What are the other Names for this Condition? (Also known as/Synonyms)

• 7^th Cranial Nerve Palsy
• Acute Idiopathic Facial Neuropathy
• Cranial Nerve VII Palsy

What is Bell’s Palsy? (Definition/Background Information)

• Bell’s Palsy is a fairly common disorder characterized by muscle weakness and paralysis on one side of face with involvement of facial muscles
• The onset is rapid and may occur overnight or within a couple of days. Symptoms tend to worsen over 1-2 weeks, before any signs of improvement are seen
• The exact cause of Bell’s Palsy is not well understood, though young adults are most prone to the condition
• Common signs and symptoms of Bell’s Palsy include drooping of the eyelid, difficulty raising the eye brows and, closing the eyes, and problems with pursuing lips and smiling
• In most cases, Bell’s Palsy is a self-limiting condition for which symptomatic treatment is provided
• The prognosis is generally good and most individuals make a full recovery, though the symptoms may last for about a few months

Who gets Bell’s Palsy? (Age and Sex Distribution)

• Individuals of all ages can be affected by Bell’s Palsy, but most cases occur between the ages of 15 -45 years
• The peak incidence is in the third decade (between age 20-29 years) of life
• Men and women are equally affected. Rarely, children can also get  Bell’s Palsy
• Overall incidence is approximately one case per 4,000 people per year or one case per 60 people over a lifetime
• The condition is observed worldwide; there is no racial or ethnic predilection

What are the Risk Factors for Bell’s Palsy? (Predisposing Factors)

Following are the risk factors associated with Bell’s Palsy:

• A previous episode of Bell’s Palsy
• A family history of the condition (accounts in about 10% of the cases)
• Infection with herpes simplex virus type 1 (also causes cold sores)
• Recent infection with herpes zoster (shingles), mumps, rubella, or HIV
• Recent cold or flu
• Pregnancy
• Diabetes

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bell’s Palsy? (Etiology)

The exact cause of Bell’s Palsy is not known.

• Most often, it is linked to the exposure of certain viruses such as herpes simplex virus (cold sore virus), Epstein-barr virus, herpes zoster virus (chicken pox and shingles), measles and rubella viruses, and influenza B virus (flu)
• Symptoms of Bell’s Palsy occur due to swelling of the facial nerve, as it travels from the brain to innervate the muscles of the face
• Swelling causes dysfunction of the nerve and loss of motor control of muscles supplied by this nerve

Bell’s Palsy is not caused by a stroke, another common cause of facial weakness and paralysis.

What are the Signs and Symptoms of Bell’s Palsy?

The signs and symptoms of Bell’s Palsy include:

• Weakness and paralysis of both the upper and lower face, on the affected side only
• Drooping of eyelid and mouth
• Difficulty raising eyebrow and closing eyelid
• Difficulty wrinkling the forehead and frowning
• Difficulty in pursing lips and smiling
• Dry eye and drooling
• Possible loss of taste on the affected side
• Hyperacusis (increased sensitivity to loud noises) on affected side
• Mild facial numbness on affected side is also common at onset of symptoms
• Discomfort, numbness, or pain behind the ear on the affected side, early in the course of the disorder

How is Bell’s Palsy Diagnosed?

• Diagnosis of Bell’s Palsy is made based on the complete evaluation of medical history and thorough clinical examination
• Laboratory tests are generally unnecessary, but may be done to help rule out other causes of facial nerve paralysis

The tests and exams for Bell’s Palsy may include:

• A neurologic exam testing the function of all nerves will show deficits limited to muscles supplied by the facial nerve. Limb movement, strength, coordination, and reflexes of all other muscles are generally normal
• CT scan or MRI scan of the head may be performed to look for other causes of facial muscle paralysis such as stroke and multiple sclerosis
• Some other medical conditions, such as Lyme disease, Guillain-Barre syndrome, myasthenia gravis, and sarcoidosis, can cause bilateral facial paralysis and should be distinguished from true Bell’s Palsy, in order to ensure proper treatment

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bell’s Palsy?

The possible complications of Bell’s Palsy are:

• Excessive dryness or irritation of the eye (because the eyelid cannot be completely closed)
• During recovery, problems with reinnervation (restoration) of muscles can occur that result in eye tearing or sweating while eating
• Synkinesis is the involuntary contraction of facial muscles when attempting movement of other facial muscle groups and may occur during recovery due to the misdirected growth of the nerve fibers (e.g. when you smile, the eye on the affected side may close)

How is Bell’s Palsy Treated?

The treatment of Bell’s Palsy may include:

• Corticosteroids shorten the length of symptoms and help prevent residual weakness in majority of the patients
• Antiviral drugs, such as acyclovir, may be helpful in few cases if a virus is known to have caused the condition
• Physical therapy is also very beneficial because it helps to maintain the muscle tone of the affected muscles and stimulate the facial nerve
• Facial massage and exercises may help prevent permanent contractures of the affected muscles
• Cosmetic or reconstructive surgery is rarely required in patients to reduce deformities and to correct some damage (e.g. a smile reconstructive surgery for a crooked smile)

How can Bell’s Palsy be Prevented?

Currently, there are no known preventative measures for Bell’s Palsy.

What is the Prognosis of Bell’s Palsy? (Outcomes/Resolutions)

• The prognosis of Bell’s Palsy is generally very good. Most of the patients with Bell’s Palsy begin to feel better within 2 weeks
• A spontaneous recovery, with or without treatment, occurs in approximately two-thirds of the patients within a few weeks to several months
• Those with partial paralysis of the facial nerve have a better prognosis than those with complete paralysis
• In a few patients symptoms never disappear completely, with some residual weakness of facial muscles

Additional and Relevant Useful Information for Bell’s Palsy:

• Facial nerve palsy due to birth trauma is characterized by a loss of muscle control in the face, which results when the facial nerve gets damaged during difficult labor

The following article link will help you understand facial nerve palsy due to birth trauma:

http://www.dovemed.com/diseases-conditions/facial-nerve-palsy-due-to-birth-trauma/