FACIAL PALSY (BELL'S PALSY)

FACIAL PALSY (BELL'S PALSY)

What is Bell's palsy?

Bell's palsy refers to unilateral (one side) paralysis of muscles of face.

What are the symptoms of facial palsy?

Facial palsy causes weakness of facial muscles. So, patients may face the following problems:

1. Difficulty in closing the eye, so, the eye on affected side may look bigger.

2. Difficulty in frowning, leading to absence of wrinkles over forehead on the affected side.

3. Difficulty in blowing out cheeks (air leaks out on the affected side).

4. Watering of eye on the affected side,

5. Difficulty in chewing food, food may get stuck within the mouth on the affected side

6. Facial asymmetry, face may seem to get pulled to the normal side.

Other symptoms may include:

1. Loss of taste on the affected side,

2. Faint sounds may also seem louder (hyperacusis)

3. Headache, facial pain and neck pain may occur on the affected side. The pain may start a few days prior to the onset of facial paralysis. 

How does facial palsy start?

Symptoms of facial palsy starts suddenly over hours, so, it is very alarming for the patient. At the onset, patient may have pain behind the ear, in the neck, or the head on the side of paralysis. Symptoms are minor in the beginning, so, they often get noticed first by others or may be noticed on looking into a mirror.

What should be done, if one suspects facial palsy?

There is no need to panic, as it is a benign condition, and often improves over time. One should first consult their family physician or GP and subsequently a neurologist. Care should be taken to avoid any dirt entering the eye (as the eye can not be properly closed) to prevent corneal (a part of eye) infection.

What are the causes of facial palsy?

Bell's palsy is idiopathic (no definite cause has been identified). However, research has shown that it is often caused by viral infections such as herpes simplex. Facial palsy is more common in people with diabetes mellitus and in pregnant women. Patients with facial palsy often give a history of exposure to cold prior to the onset of symptoms (such as direct exposure of AC wind, going out at night or early morning, or long road journey with open windows), but their role in causing facial palsy has not been proven.

Other causes of facial palsy may include brain stroke (decreased blood supply to brain), tumors, other infections, trauma, infections of ear, etc.

What investigations would the doctor ask in facial palsy?

• Generally, no investigations are necessary as the diagnosis of facial palsy is obvious on clinical examination.
• However, brain scan (CT or MRI) may be done if one suspects brain stroke or tumors.
• Blood sugar should be checked to exclude diabetes mellitus.
• Nerve conduction studies (NCV/EMG) may be done to estimate the extent and severity of facial nerve involvement and in some cases to predict the outcome of facial palsy.
• In patients with recurrent facial palsy, certain blood tests may be done to look for the presence of disorders like collagen vascular diseases or vasculitis.

How is facial palsy treated?

Medical management of facial palsy may include the following:

1. Anti-viral drugs: Aciclovir tablets (2000 mg per day in divided doses) are given for 7-10 days.

2. Corticosteroids: Prednisolone 50-60 mg per day for 5-10 days are helpful in speeding the recovery. 

3. Vitamins: Mecobalamin (vitamin B12), alpha lipoic acid, etc are given to speed up recovery and regeneration of the facial nerve.

4. Physiotherapy: includes facial exercises, massage, and electrical stimulation of the facial nerve.

What is the prognosis of facial palsy?

• As earlier mentioned, facial palsy is not a serious condition and most patients recover well. Almost 60-70% patients recover in 3-4 weeks and the remainder in another few months.
• Less than 5% patients either do not recover or recover only partially.
• Facial palsy does not lead to death.
• Facial palsy usually does not recur, and recurrence is seen in only about 2-5% of cases.
• Patients with residual palsy may have facial asymmetry and they may consult cosmetologist/cosmetic surgeon for correction of asymmetry.

Miscellaneous questions about facial palsy

1. Is it contagious?

No, facial palsy does not spread from one patient to another, so, isolation is not required.

2. How common is Bell's palsy?

It is quite common and I see about 5-10 new cases per month.

3. Is Bell's palsy hereditary?

No

DR SUDHIR KUMAR MD (MEDICINE) DM (NEUROLOGY)

SENIOR CONSULTANT NEUROLOGIST

APOLLO HOSPITALS, HYDERABAD, INDIA

Email: drsudhirkumar@yahoo.com

Phone: 040-23607777/60601066
Facebook: www.facebook.com/bestneurologist