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Bells Palsy
Bell’s palsy a condition characterized by acute (occurring suddenly) idiopathic (arising from an unknown cause) weakness or paralysis on one side of the face. It is caused by a dysfunction of the facial nerve, otherwise known as the seventh cranial nerve, from reactivation of a herpes virus at the geniculate ganglion in most cases.
Typically, only one side of the face will be affected by Bell’s palsy, but both sides can be involved in rare cases. Patients 15-40 years of age are most commonly affected; however, it can occur at any age.

Most patients will recover spontaneously within a month, but some may take longer. Recovery is usually complete but severe cases (up to 30%) may be incomplete, leading to permanent weakness of one side of the face. This may only be noticeable when the patient makes a facial expression such as smiling.

Other than the obvious disfigurement, the most serious problem associated with Bell’s Palsy is potential injury to the cornea of the eye from an inability of the eye to blink, and oral incompetence (inability to hold liquid in the mouth).

All patients with Bell’s Palsy will have drooping on one side of the face to some degree, but the different branches of the facial nerve (there are five) may be affected to varying degrees, leading to more weakness in one region of the face than others in some cases. Patients with Bell’s Palsy may also experience mild pain, numbness, and increased sensitivity.

Many patients with Bell’s Palsy will seek care from an Emergency Department, believing they have had a stroke. They will often undergo CT and/or MRI scanning of the brain, which is unnecessary and not recommended, as stroke does not present with facial weakness on one side as an isolated finding.

The currently approved treatment for Bell’s palsy is oral steroids (prednisone), typically given as a taper (reducing amount over one to two weeks) at a starting dose of one milligram per kilogram of body weight. Anti-viral medications (acyclovir or valacyclovir) are also often prescribed, but their benefit has not been firmly established. Steroids are usually most beneficial when administered early on (within 72 hours) of the onset of symptoms in Bell’s Palsy.

In cases where the patient cannot close their eye on the affected side, it is extremely important to keep their cornea lubricated and moisturized to avoid drying and possible corneal abrasion (potential loss of vision). This is accomplished with an ophthalmologic lubricating gel such as Lacrilube and artificial tears (lubricating eye drops) used every few hours. Many patients will also tape their eye shut at night when sleeping. If you have Bell’s Palsy and your eye appears red or irritated, it is extremely important that you see an ophthalmologist as soon as possible.

In severe cases of Bell’s Palsy where there is complete paralysis, special tests are performed to determine whether any nerve function is still present, and surgical decompression may be necessary to prevent permanent injury to the nerve. However, this is only of value within two weeks of the onset of the paralysis.

Bell’s palsy is distinct from a more serious disorder involving paralysis of the facial nerve known as Ramsay-Hunt syndrome, which also includes ear pain and a vesicular rash in the ear canal or on the side of the face, though the two conditions may be difficult to differentiate early on. In contrast to Bell’s palsy, Ramsay-Hunt syndrome is caused by a reactivation of the varicella zoster (chickenpox) virus. Like Bell’s palsy, it is treated with steroids and anti-viral medication. Patients can also experience hearing loss, ringing in the ear, dizziness, vertigo, nausea, and nystagmus (involuntary eye movements), and the prognosis for recovery of facial nerve function is worse than in Bell’s palsy.

If you believe you have Bell’s palsy, you should see a specialist like Dr. Paul Shea at the Shea Clinic at your earliest convenience.

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