Bell’s Palsy

Creator: Dr. Sneha Kannan
Published: 2019-01-25T12:27:21

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Bell's palsy, also known as facial palsy, is a condition that causes sudden and temporary weakness or paralysis of the facial muscles. The below article details the same.

Written by

Dr. Sneha Kannan

Medically reviewed by

Dr. Nene Devavrat Harihar

January 25, 2019

December 27, 2023

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Contents

What Is Bell’s Palsy?
What Causes Bell’s Palsy?
What Are the Symptoms of Bell's Palsy?
What Are the Risk Factors of Bell's Palsy?
How Is Bell's Palsy Diagnosed?
How Is Bell's Palsy Managed or Treated?
What Are the Complications of Bell's Palsy?
What Is the Prognosis For Bell's Palsy?

What Is Bell's Palsy?

Bell's palsy, also called facial palsy, causes sudden or temporary paralysis, or weakness, of facial muscles. The condition was first described by a Scottish surgeon, Sir Charles Bell, in the 19th century. The exact cause is unknown, but experts believe it may occur as a reaction after a viral infection, causing swelling and inflammation of the nerve that controls facial muscles (seventh cranial nerve). The weakness makes a facial droop on one side or, rarely, both sides. In addition, there is a lopsided or one-sided smile and an eyelid that resists closing. These effects usually improve within a few weeks, with complete recovery in about six months. But unfortunately, some people may continue to have some Bell's palsy symptoms for life. Rarely Bell's palsy occurs more than once in a lifetime, and the recurrence is most likely to happen within two years of the first incident.

What Causes Bell's Palsy?

The exact reason for Bell's palsy is still unknown, but the incidence of Bell's palsy is related to exposure to a viral infection, which causes inflammation of the facial nerve. The condition typically occurs when swelling or inflammation from a viral infection temporarily puts pressure on the nerve that controls facial muscles (seventh cranial nerve). This pressure damages the nerve function, making it difficult to control facial muscles or expressions. However, as the inflammation subsides, the nerve starts functioning again. Viruses that are known to cause Bell's palsy include:

Infectious mononucleosis (Epstein-Barr).
Cold sores and genital herpes (herpes simplex).
Chickenpox and shingles (herpes zoster).
Cytomegalovirus infections.
German measles (rubella).
Respiratory illnesses (adenovirus).
Mumps (mumps virus).
Flu (influenza B).
Hand-foot-and-mouth disease (coxsackievirus).
HIV (human immunodeficiency virus).

What Are the Symptoms of Bell's Palsy?

Bell's palsy symptoms often come suddenly and reach peak severity within 48 to 72 hours. While some people may develop mild symptoms, others may experience complete paralysis.

The symptoms start improving gradually in three weeks. Approximately 80 % of people fully recover and show no signs or symptoms of Bell's palsy within three months. Some of the signs and symptoms of Bell's palsy include: In addition to facial drooping, signs of Bell's palsy include:

Facial drooping.
Drooling.
Difficulty speaking, eating, or drinking.
Difficulty making facial expressions on the affected side.
Twitching of the facial muscles.
Loss of taste.
Dry eyes.
Facial or ear pain.
Headache.
Ringing in the ears (tinnitus).
Sensitivity to sounds.
Reduced tears and saliva production.
Occasional facial numbness.
Usually, one side of the facial nerve is affected, but nerves on both sides are involved in sporadic cases, causing bilateral symptoms.

What Are the Risk Factors of Bell's Palsy?

Bell's palsy can equally affect men and women of any age. However, people with the following conditions are more prone to Bell's palsy:

Diabetes.
Autoimmune disease.
Family history of Bell's palsy.
Cold sores (herpes simplex virus).
High blood pressure (hypertension).
Mononucleosis (Epstein-Barr virus).
Shingles (herpes zoster virus).
Pregnancy, particularly during the third trimester and a week post- delivery.
Upper respiratory tract infections, such as cold and flu.

How Is Bell's Palsy Diagnosed?

There is no specific diagnostic test for Bell's palsy. Instead, the healthcare provider can diagnose the condition based on its symptoms. Other conditions, such as stroke, sarcoidosis, infections, and Lyme disease, can also cause facial paralysis that resembles Bell's palsy. So, if the symptoms are not apparent, the healthcare provider may recommend the following tests to rule out the other causes:

Blood Tests: Blood tests can be done to rule out conditions such as Lyme disease or other infections.
Electromyography (EMG): This test can be done to measure nerve damage and its severity. The test also helps the provider predict how quickly the person with Bell's palsy will recover.
Magnetic Resonance Imaging (MRI) or Computed Tomography (CT): These scans are done to rule out other sources of pressure on the facial nerve, like tumors or skull fractures.

How Is Bell's Palsy Managed or Treated?

Bell's palsy often improves with or without treatment. There is no specific treatment for Bell's palsy. Still, the healthcare provider may recommend one or more of the following medications or physical therapy for symptom relief and faster recovery:

Medications:

Oral corticosteroids, such as Prednisone, are powerful anti-inflammatory agents that reduce nerve swelling and help regain facial movement faster. Corticosteroids are most effective when they are started within 48 hours of noticing symptoms. In addition, when started early, corticosteroids improve the likelihood of complete recovery.
Antiviral drugs, such as Acyclovir for herpes, may speed recovery, although it is still unclear how beneficial they are. When combined with oral corticosteroids, antivirals may benefit some people with Bell's palsy, but it is still unproven. Antiviral drugs, such as Valacyclovir or Acyclovir, are sometimes prescribed in conjunction with Prednisone in people with severe Bell's palsy.
Eyedrops, such as artificial tears, help soothe dry, irritated eyes. However, if the eyelid does not close, one may need to wear an eye patch to protect the eye from injuries and irritants.

Physical Therapy:

A physical therapist can help teach how to massage and exercise the facial muscles to help prevent paralyzed muscles from shrinking and shortening.

Surgery:

Decompression surgery was initially used to lessen the pressure on the facial nerve and ease pressure on the nerve. But now, it is rarely performed because of the risks associated with this surgery, including permanent hearing loss and facial nerve damage.
Facial reanimation surgery may be used to make a face look more even and restore facial movement. Such surgeries include an eyelid lift, eyebrow lift, facial implants, and nerve grafts.

What Are the Complications of Bell's Palsy?

Usually, the Bell's palsy symptoms fade after a couple of weeks, and people recover fully within six months. But severe cases of total paralysis may cause the following complications:

Irreversible facial nerve damage.
Synkinesis: The irregular or abnormal regrowth of nerve fibers may result in the involuntary contraction of certain muscles when trying to move other muscles. For example, when a person tries to smile, the eye on the affected side closes on its own.
Partial or Complete Blindness of the Eye: The eye becomes dry because of the inability to close the eyelids. This happens due to excessive dryness and scratching of the clear protective covering of the eye called the cornea.

What Is the Prognosis For Bell's Palsy?

The prognosis for people with Bell's palsy is usually good. Most people with Bell's palsy recover with or without treatment. However, it is essential to notice a gradual lessening of symptoms within a few weeks. Complete recovery can take two to six months, depending on the severity of nerve damage. In rare cases, people never fully recover. Call a doctor immediately if a person experiences symptoms of Bell's palsy. Early diagnosis and treatment can help speed up recovery.

Conclusion

Bell's palsy, also called facial palsy, causes sudden or temporary paralysis, or weakness, of facial muscles. Fortunately, the symptoms gradually fade with time, with or without treatment. This is usually a temporary condition, but it can still require a lot of patience as one must wait for the facial nerves and muscles to start working again. See a healthcare provider when the symptoms first appear. Medications and physical therapy help speed up the recovery. Surgery is rarely an option for this condition.

Frequently Asked Questions

1. Does Bell's Palsy Go Away?

Most of the time, Bell's palsy is not known to be permanent, but it does not go away in certain rare situations. Also, there is no discovered cure to treat Bell's palsy. However, the recovery period usually begins by two weeks to six months, starting from the onset of the symptoms. Most of the time, people affected with Bell's palsy recover full facial strength and expressions and come back to normal.

2. Does Stress cause Bell's Palsy?

Many researchers have studied that stress can weaken the immune system and can damage the seventh cranial nerve. It is named as the facial nerve. Any damage to the facial nerve causes facial paralysis. The condition presents as one side of the affected person's face droops and becomes stiff. A Bell's palsy patient will face trouble in activities like smiling or closing the eye on the affected side of the face.

3. Is Bell's Palsy a Sign of a Stroke?

Bell's palsy is a medical condition that causes temporary paralysis of the facial muscles, which leads to drooping and weakness on any one side of the face, and it is, most of the time, mistaken for a stroke. Unlike a stroke, Bell's palsy usually is not permanent, and it resolves by itself in a period of two weeks to six months, which depends on the severity.

4. Is Bell's Palsy Serious?

Bell's palsy is a medical condition that usually resolves by itself with time, and it does not cause any long-term complications. However, most people affected by Bell's palsy are known to have an inability to close their eyes on the affected side of their faces during the disease process. There are some specific difficulties and can be treated symptomatically.

5. Can High Blood Pressure Cause Bell's Palsy?

Yes, Bell's palsy is sometimes noted to be associated with disease conditions like diabetes mellitus and very high blood pressure.

6. Does Chewing Gum Help Bell's Palsy?

The information that chewing gum helps Bell's palsy is a myth. Patients are often advised to chew gum when they are diagnosed with Bell's palsy. However, the reality is that chewing is performed by the muscles of mastication that are chiefly supplied by the trigeminal nerve. In Bell's palsy, the affected nerve is the facial nerve. Thus, chewing gums during Bell's play might, in turn, increase facial synkinesis. It will not help the condition.

7. Is Bell's Palsy a Medical Emergency?

There are certain medical conditions, like a stroke, that might often look like Bell's palsy and are medical emergencies. Therefore, the affected individual should always seek emergent medical care if he or she notices any facial weakness or drooping. Bell's palsy might appear alarming but is only rarely serious.

8. What Are the Recovery Signs of Bell Palsy?

Though the recovery time varies from person to person based on the severity, most affected individuals recover entirely, especially those who start to improve by three weeks after the onset of symptoms. The signs of recovery are usually a gradual decrease in the symptoms of the disease like the ability to open eyes well, and the ability to chew.

9. What Happens If Bell's Palsy Is Untreated?

All untreated patients of Bell’s palsy do not suffer from severe complications. About one-third of the patients who do not undergo treatment for Bell’s palsy are known to be affected by health issues like spasms of the face and pain. However, some of the affected populations suffer from permanent muscle weakness due to the lack of treatment.

10. Can I Go to Work With Bell's Palsy?

When Bell’s palsy is first diagnosed in a person, he or she should understand that they are unwell. It is important to get as much rest as possible even if the person has no other symptoms. The affected person should also follow a healthy diet. If the person is at work or school, it might be necessary to take some time off to recover. Still, if the person feels mentally strong, the person can still work if needed.

11. How Can I Recover From Bell's Palsy Fast?

The following are different ways for a speedy recovery from Bell's palsy. Always do not panic. Consult the doctor at once the symptoms are experienced and follow the doctor's recommendations strictly. Take adequate rest and sleep as much as possible. Avoid going to work for at least several days until you adapt to the disease condition. Protect your affected eye from getting dry. Follow up properly as recommended by the doctor.

12. What Should I Eat If I Have Bell's Palsy?

A healthy diet is very mandatory for functional recovery from Bell's palsy. However, it is good to avoid certain hard foods, chewy foods since these foods can be challenging to chew. So, choose a soft, natural chew diet like foods that include pasta, fish, deeply cooked meats, and vegetables. Also, try smaller mouthfuls of foods since that could be easier to control and less likely to spill your food from your mouth.

13. Do Facial Exercises Help Bell Palsy?

Yes, facial exercises help with the prognosis of Bell's palsy patients. It helps by increasing muscle strength and also improving the coordination in the face. In that way, Bell's palsy patients could improve their capability in performing certain facial movements like jaw and mouth movements.

14. How Do You Smile With Bell's Palsy?

The facial weakness caused during Bell's palsy makes half of the affected person's face appear to be dropped. Their smile is one-sided, and their eyes on the affected side resist to close normally.

15. Is Vitamin B12 Good for Bell's Palsy?

Vitamin B12 formulations have been showing to be very beneficial to people who are affected by Bell's palsy. Vitamin B12 deficiency could lead to nerve degeneration. Therefore, both oral tablets and also injected vitamin B12 are being used to treat many types of nerve disorders like the Bells' palsy.

16. Why Is Bell's Palsy So Painful?

In Bell's palsy, pain and discomfort are usually noted to occur on one side of the face or head. This condition mainly results due to the sudden unexplained damage to the facial nerve that can be because of many causes.

17. Will My Face Go Back to Normal After Bell's Palsy?

Many people note an improvement in their symptoms like weakness and inability to close their eyes on the affected side after two to three weeks. Still, complete recovery can happen after a period ranging between three and six months. While most people recover with treatment, only some patients are left with some degree of permanent facial weakness, mainly due to the lack of proper medical care.

18. How Is Bell's Palsy Transmitted?

Bell's palsy is a medical condition that occurs when the seventh cranial nerve known as the facial nerve becomes swollen or compressed due to any cause. That, in turn, results in facial weakness or paralysis. The exact etiology of this damage is unknown, but many researchers believe a viral infection mostly triggers it.

19. Where Do You Massage for Bell's Palsy?

Facial massage in people affected with Bell's palsy can help alleviate the disease’s symptoms and maintain adequate flexibility and circulation in those affected muscles. The massage should be done at the affected side of the face involving all muscles from the forehead to the chin.

20. How Do You Know Bell's Palsy Is Getting Better?

In Bell's palsy, there are sure signs of recovery usually that include the ability to smile correctly, to squint, blinking, or closing the eyelid, which is not typically possible easily during the disease. Patients in their recovery course also tell that their feelings in their faces feel back to normal as before.

21. Are There Any Home Remedies for Bell's Palsy?

Along with a healthy diet, you can do your physical therapy exercises as instructed by your physiotherapist. Massaging and exercising your face frequently according to your physical therapist's advice will help in relaxing your facial muscles. Above all, adequate rest is mandatory to speed up the disease process.

22. Can Bell's Palsy Affect the Brain?

In some mild cases of Bell's palsy, the recovery is very rapid. Therefore there is damage only to the myelin sheath of the facial nerve. The brain is not affected by Bell's palsy.

23. What Are the Long Term Effects of Bell's Palsy?

Bell's palsy is a disease that usually resolves itself with time, and it does not cause any long-term complications. However, most people affected by Bell's palsy are known to have an inability to close their eyes on the affected side of their faces during the disease process. These are the difficulties during the disease that can be treated symptomatically.

24. Is Bell's Palsy an Autoimmune Disease?

Studies suggest that Bell's palsy is most probably an autoimmune condition. A viral infection might prompt an autoimmune reaction against a segment of the peripheral nerve myelin, leading to the demyelination of the facial nerve.

Sources

Dr. Nene Devavrat Harihar

Neurology

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