Dr Sylvia Kama-Kieghe writes about a very common cause of facial weakness, the ‘drooping face’ – read about Bell’s Palsy symptoms, diagnosis and treatment below:

What is it?

Bell’s palsy is weakness on one side of the face that may be associated with stiffness or numbness.

When the face is weak certain changes happen – for example, the eye and mouth do not ‘work’ as usual – which tends to be among the first problems people observe when this condition develops.

Features of Bell’s Palsy

The condition can develop quite suddenly – as happened in our fictional story about a young man, Jim’s Bells Palsy story.

It is not very common in children, though, and it affects both men and women of different ages.

Though the actual cause is generally unknown, we suspect it may be associated with a recent viral illness that may have gone unnoticed.

Scientific studies suggest that it seems more common in people with Diabetes Mellitus – for reasons that are not very clear at present.

Why Does Bell’s Palsy Happen?

Bell’s Palsy is thought to happen due to damage to one of the ‘big nerves’ arising from the brain known as Cranial nerves.

There are 12 of these cranial nerves on each side of the head.

In Bell’s palsy, it is damage to seventh cranial nerve – also known as the Facial nerve – is responsible for the symptoms.

What are the Symptoms of Bell’s Palsy?

• As already highlighted, very commonly there is weakness, stiffness and numbness usually on one side of the face.
• The weakness does NOT involve the arms or legs or parts of the body below the face

• There is difficulty closing the eye on the affected side and problems blinking

• This (weak eye) may be associated with watering or in some other cases there may be a very dry eye.

• On the mouth, the person with Bell’s palsy will experience difficulty with chewing or drinking because the jaw muscle is too weak too do so effectively.

• Drooling happens as a result of the weakness in the muscles preventing the mouth closing properly on the weaker side.

• However, there is no change or slurring of speech as happens during a stroke and a person with Bell’s palsy is able to communicate normally.

• There may be pain in the face around the cheek, jaw or ear on the affected side.

• Normal taste and hearing may be affected because – in addition to controlling the muscles of the forehead, eyelids, jaw etc; the facial nerve also controls some of the sensory function affecting the taste and hearing.

How does Bell’s Palsy progress?

The weakness in the face may progress for 1-2 days after which things slowly start to improve.

Most people start to get better after 6 weeks – in others, it may take up to 12 weeks to completely return to normal.

Rarely a small number of people are left with some changes as a result of developing Bell’s Palsy.

What Bell’s Palsy is NOT

Bell’s palsy is not the same as Stroke.

It is also not:

• transmitted from one person to another.

• associated with permanent nerve damage (except in a minority of cases where problems like taste or speech or other function may not return to their state before the illness)

• a cause of mental illness such as Depression, Anxiety, Schizophrenia etc; though some people may experience anxiety or low mood if symptoms persist for a very long period of time.

• associated with sexually transmitted infections. It is thought Bell’s Palsy may be linked to the Herpes Simplex I Virus (responsible for cold sores) or the Shingles virus.

Diagnosis of Bell’s Palsy

From clinical examination, the doctor can identify symptoms associated with Bell’s palsy.

There are no specific tests that can confirm the condition, but in some instances where there is an unusual presentation, tests like brain x-rays or scans may be required.

Conditions that may mimic Bell’s Palsy include headaches like Migraine, Stroke or some other neurological conditions.

How to Treat Bell’s palsy

Doctors will usually prescribe high-dose steroids to be taken over a number of days to treat Bell’sPalsy.

The purpose is to reduce the effect of the injury to the Facial nerve like swelling.

Even though we suspect the involvement of viral infections, antiviral medications have not been shown to be of any benefit and so they are not used.

Other medicines that will be of benefit are eye lubricants to prevrnt dryness – see below:

The Eye in Bell’s palsy

The eye can be at serious risk of injury because of the weakness of the eye muscle.

This means the eyelids cannot close properly and expose the eyeball to foreign materials or irritation.

The following measures will be useful:

• Wearing sunglasses
• Using surgical tape to keep the affected eye closed during sleep.
• Avoid swimming or areas that are dusty to reduce the risk of irritation to the eye.

Eye complications – if there is severe eye pain or changes to the vision, an urgent assessment by an eye specialist is required.

Prompt assessment is required if weakness in the face or other aspects of the body occur.

People are encouraged to seek the advice of a competent medical practitioner to be appropriately diagnosed and treated.

Read more

• Sudden weakness of the face – Jim’s Bell’s Palsy story
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More Reading

• Basics of Bell’s Palsy
• Bell’s Palsy Treatment

Edited by AskAwayHealth Team

Disclaimer

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