Bell palsy is total or partial paralysis (loss of function or movement) of one side of the face. It is believed to be caused by an inflammation of the nerve that controls the facial muscles. The inflammation causes the nerve to swell and to be compressed inside its bony passage in the skull. This compression reduces the blood supply to the nerve and thus its ability to function.

Symptoms

Bell palsy can occur in someone of any age but is most common from ages 20 to 50. The first sign may be an aching pain behind or below the ear. Paralysis may develop in a few hours or more slowly, causing the entire side of the face to be flat and without expression (this is different from the facial paralysis caused by stroke or brain tumor, in which the weakness is mostly below the forehead).

The mouth droops on the weak side and the sense of taste may be impaired. The eyebrow cannot be raised. In most cases, the eye cannot be shut. When the patient tries to close the affected eye, it can be seen to roll upward (which also happens in a healthy person but is not seen because the eyelid normally closes). Unprovoked tears may come from the affected eye.

Diagnosis

In making a diagnosis, the doctor must determine if the paralysis might be caused by other disorders affecting the facial nerve, including ear infections, cancer, or a skull fracture. In such disorders, there is usually involvement of other nerves as well, and distinctive signs and symptoms are frequently present. X-ray studies of the head may be performed.

Treatment

Primary treatment of Bell palsy is aimed at reducing the inflammation of the nerve before any permanent damage is done to it. An oral corticosteroid, such as prednisone, may be given for this purpose. However, in many (if not most) uncomplicated cases, treatment with medication is unnecessary. After two weeks, if there has been no improvement in the ability of the muscles to move, the muscles of the weak side of the face may be stimulated electrically to maintain muscle tone.

The affected eye should be covered with an eye patch, especially when the patient is outdoors, and protected from dirt and wind. Application of moist, moderate heat on the affected side of the face can reduce pain. Brief periods of upward facial massage help maintain muscle tone, as do specific facial exercises.

Fortunately, most Bell palsy patients recover in one to eight weeks. Elderly patients may take much longer -- up to two years. Complete recovery usually follows within several months if the paralysis is partial.



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