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What could be more central to our sense of self than our faces?
So imagine what it would be like to watch powerlessly while half
your face progressively droops like melted wax. That's what
happens in Bell's palsy.
Bell's palsy is a condition causing weakness or even total
paralysis of the muscles on one side of the face, typically
developing over 3-72 hours. It can occur at any age and affects
the genders about equally. People with diabetes and depressed
immune systems are at increased risk of having this condition,
as are women in the third trimester of pregnancy. Bell's palsy
affects about 11 out of 1000 people sometime during their lives.
The problem lies within the facial nerve, also known as the
seventh cranial nerve. The nerve is like a telephone-cable and
contains thousands of individual nerve-fibers. There are two
facial nerves, one for each side of the face, and by far the
most common pattern is that one side of the face is affected and
not the other.
The facial nerve ultimately connects the brainstem (junction
between the upper brain and spinal cord located at the base of
the skull) to the muscles of the face. Along the way it travels
through a narrow canal in the skull bone. After exiting this
canal near the bottom of the ear it divides into thousands of
tiny branches before reaching the facial muscles.
In Bell's palsy the portion of the nerve within the skull's bony
canal becomes inflamed for unclear reasons, though an infection
with herpes simplex virus (the same virus that causes cold
sores) is suspected in most cases. The condition is not
contagious.
Because the bony canal is rigid and narrow, the swollen
nerve-bundle has little room to expand, and compression of the
nerve-fibers can further injure them and cause more loss of
muscle function. MRI scans of the head can detect the
inflammation, but only if gadolinium (the MRI-equivalent of
x-ray dye) is infused into a vein prior to scanning.
The weakness in the lower facial muscles produces a lop-sided
smile. Patients sometimes mis-identify the side of their face
that is affected: they focus on the side of the face that is
"drawn" rather than on the side that lacks the ability to draw.
Weakness in the lower face also interferes with talking,ED hardy sunglasses cheap, eating
and drinking, and beverages can dribble from the corner of the
mouth. Weakness of the upper face causes flattening of
forehead-wrinkles and inability to raise an eyebrow.
But the most significant problem is weakness in the muscles that
close the eye, including those involved in blinking.
Blinking��like other things we take for granted until they're
gone��is an underappreciated but important activity that cleanses
and moistens the front of the eyeball. So people with Bell's
palsy experience dryness and irritation of the eye on the side
of the weakness. As a result, they try to blink even more
frequently, but end up blinking the unaffected eye more than the
eye that really needs it.
Other symptoms include pain in or behind an ear in about half
the cases. Pain usually fades within the first 1-2 weeks of the
illness. Because branches of the facial nerve modify the senses
of hearing and taste, patients can also notice excessive
loudness of sounds, and foods might not taste as they should.
Bell's palsy is considered a "diagnosis of exclusion,cheap Oakley sunglasses," meaning
that other diseases producing similar symptoms should be
considered first. For example, especially in childhood, Lyme
disease��a bacterial infection transmitted by tick bite anywhere
on the body��can produce a very similar picture, and needs to be
treated with an antibiotic drug.
In adulthood a different kind of infection, Ramsay Hunt
syndrome, needs to be considered, because it should be treated
with an antiviral drug. Like Bell's palsy, Ramsay Hunt syndrome
damages a facial nerve, but involves the varicella zoster virus,
the same virus that produces chicken pox and shingles. Apart
from causing facial weakness, this virus typically produces
blisters within the ear��or sometimes in the mouth or throat��that
are not seen in cases of Bell's palsy.
Strokes can also produce weakness on one side of the face, but
almost always produce weakness in other parts of the body as
well. Another point of distinction is that strokes seldom
interfere significantly with the ability to blink or raise an
eyebrow.
Fortunately, even without treatment most cases of Bell's palsy
do well. About 50% obtain a full recovery within the first six
months, with the first hint of improvement occurring after 10
days to two months. Another 35% obtain good, though sometimes
incomplete, recovery within the first year.
How about treatment? Prescription drugs often receive the most
attention because they seem more important or definitive than
measures that don't require a doctor's prescription. The two
most prescribed medications are anti-inflammatory steroids, like
prednisone, and anti-viral drugs,Prada Sunglasses sale, like acyclovir. Based on what
is known or suspected about Bell's palsy, their use makes sense.
But what seems logical is not always true. Thus far, randomized,
controlled trials��the gold standard for judging the
effectiveness of treatments��have shown minimal if any effect of
these drugs on the course of symptoms.
A little-heralded treatment is probably the most important. And
that is to protect the eye. With loss of blinking, the eye needs
to be moistened and cleaned in order to prevent irritation and
the worst complication��secondary infection of the eyeball's
surface.
During waking hours this can be accomplished with liberal use of
unmedicated eye-drops. At bedtime, a soothing, unmedicated
ointment��like Lacrilube��can be squeezed from its tube into the
lower eyelid sac. Then the patient can pad and tape the upper
and lower eyelids into a shut position overnight. Upon awakening
the next morning, he or she can uncover the eye and resume
eye-drop treatments. Any loss of vision should be reported
promptly to a physician.
Can Bell's palsy recur? It does in about 5-9% of cases after an
average interval of 10 years. The world's record for recurrences
probably belongs to one poor soul described in a Slovakian
medical journal as experiencing 11 relapses!
(C) 2005 by Gary Cordingley
About the author:
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and
researcher. For more health-related articles see his website at:
http://www.cordingleyne
urology.com