Bell’s Palsy: The Mysterious Syndrome You Need To Know About

Imagine waking up one day with a cold, and noticing that the cold isn’t quite like anything you’ve ever experienced before. Sure, there may be coughing and sneezing, or maybe even nothing at all, but all of a sudden, your face feels a bit different.

Part of your face doesn’t seem to want to move. Your eye starts to twitch. You look in the mirror, only to realize that part of your face is paralyzed. You begin to panic — and call up a doctor, even though speech is kind of difficult. Your heart races because you are afraid you may have had a stroke. You make it to the hospital, where the doctor tells you that now you’ve been diagnosed with Bell’s Palsy.

Bell’s Palsy is in that sense an absolutely alarming condition for anyone to experience.

Although rare, it can occur in anyone at any time. It is not contagious, nor is there any way to prevent it. It is a mysterious syndrome and doctors still have not been able to determine the precise cause. We have been able to figure out that Bell’s Palsy happens when the facial nerve become so inflamed in our skulls that it cuts off its own blood supply, causing ischemia to the nerve and the face becomes paralyzed. We suspect that somehow reactivation of a virus living dormant in the nerve may be to blame. Though not entirely sure what viruses may cause Bell’s Palsy, the herpes family of viruses that cause cold sores is often implicated.

Terrifying as it is, there is some good news.  Most people diagnosed with Bell’s Palsy do eventually regain their ability to move their face —even if it does take months or years to regain them.

How is Bell’s Palsy treated?

Corticosteroids and antiviral medications have been helpful in the early treatment of this disease. Most patients with minor nerve injury can anticipate movement to begin to return within 3-4 weeks and recovery to be nearly complete.

For deeper nerve injuries, it will take months for the nerve to heal, and in those cases, less than perfect recovery is anticipated. As the deeply injured nerve attempts to restore the complex neuronal networks that provide thousands of different facial expressions, it inevitably takes a few wrong turns. This most commonly results in painful muscle spasms and abnormal facial movements called facial synkinesis. Synkinesis appears like twitches or tics to onlookers triggered by blinking, chewing or smiling.

How does Bell’s Palsy affect people?

Those who are unlucky enough to have Bell’s Palsy often feel embarrassed by the symptoms they have. The appearance of an uneven face may make it hard to remain confident, even when the majority of the paralysis has subsided. Partial or faulty regeneration may make it hard to talk clearly, drink through a straw or eat without drooling, or feel comfortable in public.

What is hyperkinetic paralysis and why is it often mistakenly dismissed?

When Bell’s Palsy is first diagnosed, it’s pretty obvious that the drooping face is paralyzed because it can’t move at all. This is called ‘flaccid’ paralysis. After the nerve regenerates there is a movement that may be uncoordinated, or even over-active. We term this ‘hyperkinetic’ paralysis. It is the type of weakness we see after faulty regeneration from Bell’s Palsy is complete. Symptoms might not be obvious when patients are not moving because muscle tone has at least returned, and they are often counseled there is nothing further that can be done. But the discoordinated movement limits a patients ability to control tearing, emotional expressions, drooling, and speech articulation and should not be dismissed.

What happens when Bell’s Palsy isn’t getting better quickly?

Recovery from Bell’s Palsy depends on the degree of nerve injury. Most patients diagnosed with Bell’s Palsy have superficial nerve injury and will see their symptoms subside within 3-4 weeks.  Corneal protection of the eye is the most important early consideration and usually involves lubricants or in extreme cases the implantation of eyelid gold weights.

If spontaneous recovery does not start within this time frame, then deeper nerve injury has occurred and further recovery will likely be delayed for 4-6 months.  While it is best to see a neurologist for the immediate diagnosis and treatment of Bell’s Palsy, a facial nerve specialist may help best manage your recovery. Botox therapy may be used after 3 months to treat discoordinated movement, decrease facial spasms and improve facial symmetry.

When can I seek additional treatment for Bell’s Palsy?

It is never too late nor too early to seek additional treatment if recovery is not quick.  Our office specializes in the treatment and prevention of facial abnormalities including facial spasms, muscle atrophy, premature aging, synkinesis, hyperkinetic facial paralysis and the sequelae of Bell’s Palsy after faulty regeneration from simple and complicated Bell’s Palsy.

After the initial emergency treatment by a neurologist involving diagnosis, MRI evaluation and steroid, and antiviral therapy, patients typically see us within four weeks to track their recovery. Most cases of delayed recovery will require physical therapy and Botox therapy in order to help reduce the effects of the paralysis as we relearn how to use facial muscles.

Patients also come in after years, even decades after diagnosis for a variety of treatment strategies depending on their concerns. More severe cases involving long-term loss of muscle tone and tissue atrophy may respond better to a variety of surgical facial reconstructive procedures including fat grafting, face lifting, tissue and lip restoration, nasal valve repair, brow lifting, ectropion repair, and eyelid reconstruction.

The significant emotional and psychological issues that often accompany disorders of the face are especially significant in cases of facial paralysis where patients cannot smile or adequately convey their emotions.

The sequelae of Bell’s Palsy is a medical condition that deserves rehabilitation.  We specialize in the treatment of facial nerve paralysis and Bell’s Palsy to help determine your best course of treatment.  Feel free to give us a call or complete a request for consultation through our website.