DEAR DOCTOR K:
I went to my doctor with some alarming symptoms and he diagnosed me with Bell’s palsy. I don’t know anything about this condition.
Bell’s palsy, named after the person who first reported it in the medical journals, Charles Bell, is a weakness of the muscles on one side of the face. All muscles in your body take their orders from nerves leading to them. When you think of muscles, you probably think of the big, bulky muscles in your arms and legs. But there are small muscles in your face as well.
Smile as big a grin as you can. Now blink your eyes. Now raise your eyebrows. To do each of these things, your brain sent signals that traveled down certain nerves to the small muscles in your face. Those signals told the muscles to tighten — which, in turn, caused different parts of your face to move in a certain way.
There are two main nerves leading to the facial muscles, one on each side of your face. (Smaller branches of the facial nerves go to the tongue and ear.) Bell’s palsy occurs when a facial nerve (usually just one of the two) becomes inflamed and swollen and stops sending signals to muscles in your face. Below is an illustration that shows an inflamed facial nerve, as happens in Bell’s palsy:
|Bell’s palsy is a weakness of the muscles on one side of the face. It occurs when a facial nerve becomes inflamed and swollen and stops functioning properly.|
Your early symptoms may have included changed sensation in part of your face, pain in or around your ear, change in hearing and impaired taste. As the condition progressed, you may have had trouble closing your mouth or one eye. Perhaps you were unable to hold food in your mouth, or your eyes made more tears than usual (or made none, causing the eye to become dry and gritty).
Researchers suspect the nerve inflammation that causes Bell’s palsy is often triggered by an infection with a virus, such as herpes simplex. That’s the same virus that causes cold sores. Some of the other members of the herpes virus family also may be responsible.
If your symptoms are very mild, you may not need treatment. Otherwise, doctors usually prescribe a corticosteroid called prednisone. Prednisone reduces inflammation and swelling in the affected facial nerve and decreases pain. Some doctors prescribe a combination of prednisone and an antiviral drug that acts against the herpes virus.
If Bell’s palsy is making it difficult to close your eyes or to make tears, your cornea can become dry and get scratched. (Your cornea is the curved, transparent dome at the front of your eye.) To prevent this, you must protect your eyes from wind and dust by wearing glasses. You will need to keep your eyes moist with artificial tears during the day and by lubricating your eyes at night with a sterile eye ointment. Sometimes the doctor may suggest that you wear an eye patch for a period of time to keep the eye closed.
The symptoms of Bell’s palsy can be frightening, but in most people, symptoms start to improve by two weeks. Most people are back to normal by six months.