What is peripheral facial paralysis – Bell's palsy?
Peripheral facial paralysis is often referred to as Bell's palsy after Sir Charles Bell, the Scottish anatomist who first described the condition in the 19th century.
The paralysis, which is a neurological disorder, affects the 7th cranial nerve, which is the nerve that sends signals to the facial muscles. This nerve controls the movement of the facial and neck muscles and is involved in articulation. It also stimulates lacrimation (tears) and the secretion of saliva. The nerve damage is on the same side of the face as the paralysis.
Facial paralysis is also observed in stroke and brain tumours, when it is termed central facial palsy. In that case, the damage is in the opposite cerebral hemisphere. Stroke also affects more muscles in the body than just the facial muscles. To distinguish stroke from peripheral facial paralysis, you can try to frown. In the case of stroke, you can frown, but you generally cannot frown in the case of peripheral facial paralysis.
If you suspect stroke (central facial palsy), you should always seek medical care immediately!
In the case of a brain tumour, the progression is usually slower compared with Bell's palsy.
Who are affected?
Men and women are generally equally affected, but children can also suffer from Bell's palsy. In more than 60% of cases, the right side of the face is affected.
How many are affected?
What are the signs of Bell's palsy?
The onset is generally sudden, with increasing weakness and asymmetry in the face. Symptoms generally develop over around 3–72 hours.
One sign can be that one eyebrow droops, or it is difficult to close an eye and difficult to hold one's lips together.
Are there symptoms before the paralysis?
In most cases, people simply realise that their face has drooped on one side. Sometimes there are heralding signs, for example, the tongue, lips or the area around the ear may feel different, in some cases painful. There is no dizziness or hearing loss associated with Bell's palsy.
Why are people affected?
We still do not always know what causes the paralysis. Some explanations include Borrelia, viruses and disturbances of the micro-circulation, but doctors do not always have a definitive answer.
Bell's palsy often develops without apparent reason – idiopathic paralysis. Many sufferers report that they just woke up with weakness or paralysis on one side of the face.
How can Bell's palsy be treated?
- In Sweden, most sufferers are treated with cortisone, if there are no particular contraindications. In 2 major studies, cortisone treatment has been shown to slightly improve the numbers of cured patients.
- Antiviral medications have not been shown to have any effect.
- Where Borrelia is suspected, tests are done to confirm Borrelia infection and antibiotics should then be given.'
- If the eye cannot be closed, it is important to protect the cornea from drying out. This can be treated with an eye dressing that forms a humidity chamber for the eye in the initial phase. Sometimes it may be necessary to supplement this with eye ointment. Always consult a doctor!
- Training, initially with the support of a physiotherapist, and self-training are important from the start, since it is not possible to predict who will recover spontaneously and who will have lasting problems. That is what this app is all about.
- By starting training immediately, you can maintain proprioception of the muscles when they have been weakened.
What is the prognosis?
Approximately 70% of patients recover fully within 3–6 months. The prognosis is better in the case of partial paralysis, slow development, early improvement and younger age.
The remaining 20–30% have residual weakness of varying degrees, and a proportion of these may also develop facial rigidity (contracture) or involuntary muscular movements (synkinesis).
Since it isn't possible to predict who will suffer from residual problems, it's good to get started as early as possible with training.