DEFINITION

Bell's palsy causes sudden weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.

Bell's palsy, also known as facial palsy, can occur at any age. The exact cause is unknown, but it's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. It may be a reaction that occurs after a viral infection.

For most people, Bell's palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy can recur.

SYMPTOMS

Signs and symptoms of Bell's palsy come on suddenly and may include:

• Rapid onset of mild weakness to total paralysis on one side of your face occurring within hours to days
• Facial droop and difficulty making facial expressions, such as closing your eye or smiling
• Drooling
• Pain around the jaw or in or behind your ear on the affected side
• Increased sensitivity to sound on the affected side
• Headache
• A decrease in your ability to taste
• Changes in the amount of tears and saliva you produce

In rare cases, Bell's palsy can affect the nerves on both sides of your face.

When to see a doctor

Seek immediate medical help if you experience any type of paralysis because you may be having a Stroke. Bell's palsy is not caused by a Stroke.

See your doctor if you experience facial weakness or drooping to determine the underlying cause and severity of the illness.

CAUSES

Although the exact reason Bell's palsy occurs isn't clear, it's often linked to exposure to a viral infection. Viruses that have been linked to Bell's palsy include the virus that causes:

• Cold sores and Genital herpes (herpes simplex)
• Chickenpox and Shingles (Herpes zoster)
• Mononucleosis (Epstein-Barr)
• Cytomegalovirus infections
• Respiratory illnesses (adenovirus)
• German Measles (Rubella)
• Mumps (Mumps virus)
• Flu (Influenza B)

Hand-foot-and-mouth disease (coxsackievirus)

With Bell's palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

RISK FACTORS

Bell's palsy occurs more often in people who:

• Are pregnant, especially during the third trimester, or who are in the first week after giving birth
• Have an upper respiratory infection, such as the Flu or a cold
• Have Diabetes

Also, some people who have recurrent attacks of Bell's palsy, which are rare, have a family history of recurrent attacks. In those cases, there may be a genetic predisposition to Bell's palsy.

COMPLICATIONS

A mild case of Bell's palsy normally disappears within a month, but recovery from a more severe case involving total paralysis varies. Complications may include:

• Irreversible damage to your facial nerve
• Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you're trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
• Partial or complete blindness of the eye that won't close due to excessive dryness and scratching of the cornea, the clear protective covering of the eye

TESTS AND DIAGNOSIS

There's no specific test for Bell's palsy. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.

Other conditions such as a Stroke, infections, Lyme disease and Tumors  can also cause facial muscle weakness, mimicking Bell's palsy. If it's not clear why you're having the symptoms you are, your doctor may recommend other tests, including:

• Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
• Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a Tumor or skull fracture.

TREATMENTS AND DRUGS

Most people with Bell's palsy recover fully with or without treatment. There's no one-size-fits-all treatment for Bell's palsy, but your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.

Medications

Commonly used medications to treat Bell's palsy include:

• Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they're started within several days of when your symptoms started.
• Antiviral drugs. The role of antivirals remains unsettled. Antivirals alone have shown no benefit compared with placebo. Antivirals added to steroids are also unlikely to be beneficial.

However, despite this, valacyclovir (Valtrex) is sometimes given in combination with prednisone in people with severe facial palsy.

Physical therapy

Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery

In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent Hearing loss are possible risks associated with this surgery.

In rare cases, plastic surgery may be needed to correct lasting facial nerve problems.

LIFESTYLE AND HOME REMEDIES

Home treatment may include:

• Protecting the eye you can't close. Using lubricating eye-drops during the day and an eye ointment at night will help keep your eye moist. Wearing glasses or goggles during the day and an eye patch at night can protect your eye from getting poked or scratched.
• Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help ease your pain.
• Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.
• Doing your physical therapy exercises. Massaging and exercising your face according to your physical therapist's advice may help relax your facial muscles.

ALTERNATIVE MEDICINE

Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following:

• Relaxation techniques. Relaxing by using techniques such as meditation and yoga may relieve muscle tension and chronic pain.
• Acupuncture. Placing thin needles into a specific point in your skin helps stimulate nerves and muscles, which may offer some relief.
• Biofeedback training. By teaching you to use your thoughts to control your body, you may help gain better control over your facial muscles.
• Vitamin therapy. Vitamins B-12, B-6 and zinc may help nerve growth.

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