Bell’s Palsy

Most doctors believe that Bell’s palsy is caused due to damage to the facial nerve, which causes swelling. This nerve passes through a narrow, bony area within the skull. When the nerve swells (even a little bit), it pushes against the skull’s hard surface; this affects how well the nerve works.

If the facial nerve is inflamed, it will press against the cheekbone or may pinch in the narrow gap. This can result in damage to the protective covering of the nerve. If the protective covering of the nerve becomes damaged, the signals that travel from the brain to the muscles in the face may not be transmitted properly, leading to weakened or paralyzed facial muscles.

Researchers have also believed that viral infections may also play a role in the development of Bell’s palsy. Some of these viruses associating with Bell’s palsy include:

• Mumps virus
• Rubella
• Influenza B (i.e. flu)
• Chickenpox and shingles
• Epstein-Barr
• Adenovirus
• Cold sores and genital herpes virus

If you suspect Bell’s palsy occurring, you may fear that you’re having a stroke. However, it isn’t the case. A stroke that affects your facial muscles would cause muscle weakness in other parts of your body as well. Symptoms of Bell’s palsy come on suddenly – you may go to bed one night feeling fine. But when you look in the mirror the next morning, you see that part of your face seems to be drooping. Once this symptom happens, they worsen over the next 48-72 hours.

The most noticeable sign is weakness and drooping on one side of your face. You will find it difficult to close your eye on that side or make facial expressions, like smiling. Your face may even be completely paralyzed on that side. Although rare, Bell’s palsy can sometimes affect the nerves in both sides of your face.

Besides the weakness and drooping of facial muscles, you may also experience the following below:

• Pain in your jaw or behind your ear on the side that’s affected. Some people notice pain behind their ear 1-2 days before any signs of weakness.
• Less sense of taste.
• Dry eyes and mouth.
• Hear a ringing in your ears (i.e. tinnitus).
• Find it difficult to talk.
• Have trouble eating and drinking.
• Changes in the number of tears and saliva you produce.

Once these symptoms occur, they usually recover over the next 3 weeks or so. Most patients have no symptoms at all within 3-6 months. Some people who get Bell’s palsy have a longer recovery period. In rare cases, they may even have some permanent symptoms.

Links have been discovered between migraines and facial and limb weakness. Some studies have found that patients with migraines may have a higher risk of Bell’s palsy.

This condition also commonly affects the following:

• Age – People ages 15-60 years have a likelihood of developing Bell’s palsy.
• Diabetes – Patients who are living with diabetes or upper respiratory diseases also have a higher chance of experiencing Bell’s palsy.
• Gender – Bell’s palsy affects both men and women equally.

Generally, Bell’s palsy can strike at any age, at any gender. However, Bell’s palsy is also the most common cause of facial paralysis during pregnancy. High blood pressure and obesity are two risk factors associated with Bell’s palsy while pregnant. Other factors that may increase the risk of Bell’s palsy pregnancy symptoms include:

• Lyme disease
• Multiple sclerosis
• Myasthenia gravis
• Diabetes
• Infection

For unknown reasons, pregnant women are three times more likely to develop Bell’s palsy than women who aren’t expecting. The condition typically occurs during the third trimester. You may also be more likely to develop Bell’s palsy while pregnant if you have preeclampsia (high blood pressure) or gestational diabetes.

8 out of 10 patients with Bell’s palsy recover fully without any lingering problems. Unfortunately, 20% of people have long-term facial paralysis and drooping. While uncommon, Bell’s palsy can come back, usually within two years of the initial diagnosis. A recurrence may affect the same side of the face or the opposite side.

Bell’s palsy usually resolves in time and causes no long-term complications. But during the illness, most people are unable to close their eye on the affected side of their face.

A small number of people continue to have some weakness of the face. They may need surgery if the weakness greatly affects the eyelids. Others may have abnormal uncontrolled movements of the face (also known as spasms) because of abnormal nerve repair.

During the diagnosis of Bell’s palsy, your healthcare provider will begin by looking at your symptoms. There are no specific tests used to diagnose Bell’s palsy. However, your healthcare provider may order imaging tests to rule out other conditions that can cause similar symptoms and to determine the extent of nerve involvement or damage. These tests include:

• Electromyography (EMG) – This is to help determine the extent of the nerve involvement.
• Blood tests – to determine if another condition such as diabetes or Lyme disease is present.
• Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) – These two tests are used to determine if there is a structural cause for your symptoms.

After the first couple of days to a week after symptoms start to occur, a physiotherapist will evaluate your condition, including:

• Review your medical history.
• Review your current symptoms.
• Conduct a physical examination (identify weaknesses of facial movements, eye closure, abilities to use the cheek and the lips, raising the upper lip, and raising or lowering the lower lip).

Afterward, your physiotherapist will begin to educate you about how to protect your face and your eye. Next, he or she will show you how to manage your daily life functions while you have a facial paralysis. Your physiotherapist will then evaluate your progress and determine whether you need to be referred to a specialist if progress is not being made.

During your recovery from Bell’s palsy, your physiotherapist will help you regain the healthy pattern of movements that you may need for facial expressions and function. Your physiotherapist will also help design a treatment plan to help you relearn facial movements based on your particular movement problems. Your exercise routine may change over the course of recovery. These specific exercises include the following:

Initiation exercises

In the early stages of Bell’s palsy, when you might have difficulty producing any facial movement at all, your physiotherapist will teach your exercises that “initiates” facial movement. Your therapist will also show you how to position your face to make it easier to move or how to “trigger” the facial muscles to do what you want them to do.

Facilitation exercises

Once you are able to initiate movement of the facial muscles, your physiotherapist will then design exercises to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time.

Movement control exercises

Your physiotherapist will design movement exercises to improve the coordination of your facial muscles, refine your facial movements, and correct abnormal patterns of facial movement that can occur during recovery.

Relaxation

During your recovery from Bell’s palsy, you might have facial spasms or twitches. Your physiotherapist will design exercises to reduce this unwanted muscle activity. The therapist will teach you how to recognize when you are activating the facial muscle and when the muscle is at rest. By learning to contract the facial muscle forcefully and then stop, you’ll be able to relax your facial muscles at will and decrease twitches and spasms.

Facial exercises

Facial exercises and physiotherapy for Bell’s palsy help to increase muscle strength and to regain facial coordination from this temporary facial paralysis. Some of these facial exercises include:

Nose and cheek exercise

Using your fingers, gently push up the skin next to your nose on the affected side while trying to wrinkle your nose. Next, try to scrunch up your face, focusing on the cheeks and nose. Flare your nostrils and try to take some deep breaths through your nose. You can cover your unaffected nostril to force the affected muscles to work harder. Lastly, puff up your cheeks and blow the air out, then repeat this exercise 10 times a day.

Mouth exercise

Open your mouth as if you’re going to smile and then close it, then do the opposite and practice frowning. Gently pucker your lips and let them relax. Try lifting each corner of your mouth individually, one at a time. Finally, stick out your tongue and then aim it down toward your chin.

Eye exercise

Practice raising your eyebrows up and down. You can use your fingers to lift the affected eyebrow. Look down and close your eye while gently massaging the eyelid and eyebrow. Alternate opening your eyes wide and then gently squeezing them shut. Repeat this method 10 times a day.

Commonly used homeopathic treatments to treat Bell’s palsy include:

• Acupuncture – This needle-based therapy may help lessen facial paralysis and facial disability in patients with Bell’s palsy.

• Eye care – If one of your eyes does not close, it is imperative that you protect it as the doctor recommends. Wearing protective glasses during the day, an eye patch at night, and using hydrating eye drops can help prevent long-term damage. 

• Moist heat – Many find that a warm cloth may help resolve pain and discomfort.

• Massage – Many patients find gentle massage of the face can ease symptoms and discomfort.

• Vitamin B12 – Associated with nerve growth and reduction in inflammation, vitamin B12 may be more effective than prescribed steroids. Studies have shown that complete recovery was significantly shorter in vitamin B12 group with a recovery time of just two weeks.