyme disease or other infections.

Most people with Bell’s palsy recover completely, with or without treatment. For Bell’s palsy, there is no single treatment. However, your healthcare provider may suggest medication or physical therapy to speed up recovery. Surgery is rarely an option for Bell’s palsy.

Since the eye on the affected side does not close, it is important to take steps to protect and care for this eye. Using lubricating eye drops during the day and ointment at night will help keep your eyes moist. Wearing glasses or goggles during the day and an eye patch at night can prevent you from tearing or scratching your eye. In severe cases of Bell’s palsy, your eye may need to be examined by an eye doctor.

Medications commonly used to treat Bell’s palsy include:

corticosteroids,

like prednisone. They are powerful anti-inflammatories. If they can reduce the swelling of the facial nerve, the nerve will fit more easily into the bony canal around it. Corticosteroids may be more effective if started a few days after symptoms appear. When steroids are started early, they improve the chances of full recovery.

Antiviral drugs. The role of antivirals has not yet been defined. Antivirals, by themselves, did not show benefit over placebo. Antivirals taken with steroids may benefit some people with Bell’s palsy, but this has not yet been proven.

However, antiviral drugs, such as valacyclovir (Valtrex) or acyclovir (Zovirax), are sometimes given in combination with prednisone in people with severe facial paralysis.

Paralyzed muscles may become smaller and shorter, and this may be permanent. A physical therapist can teach you how to massage and exercise your facial muscles to prevent this from happening.

In the past, decompression surgery was used to relieve pressure on the facial nerve by opening up the bony passage through which the nerve passes. At present, decompression surgery is not recommended. Possible risks associated with this surgery include facial nerve damage and permanent hearing loss.

Rarely, plastic surgery may be needed to correct permanent facial nerve problems. Facial resuscitation surgery helps make the face more even and can restore facial movement. Examples of this type of surgery include eyebrow lift, eyelid lift, facial implants and nerve grafts. Some procedures, such as an eyebrow lift, may need to be repeated after several years.