Bell Palsy

Named after Surgeon Sir Charles Bell and also known as facial palsy, Bell palsy is the sudden weakness of one side of the face. It is often temporary and is attributed to the inflammation of the facial nerve that controls the muscles on the weakened side of the face.

The direct cause is not usually known, but Bell palsy is often preceded by symptoms of a viral syndrome. Other commonly mentioned triggers include stress, trauma, fever, and tooth extractions. There is a strong correlation with the herpes simplex virus, the same virus that causes cold sores or fever blisters on the lip. There has also been an association found with shingles and its associated blistering (from the herpes zoster virus). Bell palsy has been associated with Lyme disease where it is common. The facial muscle is the most commonly paralyzed nerve of the body.

The symptoms commonly develop over hours or days. Men and women are affected equally. The most common symptoms are these:

• Weakness or complete paralysis of an entire side of the face
  
  
• An eyelid droop
  
  
• Drooling from the affected side of the mouth
  
  
• Pain around the ear
  
  
• Feeling of fullness or swelling to the affected side of the face
  
  
• Impaired sensation of taste or hearing
  
  
• Inability to wrinkle forehead
  
  
• Contour of smile affected

All episodes of facial weakness or paralysis should be immediately examined by a doctor to rule out the possibility of a stroke. If you have had a previous episode of Bell palsy and have another similar episode, you should again be examined to rule out other more serious causes of the facial weakness. Other causes of facial weakness can include these conditions:

• Stroke
  
  
• Tumors
  
  
• Other infections, such as meningitis
  
  
• Trauma
  
  
• Other neurological disease, such as multiple sclerosis

If you have any difficulty with speech (slurred speech or change in speed of your conversation), arm or leg weakness, numbness, tingling, or difficulty with balance or walking, call 911 or go to a hospital's emergency department.

Your symptoms and the physical examination by your doctor is often the most important part in making a diagnosis of Bell palsy.

Often no tests are needed for adequate diagnosis. If x-rays are taken, however, most likely a CT scan or MRI of your head will be performed. This x-ray is only necessary if your doctor suspects a stroke, tumor, or other serious neurological disease as a cause of your symptoms.

|Self-Care at Home|

After examination by a doctor and with proper diagnosis, you can begin facial exercises and stimulation of the facial muscles. These activities might speed your recovery.

• Relieve minor pain with over-the-counter pain medication such as ibuprofen (Motrin).
  
  
• Keep your droopy eyelid taped shut at night. Keep your eye moist with proper eyedrops (such as methylcellulose type) to prevent drying of the surface of your eye.

|Medical Treatment|

Electrostimulation of the muscles has been used for treatment, but its value is not proven.

|Medications|

Steroids, such as prednisone (Deltasone), can reduce the duration of symptoms by decreasing the inflammation of the nerve. Doctors will often add an antiviral agent, such as acyclovir (Zovirax) or valacyclovir (Valtrex), because of a strong correlation between herpes simplex virus and Bell palsy. If Lyme disease is possible in certain areas of the country, an antibiotic may be added, such as doxycycline.

|Prevention|

The cause is often unknown, so prevention is not possible.

|Outlook|

Bell palsy usually goes away by itself without treatment. Most people begin recovery in 2-3 weeks, with 70-85% of people showing complete recovery in 2-3 months. There is a 10% recurrence rate. Those who are at a higher risk of not getting completely better are often older and those who have a slow recovery from symptoms.

Bell's palsy, Bell palsy, facial palsy, facial paralysis

Author: Shahram Lotfipour, MD, Clinical Teaching Faculty, Department of Emergency Medicine, Pomona Valley Medical Center.

Editors: Patrick Taylor, MD, FAAEM, Medical Director, Department of Emergency Medicine, CHRISTUS St Frances Cabrini Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.