Facial Palsy | Bell’s Palsy
About Bell’s Palsy
Bell’s palsy is a condition that causes sudden, temporary weakness in your facial muscles. This facial paralysis makes half of your face appear to droop. It can affect the eye on that side, making it difficult to close the eyelid properly. The patient’s smile can also become one-sided.
In most patients, this facial paralysis resolves on its own, usually within 3 – 6 months. But in roughly one in five cases, patients don’t recover completely and may need surgery to correct their eyelid and smile functions. Dr. Douglas performs surgery to correct the eyelid form and function.
What is Bell’s Palsy?
Bell’s palsy can have similar effects on the face to what happens when a person has suffered a stroke, but the two conditions are not related in any way. The facial paralysis with Bell’s palsy is related to inflammation of the nerve that controls the facial muscles on one side of the face. The patient will possibly have a drooping eyelid and a one-sided smile. Unlike a stroke, where facial paralysis may need to be overcome with physical therapy, in Bell’s palsy the paralysis is usually temporary and resolves itself.
A mild case of Bell’s palsy normally disappears within 3 to 6 months. More severe cases can lead to complications such as facial nerve damage, abnormal growth of nerve fibers affecting movement (know as synkinesis), and partial or complete blindness of the eye that won’t close due to excessive dryness and scratching of the cornea.
What Are The Symptoms Of Bell’s Palsy?
This facial paralysis comes on quickly, usually within hours or a few days. The symptoms may include:
- Mild to total paralysis on one side of the face
- Facial droop
- Difficulty closing your eye or smiling
- Pain around the jaw
- Pain behind the ear on the affected side
- Decrease in the sense of taste
- Changes in tear and saliva production
What Causes Bell’s Palsy?
Although the direct causes are unknown, it’s believed that Bell’s palsy is the result of swelling and inflammation of the nerve that controls the muscles on one side of the face. This nerve passes through a narrow corridor of bone on the way to the face. When that nerve becomes inflamed and swollen it is impacted through that narrow corridor of bone, affecting the person’s control of the muscles that coordinate eye and mouth movements.
Bell’s palsy can often be traced to exposure to a viral infection. There are many viruses that are linked to Bell’s palsy:
- Herpes simplex
- Chickenpox and shingles
- German measles
- Respiratory illness
- Foot-and-mouth disease
How Is Bell’s Palsy Diagnosed?
Even though Bell’s palsy usually runs it’s course on it’s own, it is still imperative to see a doctor as soon as symptoms occur. This is because this type of paralysis can also be a sign of a stroke or other serious conditions.
There isn’t a specific test for Bell’s palsy, but your doctor will ask you to move your facial muscles to see what you can and cannot do. Other conditions, such as Lyme disease, infections, and stroke, can cause similar symptoms, so diagnosis may not be clear-cut. In these instances, your doctor may recommend electromyography (EMG) to test for nerve damage. An MRI or CT scan may also be used to rule out other possible sources of pressure on the facial nerve.
What Are The Treatments?
Most patients recover fully from this type of facial paralysis, but doctors often use medications and physical therapy to help with recovery.
- Medications — Corticosteroids are used to calm the inflammation in the facial nerve. As the nerve returns to normal, it no longer will be constricted through the bony corridor leading to the face, returning normal nerve and muscle function.
- Physical therapy — When your facial muscles are paralyzed, even temporarily, they can develop permanent contractures. Physical therapy can be used to massage and exercise your facial muscles to prevent this.
When Is Surgery Necessary?
In cases of Bell’s palsy, patients usually head to the emergency room. Once Bell’s is diagnosed, the patient is then watched for a period of 6-9 months. If, after 9-12 months, the patient still is experiencing paralysis, surgery could be necessary. This happens in approximately 20 percent of Bell’s palsy patients. Without surgery, the excessive dryness and scratching because the patient cannot properly close his or her eyelid can cause permanent damage to the eye, including potential blindness.
Dr. Douglas handles the eyelid surgery for facial paralysis. Because the muscles around the eyelid may have become very weak or stopped functioning, Dr. Douglas works to reposition the eyelid in a more normal position to allow it to close. He may even need to alter the eye position to allow the eyelid to close.
For the smile portion of this surgery, Dr. Douglas teams with a trusted colleague, Dr. Babak Azizzadeh of The Facial Paralysis Institute. Dr. Azizzadeh is the pioneer of a groundbreaking surgery for patients with long-term Bell’s palsy called selective neurolysis. The results of selective neurolysis are a more symmetrical, natural looking smile.
What Happens After Surgery?
The majority of patients have better control of their eyelid function after this surgery. This alleviates much of the pain and dryness that was due to the eyelid not being able to close properly. In some cases, however, plastic surgery may also be necessary.
Frequently Asked Questions
I have had multiple surgeries. Is there any hope?
Yes! We have pioneered novel approaches for facial paralysis and work with experts in the field to achieve superior results. Many of our patients have had multiple operations (some even over 50 surgeries) but have found improvement with the novel techniques that take advantage of our expertise and understanding of wound healing in this field.
What type of procedures are available?
Facial paralysis and especially eyelid paralysis can be improved with surgery to allow better eyelid closure and protection for the eye. The muscles around the eye work weakly or not at all. There are surgeries to help reinnervate these muscles in some cases but in many cases this is not possible. Since the muscles do not work we try to position the eyelid in a normal position or potential alter the eye position to help the eyelids close better. Most patients have much better pain relief and function after this procedure which is done as an outpatient procedure.
I always have red eye!
The eye redness is likely due to dryness or exposure. It is important to use eye-safe lubricant, but it also important to understand when and WHY the eye is drying out. If you wake up in the morning and the eye is painful, consider using ophthalmic lubricating ointment and saran wrap to create a moisture chamber. If it dries out during the day and your blink is poor, there may be need for increased lubrication and even moisture chamber glasses. Usually, both surgical and nonsurgical techniques can be done to help minimize pain and discomfort.
Do you function as a team?
Yes, we have a team of experts that we work closely with. We have also partnered with the Facial Paralysis Institute in Beverly Hills. This allows the most cutting edge advancements to be available to you. In addition, both Dr. Douglas and Dr. Massry presented much of their work at the International Facial Nerve Meeting which was hosted by Dr. Babak Azzizadeh.
If you or a loved one has been suffering with facial paralysis, please contact our office to schedule your clinic or online consultation.