Bell's Palsy: Symptoms, Causes & Treatment Options

Bell’s Palsy (also known as acute peripheral facial paralysis) is a condition in which the facial nerve is inflamed and the person loses control of the muscles on one side of the face, which leads to a crooked mouth, difficulty making facial expressions, and a tingling sensation.

Most of the time, the inflammation is temporary, and it happens after a viral infection, such as herpes, mononucleosis or, mumps. The condition generally takes from a few weeks to around six months to disappear, but it can also become a permanent condition, if the facial nerve canal is damaged.

If you have facial paralysis please get a doctor to look at you, as in the initial stage it may also signal a very serious problem, such as a stroke, and therefore it’s important that the cause be identified and treated. 

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Main symptoms

The main symptoms include:

  • Paralysis on one side of the face;
  • Crooked mouth and sloping eye;
  • Difficulty making facial expressions, eating or drinking;
  • Slight pain or tingling sensation on the affected side;
  • Dry eyes and mouth;
  • Headache;
  • Difficulty holding saliva.

These symptoms generally appear quickly and affect one side of the face, however, there are rare cases in which there is nerve inflammation on both sides of the face, which means the symptoms appear on both sides of the face.

Bell’s Palsy symptoms are similar to symptoms that appear as a result of serious conditions, such as stroke or brain tumor, therefore it is important that you get a doctor to check you.

How to confirm a diagnosis 

The diagnosis is normally done through assessment of the facial muscles and related symptoms, but the doctor may ask for other tests, such as a CT, MRI, and blood tests. These tests will help the doctor to see whether you have Bell’s Palsy, and they will also rule out other possible conditions that have facial paralysis as a symptom.

What can cause Bell’s Palsy?

It is not known what causes the inflammation of the facial nerve and the existence of Bell’s Palsy, however, it is common for this condition to happen after viral infections, such as:

  • Simplex Herpes or Zoster Herpes;
  • HIV;
  • Mononucleosis;
  • Lyme Disease

Additionally, Bell’s Palsy is more common in pregnant women, diabetics, patients with lung infections, or when there is a family history of paralysis.

How is treatment done?

Treatment for Bell’s Palsy can be done through medication, physiotherapy and speech therapy, and most people recover completely within one month of treatment.

Nonetheless, there are several forms of treatment:

1. Medication

Medication for Bell's Palsy should be prescribed by a neurologist and usually consists of corticosteroids, such as Prednisone or Prednisolone, and antiviral medication, such as Aciclovir or Valaciclovir, which you can start having up to three days after the symptoms appear.

As Bell's Palsy causes facial muscle contraction this can lead to pain. If this happens to you, doctors may prescribe analgesics such as Aspirin, Dipyrone, or Paracetamol to treat the pain.

Also, if the paralysis stops one of your eyes from closing, it may be recommended for you to put a lotion directly on the eye before falling asleep to protect it and avoid extreme dryness. During the day it’s important to use lubricant eye drops and sunglasses to protect your eyes from the sun, and the wind. 

2. Physiotherapy

At your physiotherapy sessions, you will do exercises that will help strengthen the facial muscles and improve the blood supply to the nerve. The following are examples of physiotherapy exercises used in bell's palsy treatment:

  1. Opening and closing eyes using a lot of strength;
  2. Trying to lift eyebrows;
  3. Bringing eyebrows together, making vertical wrinkles;
  4. Frowning so that there are horizontal wrinkles on the forehead;
  5. Smiling or grinning a lot;
  6. Fake smile;
  7. Clenching teeth together;
  8. Pouting;
  9. Placing a pen in the mouth and trying to draw something with it;
  10. Putting lips together in a kiss-like shape;
  11. Opening the mouth as far as it will go;
  12. Wrinkling the nose, as if smelling something bad;
  13. Making soap bubbles;
  14. Filling a balloon with air;
  15. Making silly faces;
  16. Opening nostrils.

These exercises can also be done at home to treat the symptoms quickly, but they should be first supervised by a physiotherapist.

During the exercises, the physiotherapist may use an ice cube rolled up in a napkin to slide over the paralyzed area to stimulate the muscle contraction. The therapist may also aid further and help the direction of the movement by placing two or three fingers on the face, then taking them away, so you can keep the contraction properly.

3. Acupuncture

Some studies that assess the benefits of acupuncture in the treatment of Bell's Palsy show that this traditional Chinese technique may improve functioning and reduce the rigidity of the facial nerve, through the stimulation of nerve fibers in the skin and in the face muscles. 

4. Surgery

In some situations, the doctor may recommend you do surgery, especially if there is a lot of nerve compression, which is confirmed after doing an electromyoneurography.

5.  Speech therapy

Speech therapy sessions can also be a part of the treatment, since doing this type therapy can help the facial movements and expressions to return. Speech therapy will, most of the time, also stimulate your speaking, chewing, and swallowing functions. This type of therapy should be guided by a trained professional and the number of sessions per week, and the duration will be set by the speech therapist together with the doctor.

How long does recovery take?  

Complete recovery generally takes approximately three to four months, and as soon as physiotherapy starts you will see progress straight away. Only 15% of people who have peripheral facial paralysis do not recover completely and may need to use Botox or do surgery a few months later.

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References

  • NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE. Bell's Palsy Fact Sheet. Available on: <https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Bells-Palsy-Fact-Sheet>. Access in 28 Apr 2020
  • NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE. Bell's Palsy Information Page. Available on: <https://www.ninds.nih.gov/Disorders/All-Disorders/Bells-Palsy-Information-Page>. Access in 28 Apr 2020
  • UPTODATE. Bell's palsy: Pathogenesis, clinical features, and diagnosis in adults. Available on: <https://www.uptodate.com/contents/bells-palsy-pathogenesis-clinical-features-and-diagnosis-in-adults>. Access in 28 Apr 2020
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