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Bell's Palsy

bells palsy


Bell's palsy is a weakness (paralysis) that affects the muscles of the face. It is due to a problem with the facial nerve. The weakness usually affects one side of the face. Rarely, both sides are affected.

What is the facial nerve?

You have a facial nerve on each side of your face. Each facial nerve comes out from your brain, through a small tunnel in your skull just under your ear. The nerve splits into many branches that supply the small muscles of the face that you use to smile, frown, etc. It also supplies the muscles that you use to close your eyelids. Branches of the facial nerve also take taste sensations from your tongue to your brain.

Who gets Bell's palsy?

Anyone can get Bell's palsy, and it affects both men and women equally. It most commonly occurs between the ages of 10 and 40.

What causes Bell's palsy?

It is thought that inflammation develops around the facial nerve as it passes through the skull from the brain. The nerve then partly, or fully, stops working until the inflammation goes. If the nerve stops working, the muscles that the nerve supplies also stop working.

The cause of the inflammation is not known but, in most cases, it is probably due to a viral infection. There is some evidence that the cold sore virus (herpes simplex virus) or the chickenpox virus (varicella zoster virus) cause most cases of Bell's palsy.

What are the symptoms of Bell's palsy?

  • Weakness of the face which is usually one-sided. The weakness normally develops quickly, over a few hours or so.
  • Your face may droop to one side. When you smile, only half of your face may move.
  • Chewing food on the affected side may be a problem. Food may get trapped between your gum and cheek. Drinks and saliva may escape from the side of your mouth.
  • You may not be able to close an eye. This may cause a watery or dry eye.
  • You may not be able to wrinkle your forehead, whistle or blow out your cheek.
  • You may have some difficulty with speech, as the muscles in the side of the face help in forming some words.
  • Most cases are painless or cause just a mild ache.
  • Loud sounds may be uncomfortable and normal noises may sound louder than usual.
  • You may lose the sense of taste on the side of the tongue that is affected.

Does Bell's palsy affect the brain or other parts of the body?

No. Bells palsy is a local problem confined to the facial nerve and facial muscles.

Other conditions that may be confused with Bell's palsy

Bell's palsy is a common cause of a facial palsy. Less commonly, facial palsy is caused by other things that can damage or affect the facial nerve. For example: a head injury, sarcoidosis, Lyme disease, growths in the ear, tumours in the parotid gland and tumours in the brain. Also, some people who have a stroke develop facial weakness.

How does Bell's palsy progress?

Without treatment, full recovery is still likely and occurs in about 70% cases. With treatment, the chance of full recovery is improved. Symptoms usually start to improve after about 2-3 weeks, and have usually gone within two months.

What is the treatment for Bell's palsy?

As mentioned, there is a good chance of full recovery without any treatment. However, drug treatment is usually advised to improve the chance of full recovery even more. Also, you need to protect your eye if your eyelids cannot close.

Steroid tablets

A course of steroid tablets is usually prescribed for about 10 days. The steroid tablet most commonly used is called prednisolone. Steroids help to reduce inflammation, which is probably the reason they help. You should start the course of steroids as soon as possible after the onset of symptoms. Ideally, within 72 hours of symptoms starting. They may not have much effect if they are taken after this.

Antiviral drugs

Some drugs can stop the chickenpox and cold sore virus from multiplying. However, research trials have shown that antiviral drugs taken alone probably make no difference to the outcome.

Eye protection
If you cannot close your eyelids fully, the front of your eye is at risk of becoming damaged. Also, your tear glands may not work properly for a while and your eye may become dry.

  • An eye pad or goggles to protect the eye.
  • Eye drops to lubricate the eye during the day.
  • Eye ointment to lubricate the eye overnight.

If the facial weakness does not recover

  • A treatment called, 'facial retraining' with facial exercises may help.
  • Injections of botulism toxin ('Botox®') may help if spasm develops in the facial muscles.
  • Various surgical techniques can help with the cosmetic appearance.

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