Bell's Palsy

Imagine waking up one morning with half your face paralyzed and frozen in a grotesque position. You can't close your eye on the paralyzed side. Your face feels huge and swollen and you can't eat because the food falls out of your mouth. Even worse, you're drooling out of that side of your mouth too. Your face is painful. Your eye is watering and it is sensitive to sunlight and bright light of any kind. Your hearing on the paralyzed side is extremely sensitive, and even a small sound is like a scream. Your ear aches. You can't smile and it's hard to talk and your sense of taste is altered. You feel ugly and miserable.

No, you aren't having a stroke and the condition isn't too serious, just uncomfortable. You have Bell's Palsy. It happens suddenly and is caused by trauma or inflammation of the 7th cranial nerve which is called the facial nerve.

One of the most common causes of Bell's Palsy is the Herpes Simplex 1 virus (the cold sore virus). Most of us have had this virus at one time. Sometimes it causes a cold sore, sometimes there are no symptoms at all but the virus can reactivate and it can trigger Bell's Palsy. Other causes can be trauma to the facial nerve, mumps, Lyme disease or tuberculosis. A tumor, skull fracture or neurological condition caused by chromic disease (diabetes, Guillain-Barre Syndrome) can also lead to Bell's Palsy.

Once a person has an attack, the facial musculature becomes weakened and it makes the person more susceptible to subsequent attacks. This weakness can be avoided with facial rehabilitation to strengthen facial muscles.

Bell's Palsy affects approximately 40,000 American's a year. Usually the paralysis is only one-sided, but it isn't uncommon to have both sides affected. Bell's Palsy usually is a once in a lifetime event, but it isn't uncommon for people to have multiple attacks.

About half the sufferers have a complete recovery within the first 30 days without any treatment or intervention. Another 20% recover within 1 and 3 months and another 5-10% recover between 4 and 6 months. Patients who do not have a complete recovery at the end of six months will require some form of facial muscle rehabilitation.

Doctors aren't sure that any treatment changes the ultimate outcome of the illness. Most recover fully without any treatment, but the following courses of treatment may be prescribed:

Anti-inflammatory Medications. A short course of corticosteroid medication such as prednisone may help reduce the inflammation and swelling in the channel where the facial nerve travels.

Antiviral medication. Antiviral medications such as Zovirax and Famvir may limit or reduce damage to the nerve cause by the virus.

Massage. Facial massage may help prevent permanent contractures of the paralyzed muscles before recovery takes place.

Residual problems that can result from a severe attack of Bell's Palsy are:

• Asymmetrical Smile
• Involuntary movement of the mouth or eye or both
• Tearing or dry eye
• Inability to close eye
• Abnormal blink
• Inability to whistle or pucker lips
• Frozen muscle in area of nostrils
• Buccinator paralysis (food caught in cheek of paralyzed side), inability to "puff" one's cheeks
• Drooling of liquids from corner of paralyzed mouth
• Hyperacussis (perceiving sounds as unduly loud)
• Excessive perspiration
• Weakened facial musculature
• Lack of wrinkling on forehead of paralyzed side
• Change in taste
• Changes in speech
• Tightness / swelling of facial muscle
• Facial pain
• Acoustic pain

Disorders of the 7th cranial nerve, the facial nerve, including paralysis, are not rare and have a variety of causes. The appropriate diagnosis and treatment are very important to achieving the best possible recovery. Even people with permanent facial nerve injury can be helped by surgical procedures designed to improve facial function.