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Status: Published
Date Completed: 01/07/97

Title: Bell's Palsy General Summary
Author: Nancy J. Austin
Topic: Nervous System
Subject:Bell's Palsy

Synonyms/Keywords:
Facial nerve palsy
Refrigeration palsy
Facial paralysis
Idiopathic Facial Palsy
Antoni's Palsy
Facial palsy

Introduction:
Bell's Palsy is a form of facial paralysis resulting from a facial nerve disorder. Paralysis is nonprogressive and results from decreased blood supply, compression or inflammation of the 7th (facial) cranial nerve. The majority of cases of Bell's Palsy are temporary and symptoms usually subside within two weeks; about 80% of patients recover completely with three months. Only in rare cases are symptoms permanent.

Symptoms
One sided facial paralysis Inability to close one eye
Facial pain Tearing
Drooling Hypersensitivity to sound
Impairment of taste Headache
Lower facial weakness

Associated diseases
Acoustic Neuroma, a benign tumor of the 8th cranial nerve, produces symptoms that are similar to Bell's Palsy. Growth of the tumor may lead to numbness in the mouth, slurred speech and hoarseness.

Myasthenia Gravis is a neuromuscular disease characterized by muscle weakness, affecting the mouth, lips, tongue and voice box. The patient may experience difficulties in speaking, chewing, and/or swallowing. Additional symptoms are drooping eyelids and double vision. Muscle weakness eventually extends to the arms and legs and the patient may experience general muscle weakness.

Affected population
Bell's Palsy affects approximately 25 to 35 people out of 100,000 people yearly. Anyone can be afflicted with Bell's Palsy, but pregnant women, and people who have diabetes, influenza, a cold, or some other upper respiratory ailment seem to be at increased risk.

Causes
The cause of Bell's Palsy is unknown, but it is thought to be caused by head injury, virus, tumor, hypertension, or infarction. The cause of the paralysis itself is the swelling of the facial nerve.

Diagnosing the condition
The doctor will usually examine the patient for upper and lower facial weakness, which usually occurs on one side of the face. The patient may often experience a loss of sensation on the side affected. The doctor may order a skull x-ray to rule out infection or tumor. An MRI or a CT scan may be done to rule out other causes of pressure on the facial nerve.

Standard Treatment
Some cases of Bell's Palsy are mild and no treatment is necessary as symptoms usually subside on their own with two weeks. Physicians may prescribe a corticosteroid drug to help reduce inflammation, swelling and pressure on the facial nerve. Lubricating eye drops or eye ointments may be recommended in some cases if the eye cannot close completely.

Investigational Treatment
Acylovir (Zovirax), an antiviral medication, is being investigated in the use of Bell's Palsy; acrylovir is frequently used in combination with prednisone.

Complementary Treatment
Massage Therapy may be used to relax muscles and to provide relief of facial pain until symptoms subside .

Acupuncture may be used to reduce swelling and inflammation and thus reduces pain. One theory is that acupuncture works by stimulating the body's release of endormorphins, the body's natural painkillers.

Acupressure may be useful to relieve symptoms of pain and muscle weakness. This therapy involves pressing on points on the body with fingers or hands along 14 body meridians, or pathways, as defined in Chinese medicine. This therapy can be done by a trained acupressure therapist or may be done in the home