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Bell's Palsy

Bell's palsy is a paralysis of the facial nerve. Here’s what you need to know about signs of Bell’s palsy and treatment for this condition.

What is Bell's Palsy?

Bell’s palsy is a paralysis of the facial nerve resulting in inability to control facial muscles on the affected side. Worldwide statistics set the frequency at approximately 0.02 percent of the population.

Bell’s palsy is a diagnosis of exclusion. As it is commonly referred to as idiopathic, meaning that it is due to unknown cause, it is important for the doctor to perform a thorough investigation, including various blood tests and/or MRI or CAT scans, to ensure that there is no specific underlying disease causing the facial paralysis.

What are the Common Causes?

Bell's palsy is thought to develop because of an inflammatory condition leading to a swelling of the facial nerve, which leads to nerve inhibition and compression. This causes the blocking of the transmission of neural signals or damage to the nerve, resulting in paralysis.

Viral and bacterial infections, as well as autoimmune disorders, appear to be emerging as the most frequent common cause of Bell’s Palsy.

What are the Signs of Bell’s Palsy?

There are many physical symptoms associated with Bell's palsy, but the effects will differ between individuals. They can vary in accordance with the degree of nerve damage and the location of the damage.

Bell’s palsy symptoms include:

• Facial drooping on the affected side

• Difficulty with facial expression such as smiling and frowning

• Difficulty with blinking and closing of the eye

• Dry eyes

• Altered lacrimation function (lack of tearing or excessive tearing)

• Sensitivity to light and sound

• Altered salivation function (lack or excessive salivation)

• Pain in or near the ears

• Drooling

What are the Risk Factors?

• Conditions that compromise the immune system, such as HIV and diabetes

• Pregnancy

• Bacterial infections (such as typhoid fever, syphillis, tuberculosis and frequent middle ear infections)

• Neurological disorders such as Guillain-Barre syndrome, multiple sclerosis and neurosarcoidosis

• Traumatic injury to the head or face

• Tumours causing nerve compression

• Viruses such as influenza (the flu) , the common cold or infectious mononucleosis

What Can I Do To Help Myself?

Before you start to exercise, get familiar with your face. Print a diagram of the muscles in the face and the list of the muscles' actions. Refer to them as you exercise. Use them to get to know your facial muscles and what each muscle is doing as it moves. This can help you learn to isolate muscle actions as well as coordinate multiple muscle movement.

It is important to remember also that patience is often more important during recovery as the muscles often return to full function without assistance.

FAQs

1. What is Bell's Palsy?

Bell’s palsy is a condition that causes the facial muscles to weaken or become paralysed. It is caused by trauma to the seventh cranial nerve.

2. How Common is Bell's Palsy?

Bells palsy is not as uncommon as is generally believed. Worldwide statistics set the frequency at approximately 0.02 percent of the population (with geographical variations). In human terms this is one in every 5,000 people, and 40,000 Americans every year.

3. Is Bell's Palsy Always on the Same Side?

The percentage of left or right side cases is approximately equal, and remains equal for recurrences.

4. Is There any Difference Because of Gender or Race?

The incidence of Bell’s palsy in males and females, as well as in the various races is approximately equal. The chances of the condition being mild or severe, and the rate of recovery is also equal.

5. What Conditions can Increase the Chance of Having Bell's Palsy?

Older people are more likely to be afflicted, but children are not immune to it. Children tend to recover well.

In addition, people suffering from diabetes are more than four times more likely to develop Bell’s palsy than the general population.

The last trimester of pregnancy is considered to be a time of increased risk for Bell's palsy.

Conditions that compromise the immune system such as HIV or sarcoidosis increase the odds of facial paralysis occurring and recurring.

6. Can Bell's Palsy Affect Both Sides of the Face?

It is possible to have bilateral Bell’s palsy, but it is rare, accounting for less than one percent of cases. With bilateral facial palsy, it is important to rule out all other possible diagnoses with thorough diagnostic tests.

7. Can Bell's Palsy Affect Other Parts of the Body?

Bell's palsy should not cause any other part of the body to become paralysed, weak or numb. If any other areas are affected, Bell's palsy is not the cause of the symptoms, and further testing must be done.

8. How do Bell's Palsy Symptoms Progress?

Very quickly. Most people either wake up to find they have Bell's palsy, or have symptoms such as a dry eye or tingling around their lips that progress to classic Bell's palsy during that same day. Occasionally symptoms may take a few days to be recognisable as Bell’s palsy.

The degree of paralysis should peak within several days of onset — never longer than two weeks (or three weeks for Ramsay Hunt syndrome). A warning sign may be neck pain, or pain in or behind the ear prior to palsy, but it is not usually recognised in first-time cases.

9. Is Bell’s Palsy Contagious?

No, it is not contagious. People with Bell’s palsy can return to work and resume normal activity as soon as they feel up to it.

10. What About Recovery From Bell’s Palsy?

Approximately 50 percent of Bell’s palsy patients will have essentially complete recovery in a short period of time. Another 35 percent will have good recovery in less than a year.

Regardless of the trigger, Bell's palsy is best described as an event — trauma to the nerve. As with any other injury, healing follows.The quality and duration of recovery is dependent on the severity of the initial injury.

If the nerve has suffered nothing more than a mild trauma, recovery can be very fast, taking several days to several weeks. An “average” recovery is likely to take between a few weeks and a few months.

The nerve regenerates at a rate of approximately one to two millimetres per day, and can continue to regenerate for 18 months, probably even longer. Improvement of appearance can continue beyond that time frame.

11. Is Bell’s Palsy Likely to Happen Again?

The possibility of recurrence had been thought to be as high as 10 percent to 20 percent. These figures have been lowered as more has been learned about conditions that are now diagnosed as other types of facial palsies.

Estimates of the rate of recurrence still vary widely, from around four percent to 14 percent. Most recent reports hover at five percent to nine percent. The average timespan between recurrences is 10 years.

What are the Available Bell’s Palsy Treatment Options?

Prognosis

Even without any treatment, Bell's palsy tends to have a good prognosis. Patients who regain movement within the first two weeks nearly always remit entirely.

In a 1982 study, when no treatment was available, of 1,011 patients, 85 percent showed first signs of recovery within three weeks after onset. For the other 15 percent, recovery occurred three to six months later. After a follow-up of at least one year or until restoration, complete recovery had occurred in more than two-thirds (71 percent) of all patients. Recovery was judged moderate in 12 percent and poor in only four percent of patients.

Physiotherapy

During the earliest stages of Bell’s palsy, when muscles are completely flaccid, it is advisable to limit therapy to:

• Moist heat (to ease soreness and reduce swelling)

• Massage (also to ease soreness, plus to provide a degree of motion and stimulation to the muscles and increase circulation)

• Mental exercises (to retain the "memory" of facial motions)

A special form of physiotherapy called facial retraining can also help minimise the asymmetrical appearance of the face that occurs when one side is weakened.

Examples of facial retraining exercises can include but are not limited to these:

• Sniffle. Wrinkle nose. Flare nostrils.

• Curl upper lip up and raise and protrude upper lip.

• Compress lips together. Pucker lips and attempt to whistle.

• Smile without showing teeth; then smile showing teeth.

• Try moving your lips into a small smile slowly. Then gently pucker slowly using equal strength from both sides.

• Draw angle of mouth upward so as to deepen furrow from side of nose to side of mouth.

• Harden (wrinkle) the chin; “stick out” the chin (like a boxer).

• Using your index finger and thumb pull the corners of your lips in toward the centre. Slowly and smoothly push out and up into a smile. Continue the movement up to the cheekbone. Use a firm pressure.

• Placing four fingertips on the eyebrow rub using a firm stroke up to the hairline. Return downward to the eyebrow. Do the same type of massage in a circular motion on your cheeks and chin, and outward to your ear.

• Try to close the eye slowly and gently, without letting your mouth pull up or your eyebrow move downward.

• Raise eyebrows and hold for 10 to 15 seconds (watch out for synkinesis — hold the brow at a point before the corner of your mouth starts to move or your cheek tries to help). Wrinkle forehead.

• Frown and draw eyebrows downward.

• Gently wink with one eye and then the other to the best of your ability.

• Open eyes widely, but without involving your eyebrow. Stop if you see any inappropriate muscle actions.