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Bell’s Palsy

Bell’s Palsy Treatment

What is Bell’s Palsy?

A medical condition when the muscles of the face become paralyzed or weak. It typically affects one side of the face and rarely on both sides. The facial muscles will droop, become tight or unable to move, limiting movements such as blinking the eye, smiling or lifting eyebrows. The 7th cranial nerve is the facial nerve, and this is the nerve affected by Bell’s palsy.

What is the cause?

Swelling or inflammation of the facial nerve and viral infections are the most typical causes, especially the herpes (cold sores) or the shingles virus.

How is it diagnosed?
Observation of the face using nerve scale assessments comparing the weak side to the normal side, history, exam, blood/lab workups are used acutely. CT or MRI brain scans are usually done to rule out tumor, stroke, lesions, or other medical conditions. If the person does not begin to recover a facial nerve conduction study or electromyography may be used to assess the nerve function.
What is the treatment?
Acutely medications of anti-viral for viral infections or antibiotics for bacterial infections and corticosteroids to reduce swelling/inflammation are typically used. Neuromuscular facial therapy should be initiated to begin to work on muscle tone and exercises, so the muscles do not atrophy as they are recovering. Therapy emphasizes normal facial movement, mimicking the normal side, stretches, if indicated, and massage. Treatments are individualized and specific to the patient and electrical stimulation is contraindicated. Therapy also emphasizes eye care. A consult to ophthalmology is recommended due to the lacrimal ducts not working well with Bell’s palsy and patients may develop severe dry eye and the cornea needs to be assessed and protected. Some people find acupuncture helpful to expedite recovery.
How long does Bell’s palsy last?
Typically, the duration is from 3 weeks to 6 months. Some cases can become chronic and if the facial nerve is completely paralyzed initially the person may develop muscle imbalance, synkinesis and muscle spasms at the 2-4-month time frame.
Is there pain with Bell’s palsy?
Typically no, if the patient is experiencing facial paralysis with pain, it may be indicative of a condition called Ramsay Hunt Syndrome that causes facial nerve inflammation and muscle weakness as a result of the shingles virus, and this condition typically lasts longer than Bell’s palsy.
What is synkinesis?
As the facial nerve is recovering from any type of facial paralysis, the nerve axons may become disoriented in the recovery and the nerve may heal going to the wrong muscles this will result in an involuntary movement associated with a voluntary movement. For example, a person my pucker their lips or talk and their eye may squint or close during this movement. Or, the person may close or blink their eyes and their mouth may grimace or the lower face pull into an abnormal expression. It can also affect the lacrimal ducts and saliva gland resulting in the person chewing and their eye may tear or water, or they may cry and their mouth increases saliva.
When does synkinesis typically begin?
If the facial paralysis does not resolve in in 2-4 months, synkinesis can result. It could be sooner or later in the recovery process.
Is there treatment for synkinesis?
Yes, neuromuscular facial therapy can provide specific exercises to reduce synkinesis with an emphasis on isolating movements, specific stretches, place and release techniques of muscles, and specific taping techniques. Botox injections can also be beneficial for synkinesis. These injections should be done by a healthcare provider that is trained in Botox treatments for synkinesis or facial spasms.
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