Bell's Palsy

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

The picture to the right features the characteristic asymmetric smile of Bell's Palsy caused by paralysis of one side of the face. (photo credit)

Five years ago I experience such a smile (and when really tired still do to a small extent). I woke up that Saturday morning and noticed that my tongue felt "thick" and my head ached, especially on the right side and mostly in my ear. Over the course of the day, I went on to loose the muscle function of my mouth on the right side, then the check, then the eyelid function, and last the forehead. I knew what it was. I had ruled out a stroke early on--no vision problems, no weakness in either arm or leg. The ascending facial paralysis cinched the diagnosis for me. Bell's Palsy.

I didn't bother any of my colleagues that weekend, but waited until Monday morning to call an ENT friend. He put me on a Decadron dose pkg and Acyclovair. The steroids decreased the swelling around my facial nerve and the ear pain subsided within 24 hours. I didn't appreciate any return of my facial nerve until 5-6 weeks later. I had a "mild" case. I didn't drool, but could not use a straw nor could I whistle (both actions need a good seal of the lips). Food tasted different on one side than the other. The teeth on the right side of my mouth were (and to a degree remain) very sensitive to cold/heat. I found myself chewing (these muscles aren't involved as they are CN V not VII) more on the left side for multiple reasons--fear of drool, taste buds off, teeth sensitivity. My right eye closed at night, but needed Lacrilube to keep it closed. I was fortunate that I did not have to patch it for more than a few weeks. With my blink reflex gone, it seemed that dust particles and gnats found there way into my right eye. I wore my sun glasses on the walks with the dogs to help protect my eye (don't usually do this). I also found I needed plain lens glasses indoors where fans or air condition drafts would irritate my eye. The glasses helped to prevent this. I kept artificial tears at home, in my purse, and at my office.

Most of my facial function returned--98-99%. There are some very minor things that didn't. There is a difference (I can feel and see) in the muscles around my eye (obicularis oculi) and the mouth (slightly uneven). And the tongue and teeth still off some. Nothing anyone would be able to measure. Also, the right ear canal is more sensitive to breezes, so on fall/winter days that are windy I am more likely to wear 180 degree ear muffs.

I did not miss a day of work. My hands still functioned, so did my brain. I admit I was very self-conscious (the plain lens glasses gave me something to "hide" behind as well as helped protect my eye) around people. With poor control over the right side of my mouth, some words were not easy to pronounce (plosive constant's need a good lip seal). If patient's noticed, I would tell them what was going on. If not, I tried to be as "normal" as possible. I did more "closed-lip" smiles than previous. Oh, yeah, it's weird kissing when only one half of your mouth works (smile).

Bell's palsy is a form of temporary facial paralysis characterized by facial drooping on the affected half. It is due to malfunction of the facial nerve (CN VII) which controls most of the muscles of the face. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause of acute facial nerve paralysis. Bell’s palsy affects about 40,000 people in the United States every year. It affects men and women equally and can occur at any age, but is most common between 15 and 60 yrs of age. It affects approximately 1 person in 65 during a lifetime. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex-- causes the disorder when the facial nerve swells and becomes inflamed in reaction to the infection.

The prognosis for individuals with Bell's palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most recover completely, returning to normal function within 3 to 6 months. For some, however, the symptoms may last longer. In a few cases, the symptoms may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.

REFERENCES

Mayo Clinic--Bell's Palsy

National Institute for Neurologic Disorders & Stroke--Bell's Palsy Fact Sheet

Bell's Palsy Information Site & Forum

HOW CRUEL TO CALL IT 'BELL'S PALSY!' By Graeme Garden

e-Medicine article--Bell's Palsy by Michael Lambert, MD