| Bell's palsy is paralysis or weakness on one side of the face because of damage to the seventh (facial) cranial nerve, which is responsible for motor innervation of the muscles of the face. Paralysis occurs in some or all of the muscles on the affected side. Other symptoms of the condition include an inability to close the eye on the affected side of the face, a hypersensitivity to sound in the affected ear, pain, headache, tearing, drooling, and impairment of taste.
The condition comes on abruptly and can range from mild to severe, with total paralysis on one side of the face within 48 hours after symptoms first appear. The cause of Bell's palsy is not known. One prevalent theory suggests that the facial nerve becomes swollen and injured, possibly by a viral infection.
Individuals with herpes simplex or other herpesviruses, diabetes, upper respiratory ailments (such as the flu or a cold), and compromised immune systems are at higher risk for Bell's palsy.Risk: The condition can occur at any age. There is increased incidence in pregnant women ("Bell's Palsy"). Incidence and Prevalence: There are approximately 40,000 cases of Bell's palsy each year in the US ("NINDS"). |
Source: Medical Disability Advisor
| History: The most obvious symptom of Bell's palsy is an unexplained episode of unilateral facial weakness or paralysis. The symptoms begin suddenly and usually peak within 3 to 5 days. Individuals may report other symptoms, including a headache, tearing, changes in the amount of saliva and tears, drooling, difficulty eating and drinking, change in facial appearance, impairment of taste, and hearing loss. Some individuals report a mild cold, influenza, or other upper respiratory tract infection within a week prior to the onset of Bell's palsy. Physical exam: The exam reveals facial asymmetry, drooling, increased distance between the top and bottom eyelids (palpebral fissure width), a smooth forehead, and a flattened crease between the nose and the upper lip (nasolabial fold). Tests: A careful cranial nerve examination should be performed, including a tuning fork examination to test hearing and testing for corneal sensation. A simple test of taste should be performed. A skull x-ray or MRI may be performed to rule out tumor or infection. Nerve excitability testing may also be performed through the use of electromyography (EMG) for assessing facial paralysis by measuring voluntary motor activity, and electroneuronography for determining the extent of nerve fiber degeneration. EMG usually is not thought to be reliable sooner than 18 days after onset of the paralysis. |
Source: Medical Disability Advisor
| There is no specific treatment available for Bell's palsy, although corticosteroids are commonly prescribed. In many cases, no treatment is recommended. When treatment is necessary, the goal is to relieve the symptoms. If an individual is unable to close the affected eye, lubricating eye drops may be used during the day, and lubricating ointment, an eye patch, or moist chamber lenses at night. Corticosteroids may reduce swelling and relieve pressure and inflammation on the facial nerve. Analgesics may be used for pain. Antiviral medication may reduce or limit damage to the nerves from viral causes. Some success in treatment has been achieved using electromyographic rehabilitation (EMGR), botulinum toxin injections to control involuntary facial contractions that may develop, and facial massage.
Surgical reanimation procedures typically involve surgical connection (anastomosis) of a peripheral branch of the spinal accessory (eleventh) cranial nerve to the affected facial nerve to restore innervation to the facial muscles. This procedure likely would be considered much later in the process, and would contribute significantly to length of disability.
Surgical procedures to decompress the facial nerve may be attempted. The goal of facial nerve decompression surgery is to relieve pressure on the swollen facial nerve in its bony canal. This reduction in pressure allows blood vessels to supply the nerve with oxygen and nutrients. |
Source: Medical Disability Advisor
| Approximately 80% of individuals with Bell's palsy experience a complete resolution of symptoms within a few weeks to a few months after onset ("NINDS"). Some cases result in residual side effects and some in permanent changes. Surgical procedures to decompress the facial nerve have not been shown to routinely benefit individuals with Bell's palsy. Bell's palsy is not life-threatening. |
Source: Medical Disability Advisor
| The priorities of rehabilitation in Bell's palsy are pain control, preservation of vision, improved facial function, and restoration of outward appearance. When addressing pain from Bell's palsy, the physical therapist may utilize electrostimulation combined with heat or cold treatment to relax painful facial muscles affected by the condition. Other therapies that may help control pain are Iontophoresis, a technique that uses a small electric current to drive anti-inflammatory medication into the painful muscle tissues, and biofeedback, a method that employs a special machine to teach the individual how to control certain body responses that reduce pain. The use of simple pain relievers (analgesics) may be necessary.
Once pain is brought under control, therapy then focuses on re-education of the facial muscles affected by the condition. Direct electrical stimulation of muscles innervated by the facial nerve is a common technique used in rehabilitation of Bell's palsy.
Modifications may need to be made in the rehabilitation program, depending on the extent of muscle paralysis and whether surgical techniques were required to restore function to the face. |
Source: Medical Disability Advisor
| Complications of Bell's palsy include disfigurement from loss of facial movement, eye damage (corneal ulcers and infections), chronic spasm of facial muscles and/or eyelids, and chronic taste abnormalities. Involuntary contraction of certain muscles may result from misdirected regrowth of nerve fibers. |
Source: Medical Disability Advisor
| Individuals with jobs that require them to be exposed to harsh lighting, wind, or dust may require glasses, goggles, or lubricants to protect the affected eye. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have an unexplained episode of unilateral facial weakness or paralysis?
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Does individual have a headache, tearing, drooling, difficulty eating and drinking, change in facial appearance, impairment of taste, or hearing loss?
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Did individual report a mild cold, influenza, or other upper respiratory tract infection within a week prior to the onset of Bell's palsy?
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Does individual have diabetes?
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Is individual pregnant?
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Did the physical exam reveal facial asymmetry, drooling, increased distance between the top and bottom eyelids, a smooth forehead, a flattened crease between the nose and the upper lip, and loss of sensation to the affected area of the face?
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Was a thorough cranial nerve examination, skull x-ray, or EMG performed?
Regarding treatment:
- Is individual receiving symptomatic treatment such as lubrication for the eyes? Corticosteroids? Analgesics?
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Does individual have residual, debilitating facial dysfunction?
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Were EMGR, botulinum toxin injections, or surgical reanimation considered?
Regarding prognosis:
- Is individual active in physical therapy? Is a home exercise program in place?
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Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Have any complications developed, such as disfigurement from loss of facial movement, corneal ulcers and infections, chronic spasm of facial muscles and/or eyelids, or chronic taste abnormalities?
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Source: Medical Disability Advisor
| "Bell's Palsy." MayoClinic.com. Mayo Foundation for Medical Education and Research. 24 Sep. 2004 <http://www.mayoclinic.com/invoke.cfm?objectid=2B73952A-337E-4AB7-95368E5C254B2D65&dsection=1>. "NINDS Bell's Palsy Information Page." National Institute of Neurological Disorders and Stroke. National Institutes of Health (NIH). 24 Sep. 2004 <http://www.ninds.nih.gov/health_and_medical/disorders/bells_doc.htm>. |
Source: Medical Disability Advisor
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