Bell's palsy occurs when the nerve that controls facial muscles on one side of your face becomes swollen or inflamed. As a result of Bell's palsy, your face feels stiff. Half your face appears to droop, your smile is one-sided, and your eye resists closing. Bell's palsy can affect anyone, but rarely affects people under the age of 15 or over the age of 60. For most people, Bell's palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell's palsy, sometimes on the other side of the face. A small number of people continue to have some Bell's palsy signs and symptoms for life.

Complications of Bell’s palsy

Although a mild case of Bell's palsy normally disappears within a month, recovery from a case involving total paralysis varies. Complications may include:

• Irreversible damage to your facial nerve.
• Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you're trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close.
• Partial or complete blindness of the eye that won't close, due to excessive dryness and scratching of the cornea, the clear protective covering of the eye.

Causes of Bell’s palsy

The most common cause of Bell's palsy appears to be the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell's palsy include:

• The virus that causes chickenpox and shingles (herpes zoster)
• The virus that causes mononucleosis (Epstein-Barr)
• Another virus in the same family (cytomegalovirus)

With Bell's palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen — usually from a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Signs & Symptoms of Bell’s palsy

Signs and symptoms of Bell's palsy come on suddenly, and may include:

• Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days — making it difficult to smile or close your eye on the affected side.
• Facial droop and difficulty making facial expressions.
• Pain around the jaw or in or behind your ear on the affected side.
• Increased sensitivity to sound on the affected side.
• Headache.
• A decrease in your ability to taste.
• Changes in the amount of tears and saliva you produce.

In rare cases, Bell's palsy can affect the nerves on both sides of your face.

Diagnosis of Bell’s palsy

No specific laboratory test can confirm a diagnosis of Bell's palsy. Your doctor may be able to make a preliminary diagnosis of Bell's palsy by looking at your face and asking you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.

Other conditions — such as a stroke, infections, Lyme disease and tumors — also may cause facial muscle weakness, mimicking Bell's palsy. If your diagnosis is still in question, your doctor may recommend other tests, including:

• Electromyography (EMG). This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
• Imaging scans. An X-ray, magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to eliminate other possible sources of pressure on the facial nerve, such as an infection, tumor or skull fracture.

Treatments of Bell’s palsy

Most people with Bell's palsy recover fully — with or without treatment. But your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.

Medications
Study results have been mixed regarding the effectiveness of two types of drugs commonly used to treat Bell's palsy: corticosteroids and antiviral drugs.

• Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it.
• Antiviral drugs, such as acyclovir or valacyclovir, may stop the progression of the infection if a virus is known to have caused it.

Some clinical studies show benefit from early treatment with corticosteroids, antivirals or a combination of both types of drugs. Other studies don't. Evidence of the effectiveness of corticosteroids appears to be stronger than that for antiviral drugs, and they tend to be most effective when given within three days of the appearance of symptoms.

Physical therapy

Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery

One way to relieve the pressure on the facial nerve is to surgically open the bony passage through which it passes. This decompression surgery is controversial and rarely recommended. In some cases, however, plastic surgery may be needed to make your face look and work better.

When to seek Medical Advice

• Seek immediate medical help if you experience paralysis, because you may be having a stroke. Actual Bell's palsy is not caused by a stroke.
• See your doctor if you experience facial weakness or drooping, to determine the underlying cause and severity of the illness.

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