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Bell’s Palsy

Overview

Bell’s palsy is a condition that causes muscle weakness or paralysis on one side of your face. The condition is named after Charles Bell, who first explained this disease. The medical name for this condition is known as acute peripheral facial palsy of unknown cause. It results in drooping of facial features. You will have difficulty closing your eye on the affected side or smiling. In the majority of cases, Bell’s palsy occurs temporarily and resolves within a few weeks or months. Bell’s palsy can occur in individuals of any age. 

Causes

The exact cause of Bell’s palsy has not been determined yet. It can occur when the seventh cranial nerve (facial nerve) becomes inflamed, swollen, or compressed. This nerve supplies the muscles of your face, so damage to this nerve can lead to facial muscle weakness and temporary paralysis. Medical researchers believe that swelling or compression of the nerves may occur due to viral or bacterial infections. Possible infections include herpes simplex virus disease, chickenpox, shingles, rubella, influenza, mononucleosis, sarcoidosis, and Lyme disease.

 

It has been noticed in some cases that a dormant viral infection may cause Bell’s palsy once it is triggered. Triggering factors can vary for different people, but common factors are stress, infection, trauma or injury, and sleep deprivation. It may also become activated in people with autoimmune diseases. Infection can trigger swelling of the facial nerve, increasing pressure on the nerve. This may disrupt normal signals, resulting in weakness and loss of stiffness of facial muscles. In most cases, Bell’s palsy affects one side of the face, and the affected side can be easily distinguished from the normal side. 

Risk Factors And Epidemiology

Certain medical conditions may make you more prone to develop Bell’s palsy. The risk of developing this condition during pregnancy is high, especially during the third trimester. People with upper respiratory tract infections such as flu, rubella, common cold, etc., are at risk because it may trigger a dormant virus already in your system. There is also some genetic tendency associated with this condition. Apart from these factors, diabetes, obesity, and high blood pressure can also put you at risk of developing Bell’s palsy.

 

The known age range for this condition is between 15 and 60 years, but it may develop at any age. The risk of Bell’s palsy increases with age. It was found that 30 out of 100,000 people are affected by this condition. There is no racial or gender predilection. 

Signs And Symptoms

The signs and symptoms of Bell’s palsy usually have a sudden onset. Prominent signs include:

·         Weakness of facial muscles on one side of the face

·          Facial drooping

·          Difficulty closing the eyelid of the affected side

·          Difficulty in making facial expressions

·          Drooling

·          Asymmetrical smile

·          Loss of nasolabial fold

·          Difficulty in eating and having a tough time pronouncing certain words

·         Increased sensitivity to sound on the affected side

·          Pain around the jaw region

·         Headaches are also a common occurrence

 

 As facial nerve also supplies to other regions of the face, your saliva, teste, tears, and a small bone in your middle ear may also be affected. 

Diagnosis

Bell’s palsy is diagnosed on the basis of its clinical presentation. Your doctor will examine your face’s affected side and ask you to smile, twitch or form facial expressions. If you have Bell’s palsy, you will have difficulty in performing these actions. Some other diseases can cause facial muscle weakness, so your doctor may require some tests to rule out those causes. These include blood tests to check for signs of viral or bacterial infection, diabetes, electromyography, imaging scans such as MRI or CT scans, and lumbar puncture if necessary. 

Differential Diagnosis

Other diseases that may resemble symptoms of Bell’s palsy include Lyme disease, Guillain-Barre syndrome, Ramsay-Hunt syndrome, stroke, head or neck tumor, skull fracture, and multiple sclerosis. Differentiation can be done on the basis of physical examination and diagnostic tests. 

Treatment

People with Bell’s palsy recover well with or without any treatment. The treatment options available can only help with symptoms, but the disease reverts to normal on its own. Your doctor may prescribe some medications and physical therapy to ease your symptoms. Conservative treatment methods are preferred, and a care routine can be followed at home. Place a warm, moist towel over the affected side to reduce pain. Perform a gentle facial massage to stimulate blood flow and follow physiotherapy exercises to improve muscle activity. One of the major concerns in this condition is risk of eye infection or dry eyes because the involved eye cannot close. Use an eye patch to protect that eye. Using lubricating drops or eye ointments can help in preventing dryness.

 

Your doctor may prescribe corticosteroids such as prednisone to reduce inflammation and swelling of the facial nerve. This may help in relieving pressure on the nerve and restore its functions. Some antivirals may also be effective if a viral infection has triggered this condition. 

Prognosis

It may take a few weeks to six months to recover from Bell’s palsy. Around 13% of people may develop slight muscle weakness on the affected side of the face for a long time if left untreated. Treatment options can speed up the recovery process. The recurrence rate of this condition is very low. 

Prevention

There are no known ways to prevent Bell’s palsy. If you feel muscle weakness on one side of your face along with other mentioned symptoms, contact a doctor immediately to get a proper diagnosis and early treatment.