Bell's Palsy: Overview and Management

Bell's Palsy

Bell's palsy is a sudden, unilateral facial paralysis caused by inflammation or dysfunction of the 7th cranial nerve, also known as the facial nerve. It is the most common cause of peripheral facial paralysis, affecting approximately 11.5 to 53.3 cases per 100,000 individuals across different populations. The condition affects both genders equally and can occur at any age, with the incidence peaking in the 40s. Although the exact cause of Bell's palsy is unknown, it is associated with several factors:

• Diabetes
• Pregnancy, particularly in the third trimester
• Hypertension
• Obesity
• Upper respiratory tract infections

Symptoms

Bell's palsy begins with mild weakness in facial muscles, which may progress to complete paralysis within 48 hours. Symptoms include:

• Facial droop
• Inability to close the eye on the affected side, leading to dryness and potential eye damage
• Weakness or paralysis of the facial muscles on the affected side
• Difficulty with smiling, chewing, and speaking
• Taste changes in the anterior two-thirds of the tongue
• Changes in salivation and lacrimation
• Hypersensitivity to sound on the affected side

Diagnosis

Diagnosis of Bell's palsy involves a thorough clinical examination and exclusion of other potential causes, such as:

• Trauma
• Neoplasms
• Congenital or syndromic problems
• Postsurgical facial paralysis/paresis
• Infection by agents including zoster and Lyme disease

Electromyography and nerve excitability tests may be used to confirm the diagnosis.

Treatment

The treatment for Bell's palsy typically involves a combination of antiviral medication, such as acyclovir or valacyclovir, and corticosteroids, such as prednisone, to reduce inflammation and promote recovery. Treatment should be started within three days of symptom onset to shorten the recovery time and increase the chances of complete recovery. In severe cases, functional facial plastic surgery procedures can be performed to correct facial asymmetry and help with eyelid closure. Laser acupuncture is also tried in some parts of Asia for patients with acute Bell's palsy, although its role in chronic Bell's palsy is still questionable.

Prognosis

Although the majority of patients with Bell's palsy recover spontaneously within less than three weeks, there is always a risk of residual paresis after treatment or recovery, which may require medical help. Incomplete closure of lids with resultant dry eye, dysphagia, and slurred speech are common short-term complications. An uncommon long-term complication is contractures and the permanent weakening of facial muscles.

In conclusion, Bell's palsy is a common condition that affects the seventh cranial nerve, causing facial muscle weakness or paralysis. Despite its prevalence, the exact etiology of Bell's palsy remains unknown. Early diagnosis and prompt treatment are crucial for managing the condition and reducing the risk of complications.