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.