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Bell's palsy

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Bell'spalsyisaparalysisorweaknessofthemusclesononesideoftheface,withyoungadultsof
eithersexmoresusceptibleforunknownreasons.
Thefacialnerveservicesthemusclesoftheface,theear,salivaryandtearglands,andprovides
someofthesensationsoftasteonthetongue.Thisnerveenterstheskullviaasmallopeningin
thepetroustemporalboneatthebaseoftheskull.
InBell'spalsy,thefacialnerveswellsandtheresultinginflammationdisruptstherelayofnervous
systemmessages.Theparalysiscanbepartialortotal.Itisthoughtthattheinflammationand
swellingofthefacialnerveiscausedbysometypeofviralinfectionorautoimmunesystem
response.
Bell'spalsyischaracterisedbyadroopyappearancearoundtheeyeandmouthontheaffected
sideoftheface.Itiscausedbyswellingofthefacialnerveatthepointwhereitpassesthrougha
smallopeningintheskull.Thepinchedandswollennervebecomesinflamed,whichinterfereswith
thenerve'sproperfunctioning.Thereasonfortheswellingisunknown,althoughinfectionor
autoimmuneresponsesaresuspected.
Bell'spalsyusuallyresolvesbyitselfwithinafewmonths.Earlytreatmentwithcorticosteroidsmay
reduceseverity.

Symptoms of Bells palsy

ThesymptomsofBell'spalsyinclude:

paralysisorweaknessononesideoftheface
numbness
painaroundtheear
theeyecan'tfullyclose
themouthdroops
thefacefeelsheavy
foodstasteslightlydifferent.

Diagnosis of Bells palsy

Avarietyofotherconditionscancausefacialparalysis,includingtrauma,stroke,certaintumours
andinfections.Itisimportanttoruleouttheseotherpotentialcauses.Bell'spalsyisdiagnosedina
numberofdifferentways,includingclinicalexamination.
Thepersonistypicallyaskedtoraisetheireyebrows,closetheireyesandsmile.Ifthepersonhas
Bell'spalsy,theireyebrowswillriseasymmetrically,theywon'tbeabletoclosetheaffectedeye
andonesideofthemouthwilldroop.Specialscans,includingCTandMRIscans,maybeusedto
excludeothercauses.

Treatment for Bells palsy

ThemajorityofpeoplewithBell'spalsy,around90percent,willrecovercompletelywithtime,
althoughtheparalysismaylastforuptooneyearinseverecases.However,theremaining10per
centwillexperiencesomedegreeofpermanentparalysis.Olderpeoplewithpre-existinghighblood
pressureareatgreaterriskofthiscomplication.
Treatmentoptionscaninclude:

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artificialtearstokeeptheaffectedeyelubricated
apatchtoprotecttheaffectedeye
usingtapetoclosetheaffectedeyelidatnight
medicationssuchascorticosteroidstohelpreducetheswellingofthefacialnerve
pain-relievingmedications
massage
facialexercises
botoxinjectionsmaybeusefulif,duringnerverecovery,unexpectedinvoluntary
movementsofthefaceoccur
surgery,althoughthisisanunusualformoftreatmentandrarelyeffective.

During recovery from Bells palsy

Duringregenerationandrepairofthefacialnerve,someneuralfibresmaytakeanunusualcourse
andconnecttoneighbouringmusclefibres.Thisproducesunusualneurologicpathways.When
voluntarymovementsareinitiated,theyareaccompaniedbyinvoluntarymovementssuchaseye
closure,withlippursingormouthgrimacingthatoccursduringblinkingoftheeye.

Where to get help

Yourdoctor

Things to remember

Bell'spalsyisaparalysisorweaknessofthemusclesononesideoftheface.
Thecauseisunknown,althoughinfectionorautoimmuneresponsesaresuspected.
ThemajorityofpeoplewithBell'spalsy,around90percent,willrecovercompletelywith
time.

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NorthEastValleyDivisionofGeneralPractice
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