Two of my friends had Bell's palsy. Both recovered completely, but they still remember it as a very bad experience. In this condition, the muscles on one side of the face are weakened or even paralyzed. The eyelid muscles are unable to close the eye completely, so the patient has to “manually” blink during the day and tape the eye closed for sleeping. Eating is a challenge, and social interaction is impaired.
The exact cause of the condition is unknown. Inflammation of the facial nerve is a generally accepted reason for the muscle weakness. Both viral infections and autoimmune disease are under suspicion. The recent medical literature reports that 70 to 75 percent of cases clear up spontaneously, but the remaining patients may experience complications including prolonged weakness or even complete paralysis of facial muscles.
Maxillofacial surgeons may treat Bell's palsy with xylocaine nerve blocks plus vitamins, anti-viral drugs, and anti-edema medication, according to Reference 1. Neurologists generally use corticosteroids to reduce inflammation of the facial nerve.
Anti-viral drugs are a controversial treatment. Herpes simplex virus type 1 has been suggested as a possible cause of the nerve inflammation. A recent review reported that of three meta-analysis papers, one reported some benefit from anti-viral drugs, and two reported no benefit from them.
Acupuncture is another controversial treatment. A recent review concluded that published data are inadequate for judging its effectiveness, and more research is needed.
A research team in Taiwan studied the degree of nerve involvement in early Bell's palsy by electroneurography. Previous studies, they report, have shown that poor scores on this test correlate with long-term symptoms. The researchers found average scores get worse with age, but better with use of corticosteroids. Thus, corticosteroids should be considered early in the course of the illness, especially in older patients.
1. Bejtovic B et al, “Comparative advantages and shortcomings of cortisosteroids in comparison with xylocaine-based perineural blocks in treatment of Bell's palsy”, Med Arh. 2009; 63(4): 225-7.