Otolaryngology–Head and Neck Surgery
Bell’s Palsy
Overview
Bell’s palsy is the most common cause of facial paralysis as it affects 20-30 people per 100,000 each year. In typical cases, people either wake up with one side of their face not working, or they notice weakness developing on one side of their face over hours, or up to three days. The weakness occurs in the forehead, eye, cheek and lip. It is common for people to have changes in taste, sensitivity to loud noises and dull pain behind or around the ear.
Bell’s palsy may be either acute or chronic. Acute means it happens suddenly – the patient is unable to close their eye, move their face, or their face has “fallen.” Chronic (or post-paralysis facial palsy) happens during recovery from acute Bell’s palsy. The nerves overgrow and crisscross, so patients have facial tightness, synkinesis (unwanted movement with wanted movement), and can also have a restricted smile.
Common Causes
While its cause is not entirely proven, most data point to the reactivation of the herpes simplex virus. This rather common virus is usually acquired in early childhood and stays dormant within the cranial nerves. The virus gets “activated” by a triggering event such as stress, fatigue, immunosuppression or acquiring another illness.
Common Symptoms
In the early phases of Bell’s palsy, the most important issue is protecting the eye since people are unable to effectively blink. Eye drops are used during the day, and thicker ointments and gels at night. Taping the eye so that it stays shut during sleep is also extremely common practice. Those who recover to completely normal usually do not need physical therapy or other interventions.
When a patient has been diagnosed with Bell’s palsy, it’s important to be certain that no other condition is being missed. If the weakness is fully evolved – meaning no longer changing for the worse – within 72 hours of onset, and the patient experiences some evidence of recovery within four months (even the tiniest bit), then it is likely to represent Bell’s palsy. However, if the condition develops more slowly, for example over weeks to months, or if the condition shows absolutely no sign of resolution in the first four months, then more thorough diagnostic testing should be performed to be certain that another kind of pathology is not being missed.
Treatment Options
Approximately 70% of people who develop Bell’s palsy recover completely. Most clinicians agree that steroids speed up and improve the overall outcome. There is more controversy surrounding whether antiviral medications also help, but in general the data points to valacyclovir as having a modest benefit to overall recovery.
Many patients with facial paralysis lose the ability to completely close their eye on the affected side of their face. This incomplete closure increases the risk of corneal irritation, injury and infection, as closing the eyelid protects the cornea from foreign objects and helps the eye stay lubricated. At the Facial Nerve Center, we perform surgical treatments to help patients protect their eyes and prevent them from drying out. These treatments include thin-profile platinum weight placement, lower lid tightening, lower lid suspension and tarsorrhaphy. However, often there will be a period between when patients lose movement in their face and when they can undergo surgery to help them close their eyes better. It is vital to protect the eye during this period. Other times, when the face is expected to recover, patients do not need surgical treatment but only need to use drops and other strategies to protect their eyes during the recovery period.
At the Facial Nerve Center, we also have a well-established eye care regimen that we recommend for patients having trouble closing their eyes. During the day, patients should use artificial tears whenever their eyes feel scratchy, irritated, and/or dry (even as often as hourly). These keep the eyes lubricated without blurring vision. At night, we recommend patients use an ophthalmic lubricant ointment as this provides longer lasting lubrication than drops provide. In addition, patients often need to tape their affected eye closed at night with a single piece of Transpore or similar tape. Lastly, we recommend performing upper eyelid stretching twice daily. These strategies will help patients protect their eyes as they recover from facial palsy.
Our Team
The Facial Nerve Centeris staffed by surgeons, physical therapists, physician assistants and other medical specialists skilled in the evaluation and treatment of facial paralysis. Our team includes Kerry Shanley Camp, PA-C, Madeline Macaluso, FNP-BC, Julia Mellon, NP-C, and Mara Robinson, PT, MS. This combination of medical expertise allows us to help patients improve their appearance, facial function, non-verbal communication and overall well-being.
