Bell’s palsy: Symptoms, Causes and Treatment

The Bell ‘s palsy is a neurological disorder that affects the facial muscles, causing changes aesthetic, functional and psychosocial level (Benitez et al., 2016).

This pathology constitutes the most common type of facial paralysis and is also called peripheral facial paralysis (León-Arcila et al., 2013).

Bell’s palsy is caused by the presence of different damages or injuries in the facial nerves (cranial nerve VII) (National Institute of Neurological Disorders and Stroke, 2010).

Although it is an alteration that can occur in any age group, the exact etiological causes are unknown. However, in some cases traumatic or viral causes can be identified (León-Arcila et al., 2013).

Bell’s Palsy Treatment

Generally, the clinical course of Bell’s palsy is temporary. In most cases, the signs and symptoms begin to disappear a few weeks later (Mayo Clinic, 2014).

bell's palsy treatment

Characteristics of Bell’s palsy

In the early nineteenth century, a Scottish surgeon named Charles Bell, described for the first time an alteration consisting of a complete facial paralysis resulting from a traumatic event in the area of ​​the stylomastoid foramen, where the facial nerve runs (León-Arcila et al ., 2013).

This medical condition was called Bell’s palsy and occurs as a consequence of an eruption of facial nerve function (National Institute of Neurological Disorders and Stroke, 2010).

The facial nerves or the cranial nerve VIII, is a structure that contains the nerve fibers that are responsible for controlling much of the facial area functions (Devéze et al., 2013).

Specifically, the facial nerve performs various motor functions of the muscles of the facial mimic, sensitive in the external auditory canal, gustatory in the anterior portion of the tongue and some parasympathetic vegetative functions that control the secretions of the lacrimal glands, nasal, submandibular and sublingual (Devéze et al., 2013).

The cranial nerve VII is a pair structure that runs through a bone channel, in the skull, below the ear area, to the facial muscles (National Institute of Neurological Disorders and Stroke, 2010).

When this nervous structure is damaged, injured or inflamed, the muscles that control facial expression can be weakened or paralyzed (American Academy of Ophthalmology, 2016).

In Bell’s palsy, there is a sudden decrease or absence of mobility of the innervated muscles controlled by the facial nerve. Thus it is possible to observe in the person affected that half of his face is paralyzed or “fallen” and can only smile using one side of his face, close a single eye, etc. (American Academy of Ophthalmology, 2016).

Therefore, affected persons usually present various deficits of the functions of the facial muscles and facial expression, such as the inability to close the eyes, smile, frown, raise the eyebrows, speak and / or eat (Benítez et al. ., 2016).

Statistics

Bell’s palsy is one of the most frequent neurological alterations, being the main cause of facial paralysis (León-Arcila et al., 2013).

Thus, it has been observed that Bell’s palsy is a neurological disorder that affects around 40,000 people in the United States every year (National Institute of Neurological Disorders and Stroke, 2010).

Worldwide, it is estimated that the incidence of Bell’s palsy is found in approximately 70 cases per 6,000 inhabitants (Benítez et al., 2016).

This medical condition can occur in men and women and in any age group, however, it is less prevalent in the stages of life before 15 years of age and after 60 (National Institute of Neurological Disorders and Stroke, 2010). ).

In addition, a series of risk factors have been identified that significantly increase their occurrence, including pregnancy, diabetes, or some respiratory pathologies (National Institute of Neurological Disorders and Stroke, 2010).

Signs and symptoms

Easy nerves have very diverse and complex functions, due to this the presence of a lesion in this structure can generate various alterations (National Institute of Neurological Disorders and Stroke, 2010).

Therefore, the signs and symptoms of this pathology can fluctuate depending on the severity and the affected person (National Institute of Neurological Disorders and Stroke, 2010).

The most characteristic symptoms of Bell’s palsy usually affect one side of the face, so in rare cases there are bilateral cases of facial paralysis (American Academy of Ophthalmology, 2016).

In general, the clinical course of Bell’s palsy usually occurs suddenly and usually includes some of the following medical conditions (Mayo Clinic, 2014):

  • Weakness of the facial muscles.
  • Facial paralysis.
  • Difficulty to emit facial expressions.
  • Mandibular pain or in the region posterior to the auditory pinna.
  • Increased sensitivity to sound.
  • Decrease in the effectiveness of the sense of taste.
  • Recurrent headache
  • Excessive tearing or dry eyes.

In addition, Bell’s palsy is an alteration with an important psychological and functional effect, since it can have a great negative impact on patients and their psychosocial environment (León-Arcila et al., 2013).

Its permanent?

The duration of facial paralysis is variable. According to the different classifications of this pathology in the medical literature, we can divide this type of condition into transient and permanent (Benítez et al., 2016).

Bell’s palsy is one of the types of transient facial paralysis (Benítez et al., 2016). In about 80% of cases, the symptoms resolve in about three months, while many others begin to disappear in just two weeks (Clevelan Clinic, 2016).

Causes

This type of facial paralysis occurs when the nerves of the cranial nerve VII are inflamed, compressed or injured, leading to the development of facial paralysis or weakness (National Institute of Neurological Disorders and Stroke, 2010).

Despite this, the etiologic cause of nerve damage in Bell’s palsy is unknown (National Institute of Neurological Disorders and Stroke, 2010).

Specifically, more than 80% of cases of Bell’s palsy are classified as idiopathic (León-Arcila et al., 2013), a term used to designate diseases that spontaneously burst and do not present a clearly defined cause.

Despite this, there is another percentage of cases in which the clinical course of Bell’s palsy is associated with the presence of another type of pathological agents, such as herpes simplex virus and varicella zoster (León-Arcila et al., 2013).

In addition, other cases have also been identified as the product of infectious processes, genetic alterations, hormonal variations or traumatic events (León-Arcila et al., 2013).

The etiological causes of facial paralysis are multiple and can be classified as congenital or acquired (Benítez et al., 2016).

The easy paralysis of congenital type can result from the presence of congenital trauma, Möebious syndrome or mandibular division, although they may not present a known cause. While facial paralysis of acquired type usually result from a traumatic event or a viral inflammatory process (Benítez et al., 2016).

In addition to the conditions indicated above, there are several cases in which the probability of suffering from Bell’s palsy is higher than that of the general population (Mayo Clinic, 2014):

  • Women in gestation period: during the third trimester or in the first post-partum days.
  • Presenting an infection in the upper respiratory tract, such as the flu or the common cold.
  • Have diabetes
  • Family history compatible with the presence of recurrent Bell’s palsy.

Diagnosis

There is no specific laboratory test or analysis that is used to confirm the presence or diagnosis of Bell’s palsy (National Institute of Neurological Disorders and Stroke, 2010).

Instead, this type of pathology of neurological origin is diagnosed on the basis of clinical presentation, ie, a detailed physical examination is performed in which it must be observed: inability to perform movements or facial expressions, facial weakness, etc. (National Institute of Neurological Disorders and Stroke, 2010).

It is necessary to exclude other medical causes of facial paralysis such as temporary bone bills, acoustic neuromas, auditory tumors (León-Arcila et al., 2013), strokes and other pathologies or neurological conditions (American Academy of Ophthalmology, 2016).

Therefore, several complementary tests are often used to confirm the presence of Bel’s paralysis (León-Arcila et al., 2013).

Specifically, the neurophysiological evaluation is one of the most used methods to determine the degree of nerve degeneration and prediction of recovery of facial function

The electro-neurography is one of them, allows to quantitatively and objectively assess the presence of a compromise in the facial nerve and also allows establishing a prognosis of approximate recovery (León-Arcila et al., 2013).

In addition to this, other techniques used in the assessment of Bell’s palsy are electromyography (EMG), magnetic resonance imaging (MRI) or computed tomography (CT) (National Institute of Neurological Disorders and Stroke, 2010).

Treatment for Bell’s palsy

Once the diagnosis of Bell’s palsy is made, it is essential to start the treatment immediately, with the objective of recovering completely and in the shortest time possible (León-Arcila et al., 2013).

This type of pathology can affect each person differently, in the milder cases it is not necessary to use a specific treatment since the symptoms resolve spontaneously in a short time, however, there are other more serious cases.

Although there is no standard cure or treatment for Bell’s palsy, the most important goal is the treatment or elimination of the source of neurological damage (National Institute of Neurological Disorders and Stroke, 2010).

In some cases, medical specialists initiate treatment with corticosteroids or antiviral drugs in a period of three to four days after the presentation of facial paralysis (Cleveland Clinic, 2015).

Recent research has shown that steroids and antiviral drugs such as acyclovir are an effective therapeutic option for Bell’s palsy (National Institute of Neurological Disorders and Stroke, 2010).

In addition, the anti-inflammatory drug known as prednisone is often used to improve facial function and limit the reduction of possible inflammation of nerve areas (National Institute of Neurological Disorders and Stroke, 2010).

On the other hand, the therapeutic option based on surgical procedures is only considered as a last option when there is total facial paralysis, without response to drugs (Cleveland Clinic, 2015).

In addition to these factors, it will also be important to take into account possible medical complications derived from facial paralysis, such as transient or permanent alteration of hearing and eye irritation or dryness (Cleveland Clinic, 2015).

Bell’s palsy can prevent blinking in many cases, so the eye can be exposed directly to the outside environment permanently. Thus, it is important to keep the eye hydrated and protected from possible injuries. Medical specialists usually prescribe the use of artificial tears, gels or eye patches (National Institute of Neurological Disorders and Stroke, 2010).

Also Read: Childhood Epilepsy: Types, Causes and Treatments

On the other hand, the use of physiotherapy to help maintain the muscle tone of the facial area is beneficial in many affected. There are facial exercises that can prevent the development of permanent contractures (National Institute of Neurological Disorders and Stroke, 2010).

In addition, massage or application of moist heat can help reduce localized pain (National Institute of Neurological Disorders and Stroke, 2010).

These and other therapeutic measures used in Bell’s palsy should be prescribed and implemented by the medical specialists in each area.

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