Bell's palsy is the leading cause of facial paralysis in the United States. It was discovered by Scottish neurologist and anatomist Sir Charles Bell and refers to facial paralysis or weakness that occurs on one side of the face.
Facial paralysis and Bell's palsy are not interchangeable. Facial paralysis may occur for a number of reasons, including tumors, trauma and salivary gland inflammation. Comparatively, recent studies have indicated that Bell's palsy occurs if herpes simplex virus (HSV) gets reactivated in the bone behind the ear (temporal bone). When this happens, the nerve becomes swollen and "shuts down" rapidly.
Bell's palsy generally results in immediate facial paralysis. It often is associated with a feeling or sensation that face movement may be inhibited.
Bell’s Palsy Diagnosis:
Patients who experience sudden facial paralysis should go to the emergency room immediately and be evaluated for Bell’s palsy. The typical studies that need to be performed include laboratory testing for Lyme disease, thyroid function test, HIV and hepatitis. A complete neurologic and ear, nose and throat evaluation needs to be done as well. If there are any questions, an ENT specialist or a facial nerve specialist needs to be consulted to make sure that there is no other cause of the facial paralysis other than the Bell’s palsy. Occasionally, a tearing test function, computed tomography (CT scan) and magnetic resonance imaging (MRI) exam may be completed to identify the root causes of facial paralysis. An electromyography or electroneurography (ENoG) may need to be performed in patients with severe cases of facial paralysis who are believed to have Bell’s palsy.
Facial paralysis and Bell's palsy are rare and complex conditions, and many physicians and internists lack the expertise and knowledge to perform sufficient testing. Therefore, an individual will want to consult with a facial nerve specialist or ear, nose and throat specialist within the first three weeks of facial paralysis. By doing so, a person can receive the necessary tests to identify and address facial paralysis immediately.
Dr. Babak Azizzadeh of the Facial Paralysis Institute is a globally recognized facial plastic and reconstructive surgeon with unparalleled expertise in the facial nerve.
In approximately 85% of cases, Bell’s palsy will go away on its own and the patient will regain full facial movements. However, if after 8 months the patient is still suffering from Bell’s palsy, it is time for them to meet with Dr. Azizzadeh to explore the broad range of Bell's palsy treatment options. Dr. Azizzadeh will evaluate each patient and work with him or her to find the best way to deliver the optimal Bell's palsy treatment results.
Please contact the Facial Paralysis Institute on the right hand side of this page if you have any further questions about finding a specialist in your area.
What Are the Different Types of Bell’s Palsy Testing?
- Complete ear, nose and throat evaluation that enables an individual to find out if there is an inner ear infection or a head or neck tumor or malignancy. The test also may be used to help a person identify and resolve dizziness associated with Bell's palsy.
- Neurologic assessment to examine an individual's movement, reflexes, cranial nerves and level of consciousness.
- Hearing test to examine whether an individual has suffered hearing damage or inner ear problems.
- Vestibular test to see if the nerve balance is intact.
- Tearing test to assess an individual's tearing function.
- CT scan of the neck and temporal bone to evaluate any tumors or trauma.
- MRI of the internal auditory canal and brain to evaluate acoustic neuroma and other types of tumors.
- Electrophysiologic test such as ENoG and EMG to study the electrical flow to the heart.
Treatment Options for Bell’s Palsy:
Bell's palsy treatment may vary based on time and presentation. If someone develops Bell’s palsy, he or she will need to be evaluated immediately, and other causes of facial paralysis such as tumor, trauma and inner ear infection must be ruled out. A patient may be diagnosed with Bell's palsy after all other causes of facial paralysis have been ruled out.
If a patient receives a Bell's palsy diagnosis, he or she will require immediate treatment with high-dose steroids (prednisone) and antiviral medications (Famvir, Valtrex). A patient should consult with a facial nerve specialist, as this specialist can administer Bell's palsy treatment immediately. If a patient is pregnant and displays Bell's palsy symptoms, she should consult with her OB/GYN. Or, if a patient shows signs of complete facial paralysis, additional tests and treatments may be needed.
At the Facial Paralysis Institute, for patients who have complete facial paralysis upon presentation we do recommend obtaining an EMG/ENoG testing in addition to CT scan and MRI. If the ENoG reveals significant dysfunction of the facial nerve, then one of our neuro-otologists will evaluate the patient to see if they are candidates for facial nerve decompression, which may help in reducing the long-term sequelae of facial paralysis. After the initial Bell's palsy treatment, a patient should follow-up with a facial nerve paralysis expert for the first year. Also, a Bell’s palsy patient may need eye protection, as patients who are dealing with total facial paralysis sometimes struggle to close their eyes completely (lagophthalmos). Patients who present with an inability to close their eyes risk ulcerations and cornea damage.
Selective Neurolysis Surgery For Bell’s Palsy
For patients with facial paralysis and/or synkinesis who are unable to effectively smile, selective neurolysis is the most advanced treatment available. Selective neurolysis is a surgical procedure that involves Dr. Azizzadeh releasing the platysma muscle (the muscle that pulls the mouth downward) and decreasing nerve activity in the nerves that counteract the smile mechanism so that the mouth can once again turn upward, restoring the patient’s ability to smile.
Powering the Facial Nerve
Patients who have partial paralysis either from Bell's palsy, or other etiologies such as acoustic neuroma or temporal bone fractures, may also be candidates for "supercharging" or "signal upgrading" procedure in order to increase the power of the facial nerve and help the facial muscles work more effectively. The concept is to help strengthen weak smile muscles while preserving basic function. The masseteric nerve is the most common nerve utilized to help strengthen the facial nerve. The procedure is an outpatient procedure.
Botox for Bell's Palsy
Botox injections are one of the most effective treatments for patients with Bell's palsy, partial facial paralysis and synkinesis. The neuromodulator relaxes the hyperactive muscles and can temporarily restore some facial symmetry and improve appearance.
Below is an image of a Bell's palsy patient before and after Botox for Bell's palsy treatment with Dr. Azizzadeh.
What Are the Causes of Bell’s Palsy?
Bell’s Palsy Risk Factors:
The risk factors associated with Bell's palsy are unclear. However, recent research has shown that Bell's palsy affects less than 2 percent of people.
Bell's palsy has been found in patients who:
- Are pregnant
- Are of Japanese descent
- Have a family member who has suffered Bell's palsy
- Have suffered Bell's palsy in the past
In addition, some of the most common risk factors for patients who suffer facial paralysis include:
- Lyme disease
- Typhoid fever
- Guillain-Barré syndrome
- Temporal bone fracture
- Tumors such as acoustic neuroma
- Various types of viruses
Although Bell's palsy is a form of facial paralysis, it again is important to remember that Bell's palsy and facial paralysis are very different. Thus, the causes of Bell's palsy and the causes of facial paralysis vary.
Recovery from Bell’s Palsy
There are three groups of patients recovering from Bell's palsy:
- Full Recovery: 85 percent of Bell's palsy patients will recover from Bell's palsy without any lingering health issues.
- Partial Recovery: 10 percent of Bell's palsy patients will suffer synkinesis and partial facial paralysis.
- Complete Facial Paralysis: The remaining 5 percent of Bell's palsy patients will require comprehensive Bell's palsy treatment.
Numerous factors may increase a Bell's palsy patient's risk, including: Failure to receive immediate Bell's palsy treatment after initial diagnosis Pregnancy Severe symptoms such as facial droop and paralyzed face Due to great advancements in facial nerve treatments over the years, Bell’s palsy patients can rest assured that there is hope to smile again! In fact, Dr. Azizzadeh is a double-board certified facial plastic and reconstructive surgeon who has helped many Bell's palsy patients throughout his career. He is Harvard-trained and happy to assist Bell's palsy patients who are not experiencing any or full movement 8 - 9 months after the onset of their facial paralysis.
Request your consultation with Dr. Azizzadeh today
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