Bell’s Palsy

Bell’s Palsy is not a stroke.

Although quite frightening to the patient, Bell’s Palsy is not a stroke, but is due to the weakness or temporary paralysis on one side only, of one of the twelve cranial nerves, specifically the seventh cranial nerve which also is known as the facial nerve. Therefore, the condition is sometimes referred to as facial nerve palsy as a result of nerve damage to that particular facial nerve.  The paralysis occurs to the face and it is one of the most common disorders of the cranial nerves. It usually develops a couple of weeks after you have a cold or an eye or ear infection. Most researchers believe that it is initiated by a viral infection, specifically the herpes virus. And for most people, the condition is only temporary. A very few have some of the symptoms for life, although they may show remarkable improvement. It does not affect any other part of the body and is somewhat common, affecting approximately .02% of the population.  Bell’s Palsy is not gender specific, effects teenagers and up to 60 year-olds, and only affects the facial muscles and nerves. The true cause of Bell’s Palsy is unknown. A stroke has more wide-spread effects and is much more permanent. A stroke usually results in numbness, weakness, and tingling in the arms and legs. Bell’s Palsy does not, but it does cause facial muscle weakness.

The facial nerves control many facial functions such as blinking the eyes, tear production, saliva flow on the affected side of the mouth, taste, smiling, and sometimes hearing. One side of the mouth usually droops but improves with time and dryness of the eyes may occur. Salivary flow may be affected and the patient may experience difficulty with facial expressions due to facial nerve weakness. The taste buds on that side may be temporarily deficient and sounds may seem louder in one ear.

Although it is unknown what causes Bell’s Palsy it is thought to be caused by the virus which causes herpes, which also is the culprit involved in fever blisters and shingles. Whatever the cause, it is said to be responsible for the inflammation and swelling of the facial nerve which is then pinched at the small opening where it emanates from the skull near the ear. This pressure temporarily (in the greatest majority of cases) affects the nerves and muscles “down line” due to damage to the sheath of the nerve.

The symptoms of Bell’s Palsy occur rather quickly, overnight usually, but sometimes in a couple of days. The paralysis of facial muscles usually ends quickly and then begins to slowly subside in most cases. Physical therapy may or may not be helpful.

Diagnosis is made by eliminating the possibility of stroke, tumor, or possibly Lyme disease. If all other possible causes are eliminated, the diagnosis becomes Bell’s Palsy. It is truly a diagnosis by exclusion of by ruling out any problems or pathology related to the brain, temporal bone, middle ear, or parotid salivary glands. Some of the symptoms in combination may include facial spasm, blurred vision, sounds seeming loud, numbness, earache, taste reduction on the tongue, problems with blinking the eye, tearing, etc. The eye on the affected side usually will not properly close and the “dry eye” must be protected to avoid corneal damage. Topical lubrication is usually all that is needed to prevent corneal problems. The onset is fairly sudden, is frightening to the patient, but usually begins to improve after 48 hours. If it is bilateral (occurs on both sides), it is probably not Bell’s Palsy. The condition is found more in pregnant women and is also more prevalent in diabetics. However, there is no prevalence of the disease in any gender or race.

The prognosis for patients with Bell’s Palsy is quite good, especially if signs of normalcy begin returning within three weeks. This includes approximately 80% of the patients. And almost 85% have a complete recovery within one year. The prognosis for full recovery is much higher for younger folks than older. The nerve regenerates a tiny amount each day and can take up to two years, with improvement even beyond that time.

Steroids or anti-inflammatory drugs are considered helpful but only immediately after the onset of Bell’s Palsy. There is a very slight chance of recurrence in about ten years but this happens in only about 5-6% and is rare.

Today’s Dentist

Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentists