| name: | Bell's Palsy |
| also known as: | Bells Palsy; Facial Palsy; Facial Paralysis; Herpes Zoster Oticus; Ramsay Hunt Syndrome; Face Paralysis; Facial Nerve Paralysis; Bell's Palsey; Bell Palsy; Bell Palsey; Idiopathic Facial Paralysis; Facial Diplegia; ICD 351.0 |
| also see: | Paralysis; Facial Paralysis; ICD |
| description: | Bell's palsy can be a sudden or slow paralysis of one side of the face, the cause of which is unknown, but is believed to be swelling of the facial nerve, possibly caused by a virus infection or by an autoimmune reaction which is when the immune system attacks itself. Bell's palsy is a diagnosis of exclusion; that is, other causes need to be evaluated for and ruled out by a doctor before assigning the diagnosis of Bell's palsy. For instance, causes of slow onset of facial paralysis might include a tumor within the brain or at the brain stem called an acoustic neuroma. Accounts for 60-75% of all cases of unilateral facial paralysis. Risk increased with age over 30, cold exposure, diabetes, pregnancy, recent cold. Bilateral facial paralysis, also called facial diplegia, is usually not due to Bell's but another cause, such as Guillain-Barre syndrome, meningitis. One form of unilateral facial paralysis is called herpes zoster oticus (Ramsay Hunt Syndrome) which results from invasion of the facial nerve and the nerve of hearing by the herpes virus. This condition results in facial paralysis, ear pain, loss of hearing, and vertigo. Treatment is similar to that for Bell's palsy but recovery is not as robust. Associated conditions include Lyme disease, diabetes, high blood pressure, herpes simplex, Sjogren's, sarcoidosis, amyloidosis. |
| signs & symptoms: | Sudden, occasionally slow paralysis of one side of the face, associated with some vague pain behind the ear, with twisted or distorted facial expressions. Since taste fibers for part of the tongue travel with the facial nerve, person might complain of lost of taste on the anterior 2/3 of one side of the tongue. Other symptoms include same side tearing, exaggerated sound, loss of corneal reflex. |
| diagnosis: | Based on signs, symptoms, history and physical exam by the doctor. Often diagnostic studies might be indicated, such as a CT Scan or an MRI Scan to evaluate for other causes of the paralysis, as well as EMG. Differential diagnosis includes stroke, TIA, brain tumor, metastatic brain cancer, bacterial meningitis, other causes of meningitis such as from sarcoidosis, amyloidosis, Guillain-Barre syndrome, Myasthenia Gravis, parotid tumor, Lyme disease, leprosy, multiple sclerosis, head trauma, invasion of the nerve with leukemic infiltrate. |
| treatment: | Treatment varies from supportive care such as taping the eye shut at night so as to avoid exposure keratitis, frequent eye lubrication with liquid tear products, to medicines. Drugs if started early might include high dose cortisone steroids in a tapering fashion, such as prednisone in order to reduce the swelling and antiviral drugs such as acyclovir, especially for Ramsay Hunt syndrome. The steroids must be started soon after onset of the paralysis; after 3-4 days there is little if any efficacy. Occasionally, surgical intervention in order to take pressure off the facial nerve as it travels from the brain to the facial muscles is performed, called a mastoidectomy. Surgery is controversial. On the one hand, time and medical management might afford a complete or near complete recovery; but waiting for medical management to work precludes surgery since surgery is only effective if performed within the first week or two. It is a sort of catch-22. |
| prevention: | None |
| outcome: | Basically all patients with mild Bell's Palsy and most patients with severe Bell's Palsy recover completely. Some patient's recover only partially, with 16% residual partial paralysis and 5-10% with severe paralysis. Long term, failure to recover can result in chronic eye irritation from failure to close the eyelid, tooth decay from decreased salivation, and emotional distress from permanent disfigurement. About 10% fail to recover enough to where they're satisfied with the outcome. |
skynetMD suggests the following:
| if: | If the person has a sudden, or gradual loss of facial muscle function, called facial paralysis, especially on one side of the face |
| go to: | Go to the doctor |
| if: | If the person has Bell's Palsy, and is under the supervision of a physician, apply heat to the painful area behind the ear, wear an eye patch at night to protect the eye, wear protective eyeglasses when outdoors to protect the eye, learn facial muscle massage and exercise techniques, and |
| go to: | Go to the pharmacy for methylcellulose eye drops to keep the eyes moist and protected. |
Last updated 7/11/2009