Bell's palsy is a paralysis of the facial muscles that control movement and expression. Each year, about 40,000 Americans develop the condition; most are over 40, although the disorder can occur at any age. Paralysis, which occurs on one side of the face, is usually temporary. The symptoms include an inability to close one eye plus weakness and lack of muscle tone on the affected side. The face may feel as if it is twisted, and speaking and eating may become difficult. In some cases, one side of the mouth droops and the senses of taste and hearing are impaired. The eye may also become abnormally dry. Bell's palsy usually develops rapidly, often coming on overnight, but some patients recall a warning pain behind the ear a few hours to a few days before the onset. The paralysis is thought to be caused by a swelling of the facial nerve that runs from the brain to the face. As the nerve swells, it becomes compressed within the surrounding bony enclosure. The underlying cause is unknown, but because Bell's palsy often follows an earache, cold, or other viral infection, some doctors believe that a virus may be involved. Injuries to the head and pregnancy have also been implicated. In80 to 90 percent of cases, Bell's palsy is a temporary condition. If paralysis begins to reverse by the end of the second week, the prognosis for a full recovery is good.
Diagnostic Studies and Procedures
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Most occurrences can be diagnosed by the characteristic symptoms and their rapid onset. If there is any doubt, a doctor will order X-rays and perhaps a CT scan or MRI of the skull to rule out a tumor, fracture, or bone erosion. Blood tests can help detect a possible underlying infection. If facial paralysis persists, nerve conduction tests or electromyography(EMG) may be ordered to assess the extent of nerve activity and damage.
Medical Treatments
Treatment for this condition is some what controversial. Because most cases resolve themselves without therapy, some doctors advise a wait and see policy. Others advocate prompt medical intervention in the hope of shortening the course of the paralysis. If improvement fails to occur within two weeks, treatment is advisable. There are two approaches: The most common entails taking corticosteroid drugs such as prednisone to reduce nerve swelling and inflammation. Typically, the drug is given in high doses for five days, and then tapered off and stopped over the next five days. Sometimes surgery is performed to widen the bony canal that surrounds the facial nerve. But this operation is done only as a last resort.
Alternative Therapies
Alternative therapies for Bell's palsy are even more controversial than those of conventional medicine, because their efficacy is doubtful. Those that are sometimes suggested include.
Acupuncture
Stimulation of meridians controlling nerves in the head and face is said to reduce swelling and reverse paralysis, provided the nerve has not been permanently damaged.
Aromatherapy
Facial massage using aromatic oils can prevent muscle spasms and may speed recovery.
Herbal Medicine
Traditional Chinese herbalists recommend the Pueraria combination, which is made up of kudzu root, mahuang, ginger, jujube fruit, cinnamon, peony root, and licorice for acute numbness of facial nerves, and a combination of cinnamon, atractylodes, and aconite for chronic disorders of these nerves.
Self Treatment
Self care is directed to preventing long term eye damage and alleviating symptoms while awaiting recovery. Because you probably will not be able to blink or close your eye, it should be protected with an eye patch, especially while sleeping. Artificial tears or medicated eyedrops help to alleviate eye dryness. Special facial exercises and self massage can prevent long term contracture and damage to the facial muscles. A physical therapist can prescribe exercises to do at home. Wearing a splint helps to prevent drooping of the lower part of the face. A doctor or physical therapist can supply an appropriate one, or you can fashion your own from a long strip of cotton or linen. Chewing and swallowing may be difficult, so avoid foods that can cause choking. In fact, you may want to switch to a liquid diet until the paralysis disappears.
Other Causes of Facial Paralysis
Infection, Guillain Barre syndrome, Lyme disease, shingles, stroke, or a tumor are among the many other causes of facial paralysis. Spasms of the facial muscles, called hemifacial spasm, can cause symptoms similar to those of Bell's palsy. In rare cases, women develop a condition called facial hemiatrophy of Romberg, which entails loss of fatty tissue just under the skin. This disorder progresses slowly, resulting in facial atrophy and distortion.
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