Bell's Palsy

What is Bell’s palsy?

Bell’s palsy, is a weakness of the muscles of the face that comes on suddenly and is not caused by any known underlying condition. Bell’s palsy is also known as idiopathic facial palsy (“idiopathic” means of unknown cause and “palsy” means paralysis). Although more common in adults, Bell’s palsy can occur in children.

Fig. 1 The facial nerve comes directly from thebrainstem, traveling through the skull bones to activate the facial muscles.

What is the Facial Nerve?

The facial nerve comes directly from the brainstem, traveling through the skull bones to activate the facial muscles. The facial muscles include the orbicularis oculi muscle, which closes the eyelid, and the risorius muscle, which is involved in smiling [See figure 1].

How did Bell’s palsy get its name?

Sir Charles Bell was a Scottish surgeon who described the nerve supply to the facial muscles over 200 years ago.

How is Bell’s palsy diagnosed?

Eyelid drooping and difficulty closing one (or both) upper eyelids are classic findings in Bell’s palsy. Asymmetric or incomplete smiles, decrease in forehead wrinkling, nasal stuffiness, and mild difficulty with speaking are also common signs. Frequent early symptoms include abrupt onset of dry eye and tingling around the mouth, with progression to more complete facial palsy occurring within one to several days.

What causes Bell’s Palsy?

Although the cause is unknown, there is some suggestion that Bell’s palsy might be partially caused by a virus. Children with facial paralysis should see their pediatrician or pediatric ophthalmologist to exclude other possible causes for the weakness. Lyme disease is an example of another cause for facial paralysis, and should be considered, especially if you live in an area where Lyme disease is common. Brain imaging (such as MRI or CT scanning) should be considered, especially if the weakness does not begin to improve in a few weeks. Your doctor should help you decide if any special tests are justified.

Fig. 2 Child with Bell's Palsy

Can Bell’s palsy be transmitted from one person to another?

No, Bell’s palsy is not contagious.

Who is at risk to get Bell’s palsy?

Most persons with Bell’s palsy are otherwise healthy. However, older individuals, persons with immune deficiency, diabetics, and women in the last trimester of pregnancy are at higher risk for developing Bell’s palsy. Men and women are affected at similar rates, and there is approximately equal incidence of the disease in different races. The severity and duration of Bell’s palsy also is not significantly affected by gender or race.

How common is Bell’s palsy?

Bell’s palsy affects about 0.2% of the world’s population, or about 1 in 5000 people. About 40,000 Americans are affected every year.

Can both sides of the face be affected by Bell’s palsy?

Bilateral Bell’s palsy is rare, affecting <1% of patients with the condition.

Are there other symptoms besides the facial weakness?

Some patients complain about pain around the ear, facial numbness, sensitivity to sound, or numbness of the tongue. Since there is a decrease in the ability to blink, dry spots may develop on the surface of the eye, causing pain or a feeling of dryness. Because the tear drainage system requires normal muscle tone, there may also be a problem with overflow tearing.

Is the weakness of the face permanent?

In almost all cases, the weakness caused by Bell’s palsy starts to improve after a few weeks. Recovery is usually full; however, there may be some permanent signs of the condition, such as twitching of the muscles around the mouth when blinking.

What is the treatment for Bell’s palsy?

Most cases of Bell’s palsy recover without the use of medications, using supportive care alone. Some researchers have suggested the use of anti-viral medications or steroid medication for Bell’s palsy. Lubricating eye drops or ointments are frequently used to prevent damage to the surface of the eye from drying.

How long does it take for Bell’s palsy to recover?

On the average, recovery from Bell’s palsy takes between a few weeks and several months. Some recovery may continue up to 12-18 months after the onset of Bell’s palsy.

Can Bell’s palsy come back after my child has recovered?

In the vast majority of cases, Bell’s palsy will not recur, but it is possible, even years after the first episode. The recurrence rate is around 5-10%. The risk of recurrence is elevated in patients with immune system diseases, such as HIV-AIDS or sarcoidosis.

What type of eye lubrication is best for Bell’s palsy?

In general, there are artificial tear drops and artificial tear ointments. The ointments will generally last longer, and frequently give more thorough protection against dryness than drops. However, because of their increased thickness, artificial tear ointments cause significant blurring of vision, which usually persists several minutes after administration. Some artificial lubricants (gels) are formulated to be intermediate between regular tear drops and ointments.

Both artificial tear drops and ointments come in preserved and non-preserved formulations. Around 15% of the general population may develop a sensitivity to preservatives used in many eye drops.

Where can I find more information about Bell's palsy?

www.ninds.nih.gov/disorders/bells