Bell's Palsy

Bell's Palsy

Been treating a couple of patients with Bell’s Palsy recently. A condition that has no small psychological impact. If you know someone who has it, they need to access treatment ASAP. Please contact the clinic for more information.

What is it?

 

Bell’s palsy is a condition where the facial nerve (7th cranial nerve) becomes inflamed or compressed. This nerve controls the muscles of facial expression, also the digastric and stylohyoid muscles which help with chewing and swallowing. Compression of the facial nerve causes paralysis of the ipsilateral (same side) of the face and difficulty swallowing. The paralysis is usually temporary and can last between two weeks to six months.

CAUSE:

The exact cause of Bell’s palsy is unknown , however it has been linked to viral infections such as herpes (cold sore) flu and upper respiratory chest infections. It is more prevalent in people with microvascular (sometimes called small artery disease or small vessel disease) disease, such as diabetes or hypertension (raised blood pressure). It is more common in pregnancy due to increased water retention in the body. Autoimmune disease causing demyelination (protective coating of nerve cells, experiences damage) of the nerve can also cause Bells Palsy. It is also found to be more common in winter; cold/wet weather inflaming the nerve is the suspected cause.

SYMPTOMS:

bell's palsy facial nerve

With the facial nerve compromised, the muscles it innervates become weak, or stop working completely. This means the eye droops, but also can’t close completely; the mouth droops, it is difficult to eat as food collects in the cheek.

It is difficult to smile or frown or purse lips. The eye on the affected side can become dry, irritated and sensitive and you can become sensitive to noise on the affected side (hyperacusis). Occasionally taste can be lost in the front of the tongue. Although very distressing, the facial paralysis is usually temporary. For a small number of people, it is not permanently resolved, and it is critical to have diagnosis and treatment as quickly as possible.

 

HOW CAN IT BE TREATED?

Start within 72 hours of developing symptoms. See your GP as an emergency. Evidence shows it is critical to recovery to begin medication as soon as possible.

Initially steroids are given for at least a week. These reduce swelling significantly and reduce nerve compression, so improving the likelihood of recovery. Antiviral medication can also be given as evidence shows that this may be of benefit for those with severe weakness. If other causes of the Palsy are identified, treatment targeting the causal factors might be added to these foundation treatments.

The eye can become dry and irritated. It dries out as the lid will not cover it completely. Covering the eye and taping it shut can help keep the lid over the eye and prevent damage from dryness and foreign bodies.

To prevent the muscles becoming stiff massage of the facial muscles can be undertaken. A physio who is trained in this massage can show you how to massage at home and also treat you.

There are exercises you can do to encourage the muscles to work as they regain nerve functionality.

Physios used to use electrical stimulation to help encourage muscle movement, but some research has shown that this can encourage synkinesis (neurological symptom in which a voluntary muscle movement causes the simultaneous involuntary contraction of other muscles) -where the recovering nerves “wire” up wrongly.

The two most common problems with this are:

  • ‘crocodile tears’ where the eye on the affected side  tears during chewing

and

  • ‘jaw-winking’ closure of the affected  eyelid when the mouth opens or the mouth is pursed.

 

Useful links

https://www.facialpalsy.org.uk Link to Facial Palsy UK website

https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/bells-palsy-fact-sheet from the The National Institute of Neurological Disorders and Stroke US website

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