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Bell's Palsy

Summary:


Bell's Palsy is a paralysis of the facial nerve resulting in inability to control facial muscles on the affected side.......




Contents

What is Bell’s Palsy?

  • Bell's Palsy is a paralysis of the facial nerve resulting in inability to control facial muscles on the affected side. Worldwide statistics set the frequency at approximately 0.02% of the population.
  • Bell's Palsy is a diagnosis of exclusion. As it is commonly referred to as idiopathic, meaning that it is due to unknown cause, it is important for the doctor to perform a through investigation, including include various blood tests, MRI, or CAT scans, to ensure that there is no specific underlying disease causing the facial paralysis.

What Are the Common Causes?

  • Bell's Palsy is thought to be developed because of an inflammatory condition leading to a swelling of the facial nerve, which leads to nerve inhibition and compression. This causes the blocking of the transmission of neural signals or damaging the nerve, resulting in the paralysis.
  • Viral and bacterial infections, as well as autoimmune disorders, appear to be emerging as the most frequent common cause of Bells Palsy.

What are the signs and symptoms?

  • There are many physical symptoms associated with Bell's Palsy, but the effects will differ between individuals. They can vary in accordance with the degree of nerve damage, and the location of the damage.
  • People with Bell's Palsy may experience:
    • Facial drooping on the affected side
    • Difficulty with facial expression such as smiling and frowning
    • Difficulty with blinking and closing of the eye
    • Dry eyes
    • Altered lacrimation function (lack of tearing or excessive tearing)
    • Sensitivity to light and sound
    • Altered salivation function (lack or excessive salivation)
    • Pain in or near the ears
    • Drooling

What are the risk factors?

  • Conditions that compromise the immune system, such as HIV,
  • Diabetes
  • Pregnancy
  • Bacterial infections (eg Typhoid fever, syphillis, tuberculosis, frequent middle ear infections)
  • Neurological disorders such as Guillain-Barre syndrome, multiple sclerosis, and neurosarcoidosis
  • Traumatic injury to the head or face
  • Tumors causing nerve compression
  • Viruses such as influenza (the flu), the common cold, or infectious mononucleosis

What types of treatment are available?

Prognosis

  • Even without any treatment, Bell's Palsy tends to have a good prognosis. Patients who regain movement within the first two weeks nearly always remit entirely.
  • In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients.

Physiotherapy

  • During the earliest stages of Bells palsy, when muscles are completely flaccid, it is advisable to limit therapy to:
  • Moist heat (to ease soreness and reduce swelling)
  • Massage (also to ease soreness, plus to provide a degree of motion & stimulation to the muscles and increase circulation)
  • Mental exercises (to retain the "memory" of facial motions)
  • A special form of physiotherapy called facial retraining can also help minimize the asymmetrical appearance of the face that occurs when one side is weakened. Examples of facial retraining exercises can include but are not limited to ([1]:
    • Sniffle. Wrinkle nose. Flare nostrils.
    • Curl upper lip up and raise and protrude upper lip.
    • Compress lips together. Pucker lips & attempt to whistle.
    • Smile without showing teeth; then smile showing teeth.
    • Try moving your lips into a small smile slowly. Then gently pucker slowly using equal strength from both sides.
    • Draw angle of mouth upward so as to deepen furrow from side of nose to side of mouth.
    • Harden (wrinkle) the chin; "stick out" the chin (like a boxer).
    • Using your index finger and thumb pull the corners of your lips in toward the center. Slowly and smoothly push out and up into a smile. Continue the movement up to the cheekbone. Use a firm pressure.
    • Placing 4 fingertips on the eyebrow rub using a firm stroke up to the hairline. Return downward to the eyebrow. Do the same type of massage in a circular motion on your cheeks and chin, and outward to your ear.
    • Try to close the eye slowly and gently, without letting your mouth pull up or your eyebrow move downward.
    • Raise eyebrows and hold for 10 -15 seconds (watch out for synkinesis - hold the brow at a point before the corner of your mouth starts to move or your cheek tries to help). Wrinkle forehead.
    • Frown and draw eyebrows downward.
    • Gently wink with one eye and then the other to the best of your ability.
    • Open eyes widely, but without involving your eyebrow. Stop if you see any inappropriate muscle actions.

How can I prevent it?

  • There is no way to prevent Bell's palsy currently.

What can I do to help myself?

  • Before you start to exercise, get familiar with your face. Print a diagram of the muscles in the face and the list of the muscles' actions. Refer to them as you exercise. Use them to get to know your facial muscles and what each muscle is doing as it moves. This can help you learn to isolate muscle actions as well as coordinate multiple muscle movement.
  • It is important to remember also that patience is often more important during recovery as the muscles often return to full function without assistance.

FAQ

1. What is Bell's Palsy?

  • Bells palsy is a condition that causes the facial muscles to weaken or become paralyzed. It's caused by trauma to the 7th cranial nerve.

2. How common is Bell's Palsy?

  • Bells palsy is not as uncommon as is generally believed. Worldwide statistics set the frequency at approximately .02% of the population (with geographical variations). In human terms this is 1 of every 5000 people, and 40,000 Americans every year.

3. Is Bell's Palys always on the same side?

  • The percentage of left or right side cases is approximately equal, and remains equal for recurrences.

4. Is there any difference because of gender or race?

  • The incidence of Bells palsy in males and females, as well as in the various races is approximately equal. The chances of the condition being mild or severe, and the rate of recovery is also equal.

5. What conditions can increase the chance of having Bell's Palsy?

  • Older people are more likely to be afflicted, but children are not immune to it. Children tend to recover well. Diabetics are more than 4 times more likely to develop Bells palsy than the general population. The last trimester of pregnancy is considered to be a time of increased risk for Bell's palsy. Conditions that compromise the immune system such as HIV or sarcoidosis increase the odds of facial paralysis occurring and recurring.

6. Can Bell's Palsy affect both sides of the face?

  • It is possible to have bilateral Bells palsy, but it is rare, accounting for less than 1% of cases. With bilateral facial palsy, it's important to rule out all other possible diagnoses with thorough diagnostic tests.

7. Can Bell's Palsy affect other parts of the body?

  • Bells palsy should not cause any other part of the body to become paralysed, weak or numb. If any other areas are affected *Bell's palsy is not the cause of the symptoms, and further testing must be done.

8. How do the symptoms of Bell's Palsy progress?

  • Very quickly. Most people either wake up to find they have Bells palsy, or have symptoms such as a dry eye or tingling around their lips that progress to classic Bell's palsy during that same day. Occasionally symptoms may take a few days to be recognizable as Bells palsy. The degree of paralysis should peak within several days of onset - never in longer than 2 weeks (3 weeks maximum for Ramsey Hunt syndrome). A warning sign may be neck pain, or pain in or behind the ear prior to palsy, but it is not usually recognized in first-time cases.

9. Is Bell's Palsy contagious?

  • No, it is not contagious. People with Bells palsy can return to work and resume normal activity as soon as they feel up to it.

10. What about recovery from Bell's Palsy?

  • Approximately 50% of Bells palsy patients will have essentially complete recoveries in a short time. Another 35% will have good recoveries in less than a year.
  • Regardless of the trigger, Bell's palsy is best described as an event - trauma to the nerve. As with any other injury, healing follows. The quality and duration of recovery is dependent on the severity of the initial injury. If the nerve has suffered nothing more than a mild trauma, recovery can be very fast, taking several days to several weeks. An "average" recovery is likely to take between a few weeks and a few months. The nerve regenerates at a rate of approximately 1-2 millimeters per day, and can continue to regenerate for 18 months, probably even longer. Improvement of appearance can continue beyond that time frame.

11. Is Bell's Palsy likely to happen again?

  • The possibility of recurrence had been thought to be as high as 10 - 20%. These figures have been lowered as more has been learned about conditions that are now diagnosed as other types of facial palsies. Estimates of the rate of recurrence still vary widely, from around 4 - 14%. Most recent reports hover at 5 - 9%. The average timespan between recurrences is 10 years.


References

  1. http://www.bellspalsy.ws/
  2. http://en.wikipedia.org/wiki/Bell's_palsy
  3. http://www.neurologychannel.com/bellspalsy/treatment.shtml
  4. http://www.ncbi.nlm.nih.gov/pubmed/18646144?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=3
  5. http://www.ncbi.nlm.nih.gov/pubmed/18520590?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=5
  6. http://www.ncbi.nlm.nih.gov/pubmed/17079755?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=8
  7. http://www.ncbi.nlm.nih.gov/pubmed/16573245?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=13
  8. http://www.ncbi.nlm.nih.gov/pubmed/15345630?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=19
- Last updated 17 Jun 2010,9:54 am




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