Symptoms and Causes of Bell's Palsy

Bell's Palsy is attributed to a 19th century physician Sir Charles Bell and describes acute facial palsy that has no other associated causes such as trauma or tumors. It is caused by viral reactivation in the facial nerve. After a past viral infection, the virus hibernates in the facial nerve nucleus. An insult such as stress, trauma or surgery may reactivate the virus. Viral reactivation leads to inflammation and swelling of the nerve causing paralysis of the muscles of facial expression. This in turn causes facial asymmetry, as each side of the face has its own facial nerve.

Symptoms

Bell's Palsy typically occurs with rapid and acute onset, resulting in facial paralysis within 1-3 days. Although permanent paralysis can occur, most patients (70%) will fully recover from Bell's palsy within weeks to months. As with other forms and causes of facial paralysis, symptoms of Bell's Palsy include facial droop, difficulty with eye closure, inability to lift the corners of the mouth, speak and eat properly.

Eye problems, such as excessive tearing or a dry eye due to the inability to close the eyelid may result. This can in some cases lead to erosion of the protective coating of the eye, and cornea ulceration. Other symptoms include an increased sensitivity to sound, loss of taste, drooling, and numbness on the affected side.

Causes

Bell's Palsy is believed to be caused by a viral reactivation (Herpes simplex or other viruses). Damage to the nerve which controls facial muscle movement is caused by inflammation. Bell's Palsy is a cause of facial paralysis identified via exclusion. That is, it is only indicated after all other possible causes of paralysis have been considered.

Bell's Palsy Treatment

Depending on the patient and how it presents, treatment of Bell's Palsy will involve the immediate use of high dose steroids (prednisone) and antiviral medications. Vigilant eye care is important. Patients require lubricating drops and eye protection. Physical therapy is also a key component in the treatment of Bell's palsy. For patients with incomplete recovery from Bell's Palsy, surgical correction is then prescribed.

Early referral is warranted. All muscles will atrophy and die if not given nerve stimulation for an extended period of time. Early referral allows us to prevent irreversible muscle loss. Nerve substitution procedures may be indicated.

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