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Today in Health & Wellness

Bell's Palsy

Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult

Common name/Other name

Idiopathic facial paralysis; facial nerve palsy (Eng.); pamamanhid o pasma ni Bell (Fil.)

Bell’s palsy is the sudden weakness or paralysis of the muscles of facial expression on one side of the face. This occurs when the facial nerve is damaged. The symptoms are similar to a stroke and severe cases lead to the drooping of an entire side of the face. The onset of the symptoms are sudden and progress to maximal weakness within 48 hours. The most favorable sign of recovery is the incomplete paralysis within the first week of onset. Most cases resolve within a few weeks to a month. Rarely, Bell’s palsy causes irreversible paralysis due to the damage of the facial nerve.

The exact cause of the damage to the facial nerve has not yet been defined but is often linked to viral infections such as cold sores, genital herpes, chickenpox, mononucleosis, respiratory illnesses, German measles, mumps, flu, and hand-foot-and-mouth disease. During a viral infection, the facial nerve can become inflamed and swollen. Some of the symptoms occur because the facial nerve also affects tears, saliva, taste, and the small bone in the middle ear.

Diagnosis of Bell’s palsy is based on the symptoms and results of simple physical tests. The physician uses simple tests to test the facial muscles of the patient like closing the eyes, lifting the eyebrows, showing the teeth, and frowning. Other tests are done to eliminate other diseases that cause facial paralysis.

  • Sudden onset of mild weakness to complete paralysis of one side of the face
  • Drooping of one side of the face
  • Difficulty making facial expressions, blinking and smiling
  • Difficulty swallowing and eventually drooling
  • Pain around the jaw or behind the ear of the affected side
  • Hyperacusis or sound is perceived as too loud on the affected ear
  • Headache
  • Decreased sense of taste
  • Change in the amount of tears produced
Risk Factors
  • Pregnancy. Increased risk during the third trimester and one week after delivery
  • Upper respiratory infection. Includes flu and colds
  • Diabetes
  • Family history of Bell’s palsy
Commonly Prescribed Drugs
  • Corticosteroids like prednisone and prednisolone are known anti-inflammatory agents. These reduce the swelling of the facial nerve and work best when given within a few days of the onset of symptoms. Side effects: nausea, increased sweating, difficulty sleeping, oral thrush
  • Antiviral drugs like valacyclovir are occasionally prescribed with corticosteroids in severe cases of facial paralysis.
  • Botulinum toxin (Botox) injections are given to patients with long term Bell’s palsy. Botox is injected into the affected facial muscles for relaxation and decreased involuntary muscle movements. Complications of Bell’s palsy like tear production when eating or winking of the eye when eating, smiling or laughing can be resolved by the injection. Botox injections may have to be repeated after four months.
Treatment and Management
  • Most patients fully recover from Bell’s palsy with or without treatment or therapy.
  • Physical therapy helps prevent the shrinking and shortening of the paralyzed facial muscles. The therapist educates the patient on useful exercise and massage for the facial muscles.
  • Maintain the moisture of the affected eye by applying lubricating eye drops or eye ointment. Wear protection over the eye like sunglasses or an eye patch. A medical tape can be used to close the eyelid of the affected eye during sleep.
  • Pain can be relieved by applying a washcloth soaked in warm water over the affected side of the face.
Home Remedies
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