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Definition
Bell's palsy is a swelling of the seventh cranial nerve, which controls most facial muscles, including those needed to smile, blink, and wrinkle the forehead. The nerve also controls the function of certain salivary glands and the lacrimal (tear) glands as well as the tiny muscles inside the ear that dampen loud noises.
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Description
Bell's Palsy, named after the 19th-century Scottish surgeon Sir Charles Bell, afflicts about 20,000 Americans each year. The nerve becomes inflamed and swollen somewhere within the confines of a bony tunnel in the skull that opens just beneath the ear.
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Causes and Risk Factors
It is not known what causes the inflammation in the first place. In folklore, exposure to cold is a frequently cited cause – for example, driving with a car window open in frigid weather, or sleeping on chilly ground. There is very little scientific evidence to support such causes. Most promising hypotheses include a reaction to certain types of flu or herpes virus, or the organism that causes Lyme's disease.
The risk increases with age up until the 40s and then remains steady until the 80s, when there is another increase. Diabetics and people with high blood pressure are at slightly greater risk, but most sufferers are ordinary people with no known predisposing factors.
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Symptoms
The classic person with Bell's palsy complains of sudden unilateral facial weakness. The potential range of weakness is wide – it may merely cause a delay in blinking, or it may extend to a complete paralysis on one side of the face with a wide fissure and inability to close the eye. Onset usually occurs within a single day, but it may develop and progress over a period of two to five days.
The first awareness of the problem may involve drooling after brushing the teeth or when drinking, an asymmetrical appearance of the mouth noticed in the mirror, an inability to whistle, or excessive tearing in one eye. A man may say that he was unable to blow out his cheeks when shaving. Sometimes the onset is subtle and a family member or a work associate is the first to notice the patient's facial asymmetry.
People with Bell's palsy may describe the sensation of unilateral loss of facial movement as deadness, loss of feeling, or numbness, although the affected part of the face is neither asleep nor tingling. Misidentification of the affected part is common. Alteration of taste or hearing is occasionally a symptom.
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Treatment
A primary concern in the management of Bell's palsy is eye care. Regardless of what other therapy is undertaken, dark glasses should be worn during the day, drops used to prevent drying and a bland ointment applied during sleep.
No treatment has been absolutely proven to speed recovery or lessen symptoms, but many physicians prescribe cortisone-type drugs in the hopes of reducing inflammation quickly. In severe cases, surgery can relieve pressure on the nerve, but the operation is not a sure thing, since the damage may already have been done.
Regardless of treatment, Bell's palsy patients tend to follow one of two recovery patterns. In about half of all cases, the nerve inflammation and swelling subside within two to three weeks. These patients recover fully.
In the other half, some of the fibers eventually die. Nerves regenerate, though not always perfectly. Most of these patients are satisfied with their improvement despite some slight residual impairment. A smaller number, 10 percent of all patients, are markedly disfigured for life.
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Questions to Ask Your Doctor
What tests need to be done to adequately diagnose the condition?
What treatment do you recommend?
Will any medication be prescribed? What are the side effects?
If severe, is surgery recommended? What is the procedure?
What can be expected from the surgery? Who will be performing the surgery?
What is the prognosis? Or what is the chance of a full recovery?
Are there any special measures that need to be taken to protect the eye, face or even to cope with eating difficulties?
Are there any facial exercises which are beneficial?
Is there any benefit from electrical stimulation to the facial muscles?
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