Bell’s palsy, also known as peripheral facial paralysis, happens when the facial nerve becomes inflamed and the person loses control of the muscles on one side of the face, resulting in crooked mouth, difficulty making expressions and even tingling sensation.
Most often, this inflammation is temporary and happens after a viral infection, as is the case of herpes, rubella or mumps, improving between a few weeks to 6 months. But it can also be a permanent situation, especially if there is any injury to the course of the facial nerve.
Ideally, any type of facial paralysis should be evaluated by a doctor, because at an early stage it can be a sign of a more serious situation, such as a stroke, and should be correctly identified and treated.
Some of the most characteristic symptoms of Bell’s palsy include:
- Paralysis on one side of the face;
- Crooked mouth and dropped eye;
- Difficulty in making facial expressions, eating or drinking;
- Slight pain or tingling on the affected side;
- Dry eye and mouth;
- Difficulty holding the saliva.
These symptoms usually appear quickly and affect one side of the face, although in rarer cases there may also be nerve inflammation on both sides of the face, causing symptoms to appear on both sides of the face.
Symptoms of Bell’s palsy are similar with some signs of serious problems, such as stroke or brain tumor, and so it is important that there is always a doctor’s assessment.
How to confirm the diagnosis
Diagnosis is usually initiated with an assessment of the muscles of the face and the reported symptoms, but the doctor may also order some complementary tests, such as CT scan, MRI and some blood tests. These tests, in addition to helping to arrive at the diagnosis of Bell’s palsy also allow to lose other problems that may have as a symptom facial paralysis.
What Can Cause Bell’s Palsy
The exact cause that causes inflammation of the facial nerve and the onset of Bell’s palsy is not yet known, however, it is common for this type of alteration to appear as after viral infections such as:
- Herpes, simple or zoster;
- Lyme disease.
In addition, it is more common in pregnant women, people with diabetes, patients with lung infections or when there is a history of paralysis in the family.
How treatment is done
Treatment for Bell’s palsy can be done through the use of medications and physiotherapy and speech therapy sessions, and most people fully recover within 1 month of treatment.
However, there are several treatment options:
Drug treatment of Bell’s palsy should be indicated by a neurologist and consists of the use of corticosteroids such as prednisone or prednisolone, and antivirals such as acyclovir or vanciclovir, which may begin to be used up to 3 days after the onset of symptoms.
As Bell’s palsy causes muscle contraction in the face can lead to the appearance of pain, and in these situations, it may be recommended to use analgesics such as aspirin, dipyrone or paracetamol to relieve this symptom.
In addition, if paralysis prevents the closure of one of the eyes, it is necessary to pass an ointment directly in the eye before bed to protect it avoiding extreme dryness, and during the day it is important to use a lubricating eye drops and sunglasses to protect from the sun and wind.
In physiotherapy sessions the person performs exercises that help strengthen the facial musculature and improve blood circulation in the nerve, such as:
- Open and close your eyes tightly;
- Try to raise your eyebrows;
- Approximate the eyebrows, forming vertical wrinkles;
- Frowning etating by making horizontal wrinkles appear on the forehead;
- Smile hard, showing your teeth and without showing your teeth;
- Give a ‘yellow smile’;
- Tighten your teeth tightly;
- Put a pen in your mouth and try to draw a picture on a sheet of paper;
- Approach the lips as if you wanted to ‘send a kiss’;
- Open your mouth as much as you can;
- Frown, as if to feel a bad smell;
- Make soap balls;
- Fill air balloons;
- Make faces;
- Try to open the nosrinas.
These exercises can also be done at home to improve symptoms more quickly, but should always be guided by a physiotherapist, according to each case.
During the performance of these exercises the physiotherapist can use an ice cube wrapped in a sheet of napkin to slide over the paralyzed area as a stimulus for muscle contraction. To help the person to do the contraction the therapist can help the sense of movement by placing 2 or 3 fingers on the face, which are then removed so that the person can maintain the contraction properly.
Some studies have been developed to evaluate the benefits of acupuncture in the treatment for Bell’s palsy, and some results point out that this technique of traditional Chinese medicine can improve function and reduce the stiffness of the nerves of the face by stimulating nerve fibers in the skin and muscles of the face.
In some situations, surgery may be indicated by the physician, especially in cases where there is enough facial nerve involvement, which is only confirmed after electroneuromyography.
After surgery, psychotherapy may be indicated for psychological support, because when the face is very different from what it was before, it can be difficult for a person to recognize and accept himself, especially when one needs to develop professional activities in which there is contact with other people.
5. Speech Therapy
Speech therapy sessions are indicated for rehabilitation of the person who had bell’s palsy, as it helps to recover the movements and expressions of the face, besides helping to stimulate the functions of speech, chewing and swallowing. This type of therapy should be done by a trained professional and the amount of sessions per week and the treatment time will be determined by the speech therapist together with the doctor.
How long does recovery take
Complete recovery should occur in approximately 3 to 4 months, and as soon as physiotherapy begins some advances may be noticed. About 15% of people who have this peripheral facial paralysis do not fully recover, and there may be a need for botox or surgery months later.