Bell’s Palsy (BP) is the most common cause of facial paralysis worldwide. Its incidence is about 20 cases per 100,000 persons. Although not age-specific, it affects young and middle-aged adults most often. There is no bias towards either sex.
Right- and left-side facial palsy occurs equally. Climate is not a contributing factor. BP does, however, have a higher prevalence among lower socioeconomic groups. 70% of patients with BP relate a previous upper respiratory infection, and 10% have a family incidence of the disorder. During pregnancy or pregnancy-induced hypertension, the significant increase in vascular volume, particularly in the last trimester, triples the risk of facial neuropathy due to edema of the facial nerve and the resulting compression.
BP is a diagnosis of exclusion. Its cause remains unknown but reactivated herpes simplex virus (HSV) heads the list as the most probable cause. An acute inflammatory response results in swelling of the facial nerve within the myelin sheath, causes reduced circulation in the nerve. The disorder usually progresses for 7 to 10 days, with sudden onset of facial weakness. Recovery from BP begins at 3 weeks for most (85%) patients, with a full recovery by 6 months. Between 4 and 6% experience severe deformity with very little return to normal facial movement, and 10 to 15% will be bothered by asymmetrical movement of the facial muscles. Recurrence may be on the same or opposite side.
Nerve conduction does not become altered until about 3 days after degeneration has occurred. These changes are then detected by observing a widened palpebral fissure (the space between the margins of the eyelids), reduced nasolabial fold (smile line), and drooping corner of the mouth. A dry eye may result from reduced blinking. Pain behind the ear is a common symptom, along with fever, tinnitus, and a mild hearing deficit. A tumor should be suspected when there is (1) associated tics or spasms, (2) slow onset of paralysis, and (3) paralysis of isolated branches of the facial nerve.
The first priority in treating Bell’s palsy or any type of facial paralysis is to eliminate the source of damage to the nerve as quickly as possible. Minor compression for a short time period can result in mild and temporary damage. As time goes on with constant or increasing compression, damage to the nerve can also increase.
Risk factors for Bell's Palsy
Vitamin D Toxicity
Hypervitaminosis D has been known to cause facial palsy.
Lyme Disease
Bell’s Palsy has been known to be both an early and late symptom of Lyme Disease.
Recommendations for Bell's Palsy
Conventional Drugs / Information
If you do decide to use conventional medications that may help relieve the compression, such as prednisone and antivirals, they should be started as quickly as possible. The “window of opportunity” for starting these medications is thought to be 7 days from the onset of Bell’s palsy.
Sulfur
MSM, an organic form of sulfur, is reported to be of benefit in reducing pain associated with Bell’s Palsy.
Hydrotherapy
The use of eye drops can be important in treating BP. The ‘dry eye’ and associated problems are caused by a combination of things. For some people the tear gland may not be producing moisture. Blinking is the mechanism that protects the eye from external debris and spreads tears over the cornea. Under normal circumstances we blink every 5-7 seconds and with every blink the eyelid spreads moisture over the cornea. With facial paralysis the ability to blink may be disrupted; eyelid closure can be weak or the eye can be stuck wide open. Take action if the eye feels uncomfortable. Manually blink your eye using the back of your finger at regular intervals, especially when it feels dry. A stinging or burning sensation can mean the eye is too dry, even if tears are apparent. The 7th nerve does not control focus, so if you are experiencing blurred vision, don’t ignore it. It may be a warning of a dry cornea that needs to be protected.
Surgery
(San Antonio, Texas)—Patients seeking help for facial paralysis have a treatment option available now offered by doctors at Wilford Hall Medical Center at Lackland Air Force Base, Texas. Col. (Dr.) Alan Holck and Maj. (Dr.) Manuel Lopez are among only a few military or civilian surgeons in the country who perform a recently developed procedure called temporalis tendon transfer to treat patients suffering from facial paralysis due to conditions such as trauma, tumors, strokes, cancer, some surgeries and Bell’s palsy. The only other physicians who offer this treatment practice are at Johns Hopkins Hospital in Baltimore.
Vitamin B12 (Cobalamine)
Methylcobalamin, a form of vitamin B12, was compared with steroids in a trial involving 60 patients with Bell’s palsy. The shortest time required for complete recovery of facial nerve function occurred in the group receiving Methylcobalamin alone. A therapeutic dose would be a minimum of 1500mcg and a maximum of 6000mcg per day, by injection. It was administered by intramuscular injection 3 times weekly for 8 weeks (or until recovery). The results of this study have not been validated, and administration of methylcobalamin has not become a common treatment.
Cyanocobalamin is reported to have worked in a couple chronic cases at high doses also. [J Indian Med Assoc 33: pp.129- 31, 1959]
Vitamin B3 (Niacin)
74 consecutive Bell’s palsy patients were treated with niacin at a dose of 100-250mg with “excellent results” noted in all patients within 2 to 4 weeks. [Arch Otolaryngol 68: pp.28-32, 1958]
Key
| Weak or unproven link |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Neuropathy
A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Herpes Simplex
An infection, often recurrent, caused by herpes virus type 1 and 2. It causes cold sores around the lips and mouth, and also causes painful blisters on the genitals and in the pubic area, thighs, and buttocks.
Virus
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Myelin
A substance made of protein and lipid (fat) that protects the nerves, especially in the brain. The myelin sheath is a jacket of insulation around axons to help them conduct their electrical discharges quickly down the axon.
Tinnitus
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Bell's Palsy
One-sided facial paralysis of sudden onset and unknown cause. The mechanism is presumed to involve swelling of the nerve due to immune or viral disease, with ischemia and compression of the facial nerve in the narrow confines of its course through the temporal bone.