Weakening of facial muscles could be Bell's palsy
Published 5:06 pm, Tuesday, May 20, 2014
Bell's palsy is a neurological condition frequently seen in emergency rooms and medical offices.
Symptoms consist of weakness involving all muscles on one side of the face. About 40,000 cases occur annually in the United States. Men and women are equally affected, and though it can occur at any age, people in their 40s are especially vulnerable.
The facial weakness that occurs in Bell's palsy prevents the eye of the affected side from blinking properly and causes the mouth to droop. Because the eyelid doesn't close sufficiently, the eye can dry and become irritated.
Bell's palsy symptoms progress fairly rapidly, with weakness usually occurring within three days. If the progression of weakness is more gradual and extends beyond a week, Bell's palsy may not be the problem, and other potential causes should be investigated.
Those with certain medical conditions, such as diabetes or pregnancy, are at greater risk of developing Bell's palsy, and those who have had one episode have an 8 percent chance of recurrence.
Bell's palsy is thought to occur when the seventh cranial (facial) nerve becomes inflamed. The nerve controls the muscles involved in facial expression and is responsible for other functions, including taste perception, eye tearing and salivation. The cause of the inflammation is unknown, although the herpes simplex virus and autoimmune inflammation are possible causes.
Other conditions can also affect the facial nerve and may present similar symptoms. These include Lyme disease; Ramsay Hunt syndrome, a zoster infection affecting the facial nerve distribution; a bacterial ear infection; and mass lesions that compress the facial nerve. However, other signs and symptoms can usually be detected that help distinguish these from Bell's palsy.
More serious conditions involving the central nervous system, such as stroke, may also result in one-sided facial weakness. However, there are physical features that distinguish Bell's palsy from these central nervous system conditions. It is, therefore, important to seek medical attention immediately for accurate diagnosis and appropriate treatment.
Bell's palsy is treated with steroids, preferably as soon as possible after the onset of symptoms. This usually consists of a 10-day course of prednisone, which has been shown to improve outcomes. Use of antivirals in addition to steroid treatment is often done, although any additional benefit has not been proven and is modest at best.
Other treatments include surgical decompression and acupuncture, but there is less evidence to support these measures.
Without treatment, 70 to 85 percent of patients with Bell's palsy will spontaneously improve in three weeks to three months. Those with milder degrees of facial weakness tend to have a more favorable prognosis. Treatment is intended to increase the likelihood, speed and degree of recovery. Eye care, including lubricating and patching the eye, is also important to prevent complications such as corneal abrasions.
Although the prognosis for recovery is generally good without treatment, prompt medical attention for Bell's palsy may increase the likelihood of more complete recovery and may exclude other potentially serious causes of facial weakness.