BELL'S PALSY

Bell's palsy is a paralysis of the facial nerve, producing distortion on one side of the face; it is the single most common cause of facial paralysis. By definition, peripheral facial nerve palsy is called Bell's palsy when it does not result from a known cause (infection, tumor, or trauma). Because many patients have a viral illness before the symptoms, some believe that Bell's palsy results from facial nerve inflammation caused by the herpes virus.

Bell's palsy can be distressing because the onset is sudden and appears as a weakness or loss of muscle tone to one side of the face, including the eye. Pain behind the ear may precede the development of facial weakness, which sometimes progresses to complete paralysis within hours. In some cases, patients may have an uneven smile, drooling from the weak side of the mouth, pain behind the ear, changes in taste, and an inability to close the affected eye properly. Recovery may take from 2 to 3 weeks to many months; 75% to 80% of patients recover completely. Of those with complete paralysis at the onset, 50% will have incomplete recovery.

Some physicians may obtain an electromyogram (EMG) to carefully study the function of the nerve. This may be helpful in forecasting the chances of recovery.

Your physician may prescribe a medication to reduce inflammation and swelling in the nerve. Often corticosteroid medications such as prednisone are used for this purpose because they effectively reduce both pain and inflammation. Your doctor will explain the side effects of the prescribed medication. Protection of the eye is critical. Eye drops may be used for comfort and protection of the affected eye during the day, and eye ointment may be used during the night. In rare cases, surgery may be performed to decrease the pressure on the facial nerve or improve facial movements in patients who do not make a complete recovery.

• Take your medications as prescribed.
• PROTECT YOUR EYE. While you sleep, you may need an eye patch to protect your eye.
• During the day, you may need wrap-around lenses to protect against dirt and dust.
• You may wish to avoid bright light or wear dark glasses during the day.
• Apply warmth to the affected side to relieve pain.
• Begin simple muscle exercises and facial massage as strength returns.

• Don't reduce your activity level because rest does not improve Bell's palsy.
• Don't stop steroid medications abruptly; these medications must be gradually tapered.

• Your eye stays red and irritated or becomes painful.
• You cannot prevent drooling.
• You have any problems associated with the medication.

American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)
Communications Department
One Prince Street
Alexandria, VA 22314-3357
703-683-5100
Micromedix Medical Information Software

Web sites:
http://www.rxmed.com/illnesses/bell's Palsy.html
www.entnet.org




Bell's palsy: facial characteristics. (From Lewis SM, Collier IC, Heitkemper MM: Medical-surgical nursing: assessment and management of clinical problem, ed 4, St Louis, 1995, Mosby. Used by permission.)

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