Bell’s Palsy Treatment IA
Bell’s palsy is damage or trauma to the facial nerve resulting in temporary facial paralysis. Cranial nerve VII is also called the facial nerve. It travels through a bony canal called the fallopian canal, where the nerve exits the skull beneath the ear and controls muscles on a side of the face. Each facial nerve controls half the muscles on the face for eye blinking and closing, along with facial expressions. Your ability to smile or frown is a result of the facial nerve on that side of the face (lateral). Cranial nerve VII also controls the lacrimal gland and your ability to produce tears, in addition to controlling secretion of the saliva glands and taste sensation for some of the tongue.
Compression or injury to the facial nerve anywhere on its path from the brain to the muscles can result in facial weakness or paralysis. Compression can occur inside the bony canals or after it exits the skull by the ear. Usually Bell’s palsy only affects one side of the face, but in rare cases it can affect both sides.
Most people develop Bell’s palsy idiopathic, as in without any precipitating cause or reason for onset. Many people think that when they wake up in the morning and are unable to move their face, that they have suffered a stroke. Strokes are an emergency and require immediate medical evaluation. This condition is not related to a stroke and is the most common cause of facial paralysis. Bell’s palsy affects men and women equally and occurs at any age. It is less common in individuals younger than 15 and older than 60. It is much more common in people with diabetes and upper respiratory conditions. Bell’s palsy is named after Sir Charles Bell, the Scottish surgeon who first described the condition in the 19th century.
Symptoms of Bell’s Palsy
Symptoms of Bell’s palsy include dysfunction of what the nerve normally carries out. The most common cause is disruption of facial control and the ability to close the eye. Symptoms can range from very mild in some people and severe and others. Mild cases could include symptoms of twitching and mild loss of facial control. Severe cases may result in drooping of the eyelid and corner of the mouth, dryness of the eyes, impairment of taste, mouth dryness, and excessive tearing in one eye.
Most cases of Bell’s palsy are short-term and only last one to two months. In mild cases, peak intensity of symptom loss occurs around 48 hours and slowly improves over the next two months. In some cases people describe pain or discomfort around the jaw and behind the ear. Some individuals experience ringing in one or both ears, while others suffer from headaches, loss of tastes, and hypersensitive to sound on the affected side. Impaired speech, dizziness, and difficulty eating or drinking also occur.
Causes of Facial Nerve Paralysis
Bell’s palsy is the result of swelling, compression, or inflammation around the facial nerve. It is unknown what exactly causes Bell’s palsy in most cases, as most are not related to direct trauma.
Most scientists believe that a viral infection is the most common cause, such as viral meningitis or a common cold sore virus. Herpes simplex virus, which causes cold sores, is the most likely offender in many cases. The facial nerve swells and becomes irritated in reaction to the infection around the nerve. The excessive swelling and fluid produced from the infection results in compression of the nerve inside the fallopian canal, leading to nerve damage. In mild cases of Bell’s palsy, the damage only affects the myelin sheath that surrounds the nerve, in which case recovery is much faster. Severe cases with greater nerve compression and damage lead to more symptoms and a longer recovery.
The disorder has been associated with headaches, chronic ear infections, diabetes, tumors, Lyme’s disease, influenza, flu-like illnesses, high blood pressure, and trauma such as skull fractures or facial injury.
Diagnosis for Damage to Cranial Nerves VII
A distorted facial appearance and inability to move face muscles on one side of the face leads to a diagnosis of Bell’s palsy. Your physician or primary care doctor will examine the location and severity of facial weakness. Most cases are limited to the forehead, eyelid, or mouth. Your doctor may order an EMG (electromyography) to confirm the presence of nerve damage and severity. Blood tests may be ordered to look for concurrent problems associated with Bell’s palsy, including diabetes mellitus or a viral infection. An MRI (magnetic resonance imaging) or CT (computed tomography) can rule out or eliminate other structural causes of compression on the facial nerve inside the bony skull, including cancerous growths or tumors.
Other causes of facial paralysis are excluded leading to the diagnosis. There are not any specific laboratory tests to confirm diagnosis of Bell’s Palsy.
Bell’s Palsy Treatment
Most individuals will respond and recover completely in one to two months without treatment. Very mild cases can be expected to improve within two weeks. In severe cases, the condition can be improved with corticosteroids or antiviral medications. Prescription steroids such as prednisone can be used to decrease inflammation and swelling, which helps reduce the compression around the facial nerve. Antiviral medications such as acyclovir, which can be used to control viral herpes zoster or herpes simplex infections, can be utilized if given within the first 72 hours of onset. The effectiveness of antivirals has been debated for patients who experience facial palsy. Patients treated with antiviral agents may experience some relief of symptoms and it may be helpful in reducing the overall recovery time. Clinical studies and research articles have shown mixed evidence of significant improvement from the antiviral drug medications, which need to be taken within days of clinical onset to have an effect on herpes simplex virus expression. More information on corticosteroids and antiviral medications can be researched and referenced on American Academy of Neurology Bell’s Palsy guidelines. Many people benefit from analgesics and NSAID (nonsteroidal antiinflammatory drugs) such as aspirin, acetaminophen, or ibuprofen taken at home to relieve pain and discomfort.
Complications of Bell’s palsy may require additional treatment if it affects the eyes’ ability to close and natural blinking ability. In these cases, the eyes are exposed to excessive irritation or drying. These patients may require additional treatment to help keep the eye moist and protected from debris. Eye drops or artificial tears may be prescribed by your healthcare provider. Some people prefer wearing eye patches to close and protect the eye to reduce dryness and discomfort.
Physical therapy or physical medicine treatments can be utilized to help stimulate the facial nerves’ repair and regeneration. Facial massage and exercises help stimulate the nerve and may prevent permanent contractures. Moist heat can also help control facial pain and increase blood flow to the facial nerve. Information and recent news has shown rest, daily relaxation techniques, acupuncture, electrical stimulation, biofeedback, and vitamin therapy, including oral B12, B6, and zinc, may help improve nerve function.
Cold laser therapy is a newer treatment used to help stimulate nerve regeneration and repair, and is commonly used in many types of neuropathy or nerve entrapment syndromes. Specific wavelengths and frequency of low level laser enhance nervous regeneration and repair. Numerous articles, reviews, and trials have shown nerve regeneration and improvement in peripheral neuropathy, diabetic neuropathy, nerve compression entrapments, and crush injuries. Trials of low level laser therapy with a class IV cold laser enhanced cellular repair mechanisms and activities inside of nerves. The increased nerve metabolic activities enhance a nerve’s recovery time and function. When Bell’s palsy is caused by a nerve entrapment or infection causing compression of the facial nerve, then it is likely the nerve would respond to cold laser. Low level laser therapy may enhance the overall recovery and treatment in individuals who experienced compression and damage to the facial nerve. Low level lasers are also in the news for their ability to decrease inflammation and pain after acute and chronic injuries.
Surgical decompression for Bell’s palsy is seldom recommended. Surgical intervention would be aimed at relieving pressure on the nerve inside the bony canal. Very rarely do patients require cosmetic or reconstructive surgery to correct deformities and damage that has occurred due to damage to the eyelid or improve a crooked smile. These cases are very rare. Severe cases may benefit from a referral to a neurologist, ophthalmologist, or craniomaxillofacial surgeon for evaluation and additional treatment.
Expectations and Prognosis
Research and studies have shown patients recover from Bell’s palsy without any long-term consequences, in most cases. The extent and level of nerve damage determines the severity of the condition and the time for recovery. Most individuals with mild cases recover within one to two months. Moderate cases may require 3 to 6 months to return to normal function of blinking, smiling, and facial control. More severe cases may take longer. And very rarely do people experience long-term limitation from the disorder.
If you suspect Bell’s palsy, it is important to consult your doctor and be evaluated to rule out more severe cases of neural compression or damage. Once the clinical diagnosis has been made, treatment options can be discussed with your physician for prescription medication, physical medicine, or cold laser treatments. More severe cases will require a more aggressive treatment for a full recovery, while mild cases can expect to improve on their facial nerve function, control of facial muscles, and ability to smile within a short time of onset.
Links for more Information
American Academy of Neurology Bell’s Palsy Guidelines