Bell's palsy is a sudden weakness and paralysis on one side of the face. It occurs in approximately 40,000 Americans each year and affects men and women equally.
The cause of Bell's palsy is unknown. It is suspected that an irritated facial nerve becomes swollen. As the facial nerve passes through narrow openings in the skull, it is compressed and symptoms result.
Doctors believe a herpes virus may cause the nerve to become inflamed, and, in turn, cause Bell’s palsy. Lyme disease may also be a cause.
Paralysis of the facial nerve may be caused by:
These factors increase your chance of developing Bell's palsy. Tell your doctor if you have any of these risk factors:
Bell's palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:
Symptoms of full-blown Bell's palsy may include:
Late complications (occurring 3-4 months after onset) can include:
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Other tests may include:
In most cases, symptoms go away within a few weeks without treatment. Many cases of Bell's palsy completely resolve after a few months.
Protecting the eye is important because people with Bell’s palsy may not be able to blink. If an underlying cause of the symptoms is known, it is treated. For some patients, however, symptoms may never go away.
Below are several ways to treat Bell's palsy:
Corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and pain. The antiviral medication valacyclovir (Valtrex) is also prescribed for this condition.
Research has shown that steroids, such as prednisolone, can significantly improve the chance of complete recovery from Bell's palsy. *¹*²
Antiviral medications, such as acyclovir (Zovirax), are also used to treat this condition.
Some doctors try to surgically relieve pressure on the nerve by removing part of the bone. This is an unproven procedure that is considered controversial and is no longer commonly performed. If the eyelid will not close, other surgeries around the eye may be considered.
Patients may need to apply lubricant or put drops in the eye. The eye can be covered and taped closed at night. Do not place tape directly on the eyelid. An eye patch may be worn to keep the eye closed. This helps moisten and keep particles out of the eye. Massage of the weakened facial muscles may be beneficial.
Most patients who do not recover are distressed by their symptoms. They may need help dealing with the emotional issues associated with the condition.
Physical therapy and speech therapy may be of value in improving symptoms.
If you are diagnosed with Bell's palsy, follow your doctor's instructions .
RESOURCES:
American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org/
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/
CANADIAN RESOURCES:
Alberta Health and Wellness
http://www.health.gov.ab.ca/
Health Canada
http://www.hc-sc.gc.ca/index-eng.php/
References:
American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org . Accessed October 12, 2005.
Bell’s palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated February 20, 2008. Accessed February 23, 2008.
Bell’s palsy fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/health_and_medical/pubs/ . Accessed August 2003.
Bell’s palsy information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/health_and_medical/disorders/ . Accessed August 2003.
Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngology. 2008;265:743-752.
Kasper DL, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine . 16th ed. New York, NY: The McGraw-Hill Companies; 2005.
National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/ . Accessed October 12, 2005.
New concepts in Bell's Palsy improve treatment options. Am Fam Physician . 2005;72:169.
Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Rakel RE, Bope ET. Conn's Current Therapy 2001, 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Russell J. Bells palsy. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation.
Samuels MA, Feske SK. Office Practice of Neurology . Philadelphia, PA: Churchill Livingstone; 2003.
*¹11/6/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med . 2007;357:1598-1607.
*²1/6/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Engstrom M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7:993-1000.
Last reviewed January 2009 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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