Imagine waking up in the morning, looking in the mirror and realizing that one side of your face is sagging, your eyelid is drooping, and you are drooling out the side of your mouth. If you have ever had this experience, you were probably experiencing Bell's palsy.
Bell's palsy is the most common cause of facial paralysis. Although Bell’s palsy duration is usually limited to a few months, the symptoms can certainly be disturbing.
What Causes Bell's Palsy?
Bell's palsy can occur at any age but is most common at around age 40. Men and women are affected equally. Every year about 15 to 30 people out of 100,000 get Bell's palsy. The cause of Bell's palsy is not completely understood but is believed to be caused by a viral infection that causes swelling of the facial nerve.
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The two facial nerves are large nerves that branch out across the face and carry electrical impulses to the facial muscles. Each nerve contains 7,000 nerve fibers. When the nerve swells in response to an infection, the electrical impulses get weak and the facial muscles lose their movement. Branches of the facial nerve are also important for tear and saliva production, and they transmit some taste sensations from the tongue.
Although the exact cause of Bell's palsy is not always clear, certain risk factors are known to increase the chances of getting Bell's palsy. Risk factors include:
Being exposed to herpes simplex virus type 1
Having had a previous episode of Bell's palsy
Bell's Palsy Symptoms
Bell's palsy usually only affects one side of the face. Bell's palsy symptoms usually start suddenly and reach their peak in 48 hours. Symptoms can range from partial to total paralysis. Common symptoms include:
Weakness of the facial muscles causing loss of facial expression
Twitching of the facial muscles
Drooping of the eyelid with inability to close the eye
Dryness of the eye and mouth
Loss of taste
Drooling from the corner of the mouth
Difficulty speaking clearly
Diagnosis and Treatment of Bell's Palsy
The typical symptoms and sudden onset of one-sided facial weakness are sufficient to make a diagnosis of Bell's palsy. Other types of diagnostic tests are not usually needed. If Bell's palsy does not seem to be getting better over time, a referral to a neurologist or an ear, nose, and throat doctor may be needed to rule out other causes of facial paralysis such as tumors, Lyme disease, or multiple sclerosis.
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Even without treatment, more than 80 percent of people with Bell's palsy start to get better within three weeks. An early sign of improvement is often the return of taste. Bell's palsy duration is rarely longer than six months. Some studies show that treatment can shorten Bell’s palsy duration and improve symptoms. Bell's palsy treatment includes:
Steroids. The anti-inflammatory drug prednisone may be used to reduce swelling of the facial nerve. Prednisone may be started as soon as the diagnosis is made and tapered off over 10 days.
Antiviral drugs. Oral acyclovir (Zovirax) or valacyclovir (Valtrex) may be started within three days of Bell’s palsy symptoms and continued for seven days.
Eye care. Taping the eye closed, using an eye patch, and using artificial tears are helpful treatments to prevent eye irritation from excessive dryness.
Physical therapy. Messaging the face, exercising facial muscles, and applying gentle heat may help recovery.
Bell's palsy can be a frightening experience. The good news is that even without treatment, most Bell's palsy symptoms go away completely in time. Your primary care doctor can help you manage Bell's palsy. In cases where symptoms are not improving, an ear, nose, and throat or neurological specialist should be consulted to rule out other causes of facial paralysis.