Bell’s Palsy: An Idiopathic Facial Paralysis

What Is Bell’s Palsy?

Bell’s palsy is a medical term that defines temporary facial paralysis or weakness on one side of the face. It is also known as idiopathic facial palsy and results in dysfunctioning of the facial nerve(cranial nerve VII). Consequently, it results in a temporary weakness or paralysis of the facial muscles, causing difficulty in blinking, smiling, and other facial expressions.

Everything that includes facial nerves gets affected, such as impulses to the tear glands, saliva glands, and the muscles of a small bone in the middle of the ears. The nerves are also responsible for transmitting taste sensations from the tongue.

Even though Bell’s palsy is the most common cause of facial paralysis, the specific reason behind it is still unknown. Usually, these disorders affect only half of the face, but they may affect both sides only in rare conditions.

The symptoms of Bell’s palsy start to originate within 48 to 72 hours and usually start to improve after a few weeks or within six months with the recovery of some or all facial functions.

What Is The Leading Symptom Of Bell Palsy?

Bell’s palsy occurs because the facial nerves become dysfunctional. As a result, the functions associated with facial nerves get affected that comes in the form of Bell’s palsy symptoms, such as:-

  • Drooling
  • Difficulty while eating and drinking
  • Difficulty while making facial expressions, such as smiling, frowning, blinking, or chewing
  • Facial weakness
  • Twitching of muscles in the face
  • Headache
  • Decreased in the sense of taste
  • Sensitivity to sound
  • Pain or numbness behind the ears
  • A feeling of irritation of the eye on the affected side
  • Change in the production of tears and saliva 

In case you experience any paralysis because of a stroke, seek medical help. Bell’s palsy doesn’t need to be caused by a stroke, but it can cause similar symptoms.

Consult your doctor in case of any weakness or any underlying cause and severity of the illness.

Coming to the next point, the causes of Bell’s palsy occur.

What Is The Main Cause Of Bell’s Palsy?

The Bell’s palsy causes are still not known. But in most of its cases, swelling, inflammation in the nerves, or viral infection has been noticed. Some of the infection may result in swelling of facial nerves and consequently becomes inflamed in reaction to the infection. As a result, it creates pressure within the Fallopian canal(it is a bony canal through which the nerves travel to the side of the face) and restricts the supply of blood and oxygen to the nerves.

While in some mild cases, the damage is caused only to the myelin sheath(the fatty covering that acts as insulation of nerve fibers), which recovers on its own.

Apart from these, other viral infections may contribute to the occurrence of Bell’s palsy, such as:-

  • Cold sores and genital herpes(herpes simplex 1 virus)
  • Chickenpox and shingles(herpes zoster virus)
  • HIV which damages the immune system
  • Infectious mononucleosis(Epstein-Barr)
  • Cytomegalovirus infection
  • Sarcoidosis causes organ inflammation
  • Respiratory illness(adenovirus)
  • Infected ticks cause Lyme disease
  • German measles(rubella)
  • Mumps(mumps virus)
  • Flu(influenza B)
  • Hand-foot-and-mouth disease(coxsackievirus)

Several other impaired immunities from stress, sleep deprivation, minor illness, autoimmune syndrome, òr physical trauma are also likely to trigger Bell’s palsy.

Who Is At Risk For Bell’s Palsy?

People suffering from some medical conditions are at high risk of developing Bell’s palsy. Medical conditions, such as:-

  • Pregnant women in the first week after giving birth to a baby or during their third trimester.
  • People suffering from an upper respiratory infection, such as flu or cold
  • Diabetic patients
  • People who have a family history of Bell’s palsy

What Are The Long-Term Side Effects Of Bell’s Palsy?

In case of mild Bell’s palsy, the symptoms may disappear within a month, but for severe cases, it may lead to total paralysis varies and includes further complications, such as:-

  • Irreversible damage to your facial nerve
  • Abnormal growth in the nerve fibers results in involuntary contraction of the muscles and may damage the seventh cranial nerve. A person may feel difficulty trying to perform certain facial activities, such as smiling and blinking, affecting one side of your face.
  • It may also result in partial or complete blindness of the eyes and inability to close because of excessive dryness and scratching of the transparent protective covering of the eyes.
  • It may also cause synkinesis, a condition in which the moving of one involuntarily part also causes other parts to move.

How Does A Doctor Diagnose Bell’s Palsy?

There are no specific tests that determine the surety of having Bell’s palsy. In fact, doctors diagnose Bell’s palsy by examining other conditions that have been ruled out. The doctor calls it a “diagnosis of exclusion”.

The doctor may go for a physical examination asking about the patient’s symptoms, including when they occurred or when they noticed it for the first time.

The doctor may also examine the patient’s facial muscle movement by asking to close the eyes, lifting eyebrows, showing teeth and frowning, and others. 

Such complications may also occur due to other conditions, such as stroke, infection, Lyme disease, and tumors. Therefore, the doctor may also recommend other medical tests, such as:-

  • Electromyography(EMG): This medical test confirms nerve damage and helps determine its severity. It also measures the electrical activity in response to stimulation along with the nature and speed of the electrical impulses through nerves.
  • Imaging scans: It includes magnetic resonance imaging(MRI) or computerized tomography(CT) scan in order to know the structural cause of the pressure on the facial nerve, like a tumor or skull fracture.

What Is The Treatment For Facial Nerve Palsy?

Many patients recover from Bell’s palsy with or without treatment. Based on the cause of the medical condition, the doctor will treat the patient accordingly. In some cases, the patient needs medication, physical therapy, or surgery.

Medicines For Bell’s Palsy: Here are the category of some commonly used medicines, such as:-

  • Corticosteroids: Sometimes, the reason behind Bell’s palsy is the swelling of the facial nerves that fits comfortably within the bony corridor that surrounds it. A medication of such categories, such as prednisone (a powerful anti-inflammatory agent), reduces these nerves’ swelling, making it function well. Consequently, lowering the signs and symptoms of Bell’s palsy.
  • Antiviral drugs: When it comes to antivirals, it remains unsettled and hasn’t shown many benefits as compared to the placebo effect. The consumption of antivirals and steroids are probably more beneficial to some people in the case of Bell’s palsy, but it is still unproven.

Even so, the combination of valacyclovir (Valtrex) or acyclovir (Zovirax) is sometimes preferred with prednisone in people who have severe facial palsy.

Physical Therapy: In Bell’s palsy, the facial muscles can shrink, resulting in permanent contractures. The physical therapist can help you massage and exercise the facial muscles that help prevent it from occurring. 

Other therapies, such as facial massage or acupuncture, may show a slight improvement in facial nerve function and pain. 

Surgery: Most of the surgeries are either controversial or involve a high risk of damaging other parts of the brain. The fundamental reason to perform surgeries is to put pressure on the facial nerves in their normal condition.

Some surgeries help reduce pressure on the nerves, such as decompression surgery for Bell’s palsy, which is controversial and seldom recommended. But it is not recommended because of the complications associated with it, such as facial nerve injury or permanent hearing loss.

Another rare one is cosmetic or reconstructive surgery that reduces deformities and improves some damages, such as eyelids that are not fully closed or a crooked smile.

In rare cases, some plastic surgeries might be needed to correct lasting facial nerve problems that help the face look good. Such surgeries include eyebrow lift, eyelid lift, facial implants, and nerve grafts. Out of these, some procedures need to be repeated after some years, such as eyebrow lift.


What Can You Do In The Meantime?

In case you start to experience facial pain, consume over-the-counter pain relievers, such as Aspirin, ibuprofen (Advil, Motrin IB, others), or acetaminophen (Tylenol), etc. You can also apply moist heat to get relief from pain, such as putting a clean soaked cloth in warm water on your face several times.

You may feel difficulty closing your eyes completely; therefore, you can use your finger to close your eye repeatedly throughout the day, use lubricating eye drops, wear eyeglass to protect your eye during the day, and may use eye patches at night.


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Janet Fudge

Janet Fudge writes on general health topics for She holds a post-graduate diploma in Public Health with a major in epidemiology. During the outbreak of COVID-19, Janet actively volunteered in vaccination drives throughout the state of Iowa. She lives in Iowa with her husband and two children.