sections include: diagnosis and treatment
Bell’s palsy involves a paralysis of the seventh cranial nerve. The condition is named after Sir Charles Bell (1774–1842), a surgeon and neurologist who described this nerve in detail and wrote the first clear descriptions of the disorder. The cardinal symptom of Bell’s palsy is a painful weakness of one side of the face. This weakness may develop within just hours, raising concern about a stroke (ischemic, hemorrhagic), but it usually appears progressively over several days. The affected side of the face becomes smooth and wrinkle-free because the underlying muscles lose their tone. Weakness around one eye may interfere with a person’s ability to blink and close that eye; on the lower face, the one-sided weakness can make it impossible to whistle, result in the face being pulled toward the side with normal muscle tone, and cause food to collect on the weak side of the mouth during eating.
Pain behind the ear often precedes the facial weakness by a day or two. Such pain associated with Bell’s palsy is frequent but transient and not debilitating.
As for other symptoms, people may describe the heavy feeling caused by the facial muscles’ paralysis as “numbness,” but they do not really lose sensation there. Some astute observers may notice a loss of taste on half of the tongue. Sounds often appear louder on the side of the palsy. Because a person may blink less on one side, which is sometimes combined with a decrease in tear production, the affected eye can become dry and irritated from exposure to the air.
The muscle weakness bottoms out within a week, usually in two or three days. Then, after remaining unchanged for several weeks to several months, a person’s face begins to improve. Satisfactory results, with problems limited to mild residual weakness and some difficulty coordinating the facial muscles, occur in more than 90 percent of Bell’s palsy cases.
Diagnosis and Treatment
It is common for people suffering from Bell’s palsy to worry about a stroke, and indeed paralysis or other neurological symptoms on one side of the body can be the first sign of that emergency. Some other neurological conditions begin with facial weakness as well, including sarcoidosis, multiple sclerosis (rarely), occasionally Guillain-Barré, and sometimes tumors. It is very important, therefore, to see a physician promptly when facial weakness or paralysis appears. Even if the problem turns out to be nothing more than Bell’s palsy, prompt treatment has been shown to improve the already good chance of an excellent recovery.
While strokes affect the brain. Bell’s palsy involves a nerve outside it. The seventh cranial nerve, which connects the brain stem to the facial muscles, is prone to attack by viruses. Several different viruses are implicated in the disorder, but herpes simplex appears to be the most frequent cause. Bell’s palsy is a common affliction, annually affecting about 25 people out of every 100,000.
If doctors confirm the diagnosis of Bell’s palsy within a week after symptoms start (and if there are no contraindications), they usually prescribe a seven-to-ten-day course of steroids (prednisone) and antiviral therapy (acyclovir).
Doctors will also offer therapy for the most damaging symptoms of the condition, which most often involves minimizing damage to an individual’s eye from exposure. When a person cannot close one eyelid—his or her blinking is limited and the eye opens during sleep—the cornea of that eye is at risk. Measures to protect it may include:
- taping the eye partially shut using paper tape along the upper eyelid
- taping the eye completely shut using paper tape stretched from the upper lid to the cheek
- applying a neutral eye ointment underneath the taped lid at bedtime
- wearing glasses or sunglasses in waking hours to somewhat reduce exposure to the air
Artificial tears (methylcellulose eyedrops) may offer some relief, but they tend to wash out of an open eye rapidly. If you see the eye becoming red, you should quickly return to the doctor. Stimulating the facial muscles by massage, acupuncture, or electrical stimulation offers no proven benefit. They usually recover on their own. In the rare event of severe residual weakness, a plastic surgeon can tighten the affected side of the face to “reanimate” it and improve a person’s appearance.
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