Bell’s Palsy is often used to describe any patient with a facial palsy. Although it is by far the most common cause of facial palsy, it is its own unique condition and requires different treatment to other causes of facial weakness.
It is thought that Bell’s Palsy is caused by inflammation around the facial nerve as it passes through the skull bone from the brain out towards the face. The exact cause for the inflammation is unknown. Possible suggestions put forward are a viral infection or something suppressing a patient’s immune system.
A patient with Bell’s Palsy will present with weakness affecting (usually) one side of the face. This comes on over a couple of hours, unlike a stroke which happens over minutes. The weakness typically affects all areas on that side of the face, such that the eyebrow and corner of the mouth droop downwards and a patient can’t close their eye or smile on the affected side. The eye can become dry and painful and eating and pronouncing certain sounds can become more difficult.
What treatment do I need?
You should seek urgent medical attention to start treatment promptly and also ensure that the weakness in the face isn’t due to a stroke.
In the initial days/weeks, treatment consists of:
Protecting your eye. This is essential. You should be given a combination of eye drops, eye ointment and advice on how to tape the eye at night. During the daytime, use the eye drops liberally to avoid any sensation of the eye becoming dry. This may be every few hours. At night, apply the thicker ointment to the eye and then tape the eyelids closed. For a great video on how to tape the eyelids closed, visit www.facialpalsy.org.uk.
Steroids. There is very good medical evidence supporting the use of high dose steroids in the management of patients with Bell’s Palsy. This is probably because they help reduce swelling of the nerve as it passes through the skull bone. For the best effect, these should be started within 3 days of the symptoms starting. Usually a 10-day course of steroids is needed.
Anti-viral medications. Although the medical literature has not shown anti-viral medications improve the outcome of patients with Bell’s Palsy, I still recommend their use in case the patient has another cause of facial palsy called Ramsay-Hunt syndrome. Ramsay-Hunt syndrome has been found to respond to anti-viral medications and can look similar to Bell’s Palsy.
Avoid trying to force the face to move. There is some evidence that trying to force facial movements to return can lead to over-activity and pulling from the healthy side of the face and encourage ‘miswiring’ on the affected side, which increases the risk of abnormal twitches and tightness on this side in the long-term. Instead, focus on massaging and gently stretching the affected side of the face to keep the soft tissues soft and pliable. Again, www.facialpalsy.org.uk has some excellent videos demonstrating what to do.
Is the facial weakness permanent?
Thankfully, just over 70% of patients with Bell’s Palsy fully recover. Most of these patients fully recover within 3 weeks.
If your facial movements haven’t started to recover at all by 3 weeks, you should be referred onto a specialist for further investigations in case the facial weakness is not due to Bell’s Palsy. Blood tests and scans should then be arranged to investigate things further.
What can I do if I don’t fully recover?
In the 30% of patients that don’t fully recover, they are left with permanent weakness whilst others develop tightness and pain within the affected side of the face. The severity of these changes varies considerably with most having fairly mild symptoms.
If you haven’t fully recovered after 3 months, you should seek referral to a facial palsy surgery expert who can look into why you haven’t fully recovered and discuss appropriate treatment options for you.
If you have facial palsy or want any further information, please get in touch by email, or call us to book an appointment on 07 578 5350.