BELLS PALSY (Facial nerve injury)

A young undergraduate had come for pre-entrance medical examination; she satisfied all the conditions for medical certification of fitness, X-rays, blood and visual tests, etc. A closer look showed that her mouth had turned to one side, with the eyelids unable to close on the affected side.

Thereafter, I engaged her in a conversation. She said she had rashes about three months before then and it was treated at home through self-medication. Thereafter, she noticed the turning of her mouth and eye to one side.

The unfortunate girl had suffered from a condition called Bell’s palsy, a complication of untreated herpes skin infections which she suffered three months earlier.

She never bothered to see any doctor due to financial constraint. After the encounter, she was first referred to a neurologist for assessment and then to a physiotherapist because of the disability involved.

Bell’s palsy is a condition that causes temporary weakness or paralysis of the muscles on one side of the face. It is the most common cause of facial paralysis.

It is common with young adults of either sex, and they are more susceptible, for unknown reasons. Bell’s palsy resolves completely in around 90 per cent of cases, given time.

The facial nerve services the muscles of the face, the ears, salivary and tear glands, and also provides some of the sensations of taste on the tongue.

In Bell’s palsy, the facial nerve swells and the resulting inflammation disrupts the relay of nervous system messages which interferes with the nerve’s proper functioning. The paralysis can be partial or total.

Bell’s palsy is more common in pregnant women and those with diabetes and HIV for reasons that are not yet fully understood.

Causes

The reason for the swelling is unknown, although it is thought that the inflammation and swelling of the facial nerve is caused by some type of viral infection or autoimmune system response.

It is caused by swelling of the facial nerve at the point where it passes through a small opening in the skull.

A variety of other conditions can cause facial paralysis, including trauma, stroke, certain tumours and infections.

Symptoms of Bell’s palsy

Bell’s palsy is characterised by a droopy appearance around the eye and mouth on the affected side of the face. The symptoms include:

• paralysis or weakness on one side of the face
• numbness
• pain around the ear
• the eye can’t fully close
• the mouth droops
• the face feels heavy
• foods taste slightly different.

Diagnosis

It is important to rule out these other potential causes. Bell’s palsy is diagnosed in a number of different ways, including clinical examination.

The person is typically asked to raise their eyebrows, close their eyes and smile. If the person has Bell’s palsy, their eyebrows will rise asymmetrically, they won’t be able to close the affected eye and one side of the mouth will droop.

Special scans, including CT and MRI scans, may be used to exclude other causes.

Treatment

The majority of people with Bell’s palsy – around 90 per cent – will recover completely with time, although the paralysis may last for up to one year in severe cases. However, the remaining 10 per cent will experience some degree of permanent paralysis.

Older people with pre-existing high blood pressure are at greater risk of this complication.

Early treatment with corticosteroids helps reduce the swelling of the facial nerve and severity of the disease.

Other treatment options can include:

• artificial tears to keep the affected eye lubricated
• a patch to protect the affected eye
• using tape to close the affected eyelid at night
• medications such as corticosteroids to help reduce the swelling of the facial nerve
• pain-relieving medications
• Physiotherapy
• massage
• facial exercises

Prevention

Viral infections, Herpes, HIV, etc. should be treated promptly.

Blood pressure and blood sugar should be controlled.

Please visit my blogspot: www.doctoradesanya.blogspot.com for more health tips.