Date: April 17, 2014 Richard Jones

Bell’s Palsy

Facial paralysis can have a significant impact on one’s life, as a lot of changes can be expected when a part of the face (or in some cases, the whole face) becomes paralysed. The muscle weakness or paralysis on the face can turn even the simplest of daily activities into very challenging chores – affecting both the physical as well as the emotional well-being of an individual.

Bell’s Palsy is the most common cause of facial paralysis, and is considered to be a rare condition that affects about 1 person in 5,000. Bell’s Palsy causes paralysis or temporary weakness on one side of the face (although in rare cases, it can cause paralysis on both sides of the face). This condition involves the cranial nerve – the nerve which is responsible for controlling the facial muscles and their movements.

 What are the Symptoms of Bell’s Palsy?

  • Partial palsy, or a mild weakness experienced in facial muscles

  • Complete palsy or paralysis of the facial muscles

  • Difficulty in opening or closing an eye, when the eyelid muscle has been affected

  • Facial pain

  • Sagging mouth

  • Loss of taste (or Metallic taste)

  • Drooling

  • Pain on the affected side of the face, or under the ear

  • Increased sound sensitivity with the affected ear

What to do immediately if you think that you Have Bell’s Palsy

It is important that you see a doctor as soon as possible. Your GP may prescribe a steroid  to reduce inflammation in your facial nerve. If you have this treatment within three days of your Bell’s Palsy symptoms starting, you’re more likely to recover. 

  • Contact NHS Direct for health advice and information: Telephone 0845 4647 (Ask to see an out of hours Doctor  called “EMDOC”

  • Or Phone your local GP and explain that you may have Bell’s Palsy

Watch the NHS Choices Video on Bells Palsy

In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it. Complications of Bell’s palsy

Bell’s Palsy can last anywhere from a few weeks, to an indefinite timeframe. There is still no evidence as to what truly causes this condition, although some research results show that the herpes virus may be responsible. The virus is believed to cause inflammation on the cranial nerve (the nerve that is responsible for controlling the movements of facial muscles); as the nerve gets inflamed, it is compressed against the cheekbone and damaged, resulting to interference of brain signals to the facial muscles. The interference of the brain signals to the muscles on the face in turn results to the facial muscle weakness, or paralysis.

How Common is Bell’s Palsy?

Bell’s Palsy is a rare condition that affects approximately one person out of 5,000; it is usually seen in individuals who are in between the ages of 15 and 45, with both men and women equally at risk. Although the reason is not clear yet, Bell’s Palsy is seen to be more common in individuals who have HIV, diabetes, or in pregnant women.

Bell’s Palsy Diagnosis

It is crucial to see a dentist, or a doctor within 72 hours of noticing the symptoms associated with Bell’s Palsy, as treatment for this condition is believed to be highly effective when done during this timeframe. The doctor will use a few tests to come up with the proper diagnosis.

By Exclusion – the doctor will perform a diagnosis by exclusion to rule out other health conditions that may be causing the symptoms. A thorough physical examination of the head, neck, ears, and the facial muscles will be done to check for any evidence that the symptoms are not being caused by another illness (with symptoms that are almost the same as Bell’s Palsy).

In cases when the dentist or doctor is still unable to come to a definite conclusion regarding the diagnosis, the patient may then be referred to an ENT (ear, nose, and throat) specialist for further tests.

Electromyography – An electromyography or EMG will determine the presence, extent, and location of nerve damage. During an electromyography, electrodes are attached to the face to measure the electrical activity in the nerves.

Imaging Scans – Imaging scans, such as an MRI (magnetic resonance imaging) scan are helpful in obtaining a detailed image of the inside parts of the human body. A CT (computerised tomography) scan, on the other hand, can be successful in detecting infections or tumours that may be the cause of the symptoms.

 

Bell’s Palsy Treatment Options

There are Bell’s Palsy cases that do not need any treatment – these are the cases when the symptoms go away by themselves without dental or medical treatment, within a few days or weeks from the time the first signs and symptoms are noticed. However, the improvement can be gradual, and it may take a few weeks to a few months for the facial muscles to get stronger and return to their previously normal condition.

Corticosteroids – Corticosteroids may be prescribed by the doctor to help with the swelling around the nerves on the face; however, there have been some discussions among health professionals during recent years, as to whether the most effective treatment of Bell’s Palsy symptoms can be obtained through the use of antiviral medications, steroids, or a combination of both medications.

Research results during recent years have led health professionals to the conclusion that a steroid called Prednisolone provides the most effective Bell’s Palsy treatment, and that this treatment should be started within a 72-hour timeframe from the first time the symptoms start. Prednisolone works by reducing the swelling or inflammation of the facial nerve, which in turn shortens the total recovery time from the muscle weakness or paralysis.

The use of Prednisolone can have a few side effects, which may include: headache, indigestion, nausea, increased appetite, increased sweating, dizziness, tiredness, mood changes (depression or anxiety), difficulty in sleeping, and oral thrush. The side effects are expected to improve within a few days after starting the Prednisolone treatment, as the body ultimately gets used to the medication.
It is very important for pregnant or breastfeeding women to speak to their doctors before taking Prednisolone.

Eye Drops – Lubricating eye drops are commonly used to help with dry eye problems, which can be the result of difficulties in closing the eyes; when the eyes remain, their natural lubrication can easily evaporate, causing the eyes to dry up. Eye drops can provide artificial tears that will replace the eye’s natural lubrication, so that further eye problems or complications can be avoided.

Botox Injections – Botox or botulinum toxin injections can be used in the treatment of long-term Bell’s palsy; the injections can be administered in either the affected, or the unaffected side of the face. Botox injected on the affected side of the face will help the tight muscles to relax or cease their uncontrolled movements; botox injections on the unaffected facial side can in turn be effective in reducing the activity of muscles that have become dominant or overactive.

Botox injections can also help with easing the discomfort that eating can bring, and can also improve the overall appearance of the face. Botulinum toxin injections are also used to help deal with long-term complications from Bell’s Palsy, such as “crocodile tears” (tears that come out when eating), or eye-mouth synkinesis (a condition when the facial nerve grows back in a different manner, causing the eye to wink when laughing, smiling, or eating).

Physiotherapy – Physiotherapy is recommended for those who do not make a full recovery from the Bell’s Palsy symptoms after nine months, as more extensive nerve damage may have occurred. The facial exercises included in physiotherapy will be helpful in strengthening the facial muscles; physiotherapy will also aid in the improvement the range of movement, and overall coordination.

Plastic Surgery – Plastic surgery will deal with the improvement of the appearance of one’s face, but may not be successful in restoring nerve function in the affected areas.

Other treatment options that may be sought to aid in the successful restoration of nerve function and Bell’s Palsy recovery include facial exercises, acupuncture, and relaxation techniques.

Bell’s Palsy Complications

Complications from Bell’s Palsy are more likely to occur for patients who:

  • Have not started to recover from the symptoms after six weeks
  • Are over 60 years of age
  • Have high blood pressure
  • Have been affected by paralysis/completely no movement on one side of the face (complete palsy)
  • Are pregnant
  • Have diabetes
  • Have bad facial nerve damage

The following are some of the complications that can result from long-term Bell’s Palsy symptoms:

Speech Problems – Facial muscles that have been damaged can lead to speech problems.

Eye Drying and Corneal Ulceration – Facial muscle paralysis or weakness can result to difficulties in closing the eyes, which in turn can lead the eyes to lose their natural lubrication and dry up. Corneal ulceration can also be the result of eyes that dry up; in severe cases, the dry eyes can lead to infections or even blindness.

Contracture – Facial disfigurements can be the result when facial muscles are always tense; examples of these facial disfigurements include the deepening of the line between the mouth and the nose, the eye becoming smaller, and the cheek appearing to be bulkier.

Eye-Mouth Synkinesis – An uncontrollably winking eye can be a complication from the facial nerve growing back in a different manner. The winking can occur when one is eating, laughing, or smiling; in severe cases, the eye can even completely close during meal times.

Reduction or Loss of the Sense of Taste – Sense of taste problems can occur when nerve damage is not repaired properly and early enough in the Bell’s Palsy treatment.

Ramsay Hunt Syndrome – A rare condition that affects around 2% of those with Bell’s Palsy, especially if the symptoms are caused by the varicella-zoster virus. Blisters appear on the tongue and the inside of the ears of those with Ramsay Hunt Syndrome, and these symptoms can often be treated successfully with antiviral medications, or with steroids.

What Research is Being Done about Bell’s Palsy?

The NHS is conducting patient recruitment for Bell’s Palsy clinical trials. Listed below are the current clinical trials about Bell’s Palsy, along with their locations and current recruitment status:

  1. The Relationship Between Psychological Factors and Bell’s Palsy – China; Recruiting
  2. Prednisolone and Acupuncture in Bell’s Palsy: a Randomised, Placebo-controlled, Multicentre Trial in China –China; Recruiting
  3. Acupuncture for Sequelae of Bell’s Palsy – South Korea; Not Recruiting
  4. Randomized Controlled Trial of Acupuncture to Treat Bell’s Palsy According to Different Stages – China; Not Recruiting
  5. Bell’s palsy: Early Aciclovir and/or Prednisolone in Scotland – United Kingdom; Not Recruiting
  6. Comparison of therapeutic effects of Prednisolone, acyclovir, and combination of these drugs in Bell´s Palsy – Iran, Islamic Republic of; Not Recruiting
  7. Acupuncture With Deqi And Psychological Effects in Treatment of Bell’s Palsy – China; Not Recruiting

Useful Resources

http://www.nhs.uk/conditions/Bells-palsy/Pages/Introduction.aspx
http://bellspalsy.org.uk/
http://www.ninds.nih.gov/disorders/bells/bells.htm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001777/
http://www.webmd.com/brain/tc/bells-palsy-topic-overview
http://www.mayoclinic.com/health/bells-palsy/DS00168

 

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Facial Injury
Dental HIV
Diabetes Dental
Pregnancy Dental
Dental CT Scan
NHS Dentistry

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