Bell’s Palsy

What is Bell’s Palsy?

Bell’s Palsy is a common condition in which temporary paralysis of the facial nerve occurs. It may come on rapidly for no obvious reason, although simple events such as sitting in a cold draught have been blamed. It may come on at any age, but the 20 – 50 age group is the most common, and the sexes are affected equally.

It is due to a swelling of the facial nerve as it travels through a bony canal, with a resulting neuritis that is nearly always reversible, once the swelling has subsided.

Bell’s Palsy most common birth developmental abnormality affecting the nervous system is termed spina bifida. This is due to faulty development of the neural tube that later forms the spinal column in the fully developed baby. It fails to close perfectly, usually at the lower (lumbosacral) end, but occasionally at the upper (cervical) end.

It is often associated with some abnormality of the spinal cord also. Tumors called meningocoeles are sometimes present as well, and hydrocephalus (enlargement of the skull due to an excess accumulation of fluid) may also be present at birth. A complete spina bifida, in which the canal is open, is incompatible with life. When the canal is closed, abnormalities may not be apparent at birth, or for some time afterwards. Symptoms. The legs may be weak from an early age in life. However, in milder cases this may not be apparent until puberty when general hormonal development occurs. Abnormalities about the feet may also be noticed. There may be inadequate control over the bladder and bowels. The skin over the feet may show signs of ageing, and there may be sensory changes. Areas may be anesthetic (no feeling of pain).

Where symptoms have been present since childhood, the diagnosis is usually confirmed by X-ray evidence of inadequate development of the bony spinal canal. Some mild cases live a relatively normal life, but others die when young. In recent years a considerable amount of research has been directed to the early diagnosis of spina bifida. There is a markedly increased risk of a second spina bifida baby being born to a woman who has already produced one. For this reason, early diagnosis by seeking the presence of the chemical called alphafetoprotein (AFP) in the amniotic fluid early in pregnancy is now advised for such women.

Bell’s Palsy Symptoms

The onset is generally rapid, frequently with some discomfort below the ear. This may last for a few days. The muscles of the face feel stiff if movement is attempted, and then the paralysis rapidly follows.

In complete paralysis, the affected side may be totally unresponsive to movement, the eye cannot be closed, and the face is pulled to the opposite side. The eye waters, speech is difficult, and eating cannot be undertaken normally. Saliva tends to dribble from the affected corners of the mouth.

If the lower part of the face only is affected, recovery is usually more rapid, indicating only partial involvement. The condition rarely recurs. Recovery is usually complete, but it may take from a few weeks to several months. Contractures may occur in the affected muscles.

Bell’s Palsy Treatment

Recovery with or without treatment usually occurs in most cases. It may take three weeks for this to commence. Some doctors prescribe the steroid drugs with the idea of reducing the swelling of the nerve in the bony canal. When given, these should be for short periods only – usually days or a week at the maximum.

The eye must be shielded, possibly by a protective covering (to protect it from wind and the elements), and the use of drops to keep the surface moist.

Sometimes a wire loop will keep the corner of the mouth in a normal position, and this may be attached higher up to the ear, or by strapping.

Sometimes massage of the affected muscles gives an improved sensation. and at least occupies the patient mentally and physically. Electrical stimulation has been suggested, but is usually of no benefit. Some surgeons recommend surgical alleviation of the bony pressure, but this is not universally undertaken, for relief’ usually occurs without it.

In some instances where unsightly and permanent facial disfigurement has taken place through the palsied muscles, the use of reconstructive surgery by skilled plastic surgeons can frequently offer excellent long-term assistance in providing a greatly improved appearance.