Bells Palsy

Jaime Mitchell 26 April 2008 Bell’s Palsy Damage to one of two facial nerves can possibly result in temporary paralysis of the facial muscles, most often to only one side of the face and in rare cases, both sides. This condition is known as Bell’s Palsy. The facial nerve that is damaged is called the seventh cranial nerve. This nerve primarily moves the facial muscles, controls the salivary and tear glands, and enables the front part of the tongue to detect tastes. The paired seventh cranial nerve is located in the Fallopian canal in the skull, inferior to the ear and is connected to the muscles on the face bilaterally. As well as controlling facial muscles and some glands, it is also responsible for letting one open and close their eyes. Damage from swelling, inflammation, or compression to the seventh cranial nerve ultimately results in the disruption of messages from the brain to the facial muscles. The cause for Bell’s Palsy is unknown. It is thought that viral infections or damage to the myelin sheath of the seventh cranial nerve can bring on the disorder. Viral infections may lead to inflammation, which in turn places pressure on the Fallopian canal leading to an infarction. Damage to the myelin sheath of the nerve can cause the disruption or slowing of signals from the brain to the facial muscles. It is also believed that the disorder can be brought on by patients with Lyme disease, diabetes, high blood pressure, tumors, HIV, chickenpox, or even trauma to the face or skull near the nerve. It is possible that anyone, at anytime can be afflicted with Mitchell 2 Bell’s Palsy, but those primarily susceptible include pregnant women and those with diabetes or upper respiratory ailments such as the cold or flu. Also, young and middle aged adults are more likely to be affected. It is quite uncommon to see a case in an individual ten or younger and sixty or older. Roughly, forty thousand Americans are diagnosed with Bell’s Palsy each year and 20-30 per one hundred thousand cases are reported worldwide annually. Bell’s Palsy is diagnosed based on clinical presentation and by the ruling out other possible causes of facial paralysis. A visual exam including that of the ears, sinus, and throat is performed and a physician may also compare the right and left voluntary and involuntary movements of the face. During a visual and physical examination, the physician will observe whether the patient exhibits severe dryness or has difficulty completely closing and opening one eye, and ultimately, drooping of one side of the face compared with the other. The physician may also question whether or not the patient has trouble tasting, if sounds are perceived louder in one ear comparably, or if there is an unusual increase in saliva produced. Radiographic images may also be administered to rule out tumors and presence or severity of nerve damage. These images may also rule out the possibility of other causes of pressure on the facial nerve. As well as the use of radiographic images, visual and physical exam, the physician may also order blood or cerebrospinal fluid tests to rule out a bacterial or viral infection. The treatment for Bell’s Palsy can take several different courses. Eliminating the source of nerve damage is the primary focus. Since, Bell’s Palsy is different in each patient’s case, the disorder may either go away on its own in milder cases and in the more Mitchell 3 extreme ones, require drug and, or physical therapy.

If the cause of damage to

the nerve is inflammation due to viral or bacterial infections, the source of recovery would be through antiviral or antibiotic medications. Prednisone may work in conjunction with these medications to reduce inflammation, thereby preventing further damage to the nerve and by possibly eliminating some of the symptoms involved. Administration of vitamins that promote nerve growth may also be given. Stimulation of the nerve through physical therapy may also improve symptoms and help with facial tone. Forms of physical therapy may include massages, acupuncture, electrical stimulation, and biofeedback training. Massage therapy can also prevent permanent contractures, that may cause deformity, before recovery takes place. It is important that the eye is protected when one is diagnosed, because normal lubrication is not being provided and damage to the eye may occur. Usually, one is given an eye patch and eye drops for this. Although, it is uncommon, patients may suffer from weakness or paralysis to the side of the face affected after their recovery. Involuntary twitching of the facial muscles may occur or normal facial expressions may be accompanied by spasms. In even rarer cases, the disorder could recur on the same or opposite side of the face. Most, recover completely with no residual effects in one to three months, and in some cases as short as two weeks. Ultimately, the determination of recovery time is based on severity of damage to the nerve.

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