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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.
Causes & Development
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.
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.
Signs & Symptoms
The disorder usually progresses for 7 to 10 days, with sudden onset of facial weakness.
Diagnosis & Tests
BP is a diagnosis of exclusion. 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.
Treatment & Prevention
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.
Prognosis
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.
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Conditions that suggest Bell's Palsy:
Risk factors for Bell's Palsy:
Recommendations and treatments for Bell's Palsy: | | | | | Drug |  Conventional Drug Use | 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. |
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Mineral |
 MSM (Methyl Sulfonyl Methane)| | MSM, an organic form of sulfur, is reported to be of benefit in reducing pain associated with Bell's Palsy. |
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Physical Medicine |
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. |
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Vitamins |
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] |
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KEY | | Weak or unproven link |  | | Proven definite or direct link | | | May do some good | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
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.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Cornea
Transparent structure forming the anterior part of the eye.
Edema
Abnormal accumulation of fluids within tissues resulting in swelling.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
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.
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.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
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.
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.
Niacin (B3, B-3, Niacinamide, Vitamin B3)
A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Tinnitus (Tinnitis)
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Virus (Viri, Viruses)
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.
Last updated: Apr 13, 2008
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