Bell's Palsy
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Bell's palsy is the most common cause of facial paralysis on one side. This face droop is usually temporary. And it isn’t life-threatening.
Any new facial paralysis may be an emergency. Get medical help right away. Treatment for Bell's palsy works best if it's started in the first three days.
If your facial paralysis isn’t getting better, you probably need a specialist. At UVA, our experts have the tools and experience to give you the options you need.
From Facial Paralysis to Recovery
Bell's palsy is a sudden weakness of muscles in one side of the face. Facial plastic and reconstructive surgeon Sam Oyer, MD, discusses Bell’s palsy treatment options and recovery.
Bell's palsy is the most common cause of facial paralysis that we see in adults. The cause of Bell's palsy is still a little bit unclear, but we think it's a reactivation of the herpes virus that causes cold sores. And it tends to cause complete paralysis on one side of the face, which for most people recovers. But a subset of people, maybe 25, even 30 percent don't see full recovery after Bell's palsy. So if someone has paralysis on one side of the face, they should immediately seek medical care to rule out other causes. And Bell's palsy is really a diagnosis of exclusion once all these other causes have been ruled out. The treatment early on is medical, with antiviral medication and steroid medication to help reduce swelling and inflammation around the nerve. Some people recover very quickly and recover completely, and it's never a problem long term. Others, again, recover much more slowly and have trouble with incomplete eye closure, mouth droop drooling when they're trying to eat or drink. And when they do recover, some get a tightness or a spasm in their facial muscles and others get synkinesis, which means that their muscle movements are linked. So when they close their eyes, their mouth moves, or when they do a big smile, their eye closes or their neck tightens. In these cases, we can usually make some improvements. The first step is usually to work with our specialized physical therapists who will work to retrain your brain to work the muscles differently. And it's a special process where they really work on training the brain to control the face. That can be augmented sometimes with Botox injections, which helps cut down spasm in the muscles that we don't want to move, but leaves alone the muscles we do want to move. So those two procedures together really can improve the spasm and synkinesis for a lot of people. For some, it doesn't get enough improvement. And so there's a surgical procedure that we may consider offering in that case where the facial nerves are mapped out and electrically stimulated during surgery. With that stimulation we can see what motion is produced and the nerves that are creating motion that we like to see, like eye closure and smile. Those nerves are saved, while the nerves that are pulling the mouth down, tightening the neck or creating too much pucker around the mouth, we cut a little segment of those nerves selectively. So it's called selective neurectomy. It is a good option for some people to be able to improve their smile and improve their facial function when the more conservative treatments may not be working well.
Bell's Palsy Treatment
If we discover the underlying cause of your facial paralysis, we may be able to treat it. Treatment for these underlying conditions may include medication or surgery.
If you're diagnosed with Bell's palsy without a clear cause, we'll likely start medical treatment right away.
Medication
Medicines for treating your Bell’s palsy might include:
- Corticosteroids, to help swelling and pain
- Antiviral medication, to fight viruses
Your provider may give you corticosteroids if you’ve only had symptoms for a short time. Antiviral medications might be prescribed along with corticosteroids. Combining these medications can improve your chances of complete recovery. It also reduces the risk of developing complications.
Therapy
Physical therapy can improve the movement in your face. It's especially helpful if movement is already returning to your face.
We also offer emotional support. Bell's palsy can be distressing. We can help you manage your feelings about your condition.
Surgery
We have several options for facial reanimation that can help.
Self-Care
If your eyelid is affected, you’ll need to protect your eye. You might need to:
- Use eye drops or other lubricants
- Cover and tape your eye closed at night
- Use an eye patch
Massaging the weakened face muscles may also help.
Sudden Face Droop? Call 911
Sudden drooping or weakness on one side of your face is an emergency. You might be having a stroke. Strokes come on suddenly and can be life-threatening. If you have sudden facial paralysis, get help immediately. Call emergency services right away.
Stroke SymptomsHow Did I Get Bell’s Palsy?
Usually, we don’t know the exact cause. Sometimes, we find that infections have caused the swelling and paralysis.
Infections in your nerves might come from:
- Herpes simplex (usually the cause of Bell's palsy)
- Shingles or chickenpox (can cause Ramsay Hunt syndrome, a more severe form of Bell's Palsy)
- Lyme disease (from a tick bite)
Factors that can increase your risk of getting Bell's palsy include:
- Family members who have Bell's palsy
- Diabetes
- Autoimmune disorders
- Infections (such as HIV, cold, or flu)
- Weakened immune system
- Chemotherapy
- Certain medications
- Pregnancy
- Smoking
- High blood pressure
Bell’s Palsy Symptoms
Bell's palsy symptoms happen suddenly or develop over a few days. Initial symptoms may include:
- Pain behind the ear followed by weakness and paralysis in your face
- Ringing sound in your ears
- Trouble hearing
- Slight increase in sensitivity to sound on the affected side
- Changes in taste
Symptoms of advanced Bell's palsy include:
- Facial weakness or paralysis, most often on one side
- Numbness just before the weakness starts
- Drooping corner of the mouth
- Drooling
- Decreased tearing
- Inability to close an eye, which can lead to:
- Dry, red eyes
- Ulcers forming on the eye
- Infection
- Problems with taste on one side
- Sound sensitivity in one ear
- Earache
- Slurred speech
Complications can also occur 3-4 months after you first get Bell’s palsy. These symptoms include:
- Long-lasting tightening of the facial muscles
- Tearing from the eye while chewing
- Facial muscle spasm or twitching
- Involuntary movements of more than one facial muscle at a time (synkinesis)
Recovery from Bell’s palsy can take up to a full year. But for most people, it goes away after a few months. Symptoms often get better on their own in a few weeks. Your face should return to normal movement. You’ll need to see specialists if you:
- Develop complications from Bell’s palsy
- Don’t see any improvement after six months
- Haven’t recovered after one year
In certain cases, some symptoms of Bell's palsy don’t go away. You may have lasting weakness, tightening, or spasming in your face muscles. As you get older, it’s more likely you’ll have lasting symptoms.
Bell’s Palsy: Getting a Diagnosis
To evaluate your facial paralysis, we’ll:
- Check your symptoms with a physical exam
- Take your medical history
- If needed, extra tests to check for other causes