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Bell’s palsy is a sudden paralysis of the muscles on one side of the face and is due to damage to your 7th cranial nerve, the facial nerve. The paralysis can start with one area and then worsen within a few hours. People between the ages of 40-70 have a higher risk of getting it, and there is no difference in incidence between males and females.

What are the causes of Bell’s Palsy?

Bell's Palsy impacts the fascial musclesa

Although the exact cause of bell’s palsy is unknown, it is thought to be related to the Herpes Simplex virus. There is inflammation and compression of the nerve which blocks its blood supply and disrupts its function.

 

What are the signs and symptoms?

The signs and symptoms are sudden and include:

  1. Sudden onset of weakness of muscles on one side of the face
  2. Drooping of the affected side of the face at rest
  3. Lack of movement of the affected side of the face
  4. Fatigue
  5. Drooling
  6. Ear pain
  7. Dry eyes or excessive watering of the eye
  8. Difficulty drinking and eating

How is Bell’s Palsy diagnosed?

It is very important that you get assessed as soon as you suspect something may be wrong. Diagnosis is made on the exclusion of other pathologies and by the clinical presentation of a sudden onset of facial paralysis between 24-48 hours. Electromyography (EMG) can be used to assess the extent of the nerve damage. MRI and X-rays can be used to exclude other causes of facial paralysis like tumours or fractures.

What are the treatment options for Bell’s Palsy?

Medical options:

  1. Corticosteroid medication is the first-line treatment to reduce inflammation. The best results are obtained if the medication is administered within 72 hours after the onset of symptoms.
  2. Anti-virals to fight Herpes Simplex virus.
  3. Analgesics to relieve pain.

Physiotherapy and other options:

  1.  Advice regarding eye care:
    • Keep the eye moist, use a damp gauze patch when sleeping, and tape the eye closed at night
    • Using eye drops or gel as prescribed by your doctor.
  2. Advice regarding eating/ drinking:
    • Use a straw
    • Eat slowly
    • Hold the cheek up
  3. Myofascial release relieves muscle tightness and releases the areas around the facial nerve.
  4. Joint mobilisation to open joint spaces along the nerve pathway.
  5. Laser to reduce inflammation and stimulate the nerve.
  6. EMG-linked electrical stimulation to help induce muscle contraction.
  7. Taping to help lift drooped areas and to stimulate active movement.
  8. Exercises to stimulate the nerve and facial muscles

Exercises to assist with Bells Palsy sufferers

What’s the prognosis?

You should start to show noticeable improvements within 2 weeks to 6 months of onset.

70% of patients who have Bell’s Palsy will have a complete recovery within approximately 8 weeks. The remaining 30% will suffer long term consequences ranging from mild to severe, which can include facial weakness, synkinesis (eg: when your mouth closes, your eye closes involuntarily), involuntary movements, and persistent tearing. Remember that the best results are obtained if you receive Corticosteroid medication within 72 hours of onset.

Content for this article was provided by Rikki Malherbe (Paulshof) and Dani Bush (Lonehill and Dainfern Practices). You can contact either of them regarding treatment for this condition by using our quick appointment form.

References:
Ahmed A. When is facial paralysis Bell palsy? Current diagnosis and treatment. Cleve Clin J Med. 2005;72(5):398-401, 405
Baugh, R.F., Basura, G.J., Ishii, L.E., et al. (2013) Clinical practice guideline: Bell’s palsyOtolaryngology – Head and Neck Surgery 149(3 Suppl), S1-S27
Butler DP, Grobbelaar AO. Facial palsy: what can the multidisciplinary team do? J Multidiscip Healthc. 2017; 10: 377-81.
De Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR et al. Management of Bell palsy: clinical practice guideline. Cmaj. 2014;186(12):917-22.
Eviston TJ, Croxson GR, Kennedy PGE, et al Bell’s palsy: aetiology, clinical features and multidisciplinary care Journal of Neurology, Neurosurgery & Psychiatry 2015;86:1356-1361
Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell’s palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews. 2010(3).
Somasundara D, Sullivan F. Management of Bell’s palsyAustralian prescriber.2017;40(3):94-7. https://doi.org/10.18773/austprescr.2017.030
Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane database of systematic reviews. 2011(12).
Van Landingham SW, Diels J, Lucarelli MJ. Physical therapy for facial nerve palsy: applications for the physician. Current opinion in ophthalmology. 2018 Sep 1;29(5):469-75.