What is Bell's Palsy?

Bell’s palsy is a form of temporary facial paralysis or weakness in the muscles on one side of the face. It results from damage, inflammation, irritation or trauma to the facial nerves. In Bell’s palsy, one side of the face appears to droop – resulting in a crooked smile and partially closed eye. Tear and saliva production, as well as the sense of taste, may also be affected.

While Bell’s palsy symptoms can mimic the facial paralysis seen in a stroke or transient ischemic attack (TIA), there is no link between Bell’s palsy and either of these conditions. Sudden weakness that occurs on one side of the face requires immediate medical attention, however, to rule out these more serious causes.

Baptist Health is known for advanced, superior care in diagnosing and treating Bell’s palsy. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient services, Home Health, physical and occupational therapy services are available to help treat people with Bell’s palsy.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Bell’s palsy symptoms include:

• Facial droop and difficulty smiling or closing one eye
• Headache
• Increased or decreased salivation or drooling
• Increased sensitivity to sound on affected side
• Increased or decreased tear production
• Pain around jaw or behind ear on affected side
• Sudden onset of mild weakness to total paralysis of one side of the face
• Reduced sense of taste

Diagnosis

To determine if someone has Bell’s palsy, we conduct a physical examination, testing the patient’s ability to use facial muscles by smiling, frowning, closing the eye and lifting the brow. We also take a thorough medical history to try to identify other causes of facial weakness. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Electromyography (EMG): This test measures the electrical activity of a muscle in response to stimulation, as well as the nature and speed of the conduction of electrical impulses along a nerve. It can confirm the presence of nerve damage and assess its severity.

Imaging Scans: Occasionally, magnetic resonance imaging (MRI) or computerized tomography (CT) scans may be needed to rule out other possible sources of pressure on the facial nerve, such as a tumor or fracture.

Causes

Bell’s palsy is usually linked to inflammation of the nerve from a viral infection, so behaviors and lifestyle factors don’t play a part in its appearance. Viruses linked to Bell’s palsy include:

• Adenovirus, which causes respiratory illnesses
• Coxsackievirus, which causes hand-foot-and-mouth disease
• Cytomegalovirus
• Epstein-Barr, which causes mononucleosis
• Herpes simplex, which causes cold sores and genital herpes
• Herpes zoster, which causes chickenpox and shingles
• Influenza B
• Mumps virus
• Rubella, or German measles

Lyme disease, an infection from the bite of a deer tick, can also present as a Bell’s palsy and may involve both sides of the face rather than just one.

Risk Factors

Risk factors that may contribute to Bell’s palsy include:

Diabetes: Bell’s palsy seems to be more common after viral infection in people with diabetes.

Pregnancy: In pregnancy, a higher fluid content in the tissues combined with viral inflammation and suppression of the immune system that occurs in the later trimesters may cause swelling of the facial nerve.

Recent or active viral infection: Upper respiratory or flu-like symptoms may precede or accompany the appearance of Bell’s palsy.

Prevention

Because the cause of Bell’s palsy is related to a viral infection or is unknown, not much can be done to prevent its occurrence. Certain viral infections can be prevented with proper immunization, including:

• Influenza B
• Mumps virus
• Rubella, or German measles

Prognosis

For most people, Bell’s palsy is temporary, improving within a few weeks to a few months. Full recovery is common. A minority of people continue to have some Bell's palsy symptoms for life and, occasionally, the condition can recur.

Treatment and Recovery

Treatment of Bell’s palsy may include:

Medications

Commonly prescribed medications for Bell’s palsy include:

• Antiviral drugs: Though their effectiveness remains unproven, antivirals are sometimes prescribed to aid in the treatment of Bell’s palsy.
• Corticosteroids: These powerful anti-inflammatory agents can reduce swelling of the facial nerve.

Mouth and Eye Care

Patients are advised to brush and floss often to avoid problems caused by reduced saliva levels. Artificial tears or ointments may be prescribed to lubricate the eye in the case of reduced tearing or an inability to fully close the lid.

Physical Therapy

A physical therapist can offer massage, electrical stimulation and exercise techniques to prevent paralyzed muscles from shrinking and tightening.

Surgery

While decompression surgery is no longer recommended, plastic surgery may be needed – in rare cases – to correct lasting facial nerve problems.

Watchful Waiting

Most people with Bell’s palsy recover fully, with or without treatment. Especially if symptoms are mild, a physician may choose to just monitor the condition over a period of weeks.

Complications

Most cases of Bell’s palsy resolve without complications. Rarely, the following complications can develop:

Facial nerve damage: In rare cases, inflammation may cause irreversible damage.

Misdirected regrowth of nerve fibers: This can cause involuntary contractions of certain facial muscles when trying to move others.

Partial or complete blindness: A scratched cornea and excessive dryness, caused by an inability to close the eye, can lead to vision problems. 

Related Conditions

Bell’s palsy can be seen with viral infections, especially herpes simplex, as a symptom of Lyme disease, or can mimic stroke.