You wake up one morning, and your face feels stiff and odd. When you look in a mirror, half your face appears to droop. You can only manage half a smile. And your eye is dripping tears and doesn't want to close. What in the world is going on?
For many people, the first guess would be a stroke. But if your muscle weakness or paralysis affects only your face, a more likely cause is Bell's palsy.
Each year, about 40,000 Americans develop Bell's palsy, a condition that occurs when the nerve that controls the facial muscles becomes swollen or compressed. The problem can occur at any age, but rarely affects people under the age of 15 or over the age of 60.
For most people, Bell's palsy symptoms begin to improve within a few weeks, with complete recovery within three to six months. Between 8 percent and 10 percent will experience a recurrence of the signs and symptoms, sometimes on the opposite side of the face. And a small number of people never recover and continue to have some signs and symptoms for life.
Signs and symptoms of Bell's palsy may include:
The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to your face. If this nerve becomes inflamed and swollen — usually from infection with a virus — it gets pinched in this tight corridor. Pressure from the bone can damage the protective covering of the nerve and interfere with communication between the nerve and your facial muscles, resulting in weakness and paralysis.
The most common cause of Bell's palsy appears to be the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell's palsy include the virus that causes chickenpox and shingles (herpes zoster), the virus that causes mononucleosis (Epstein-Barr), and another virus in the same family (cytomegalovirus).
Bell's palsy occurs more often in people who:
Most people with Bell's palsy recover completely within a few months, with or without medical treatment. But not all instances of facial paralysis or weakness are due to Bell's palsy. See your doctor if you experience facial weakness, drooping or paralysis to determine the underlying cause and severity of the illness.
There is no specific laboratory test to confirm a diagnosis of Bell's palsy. Your doctor may be able to make a preliminary diagnosis of Bell's palsy by looking at your face and asking you to try to move your facial muscles.
Other conditions — such as a stroke, infections and tumors — also may cause facial muscle weakness, mimicking Bell's palsy. If after a few days there's still doubt about the diagnosis, your doctor may recommend other tests:
Although a mild case of Bell's palsy normally disappears within a month, recovery from a case involving total paralysis varies. If the damage to your facial nerve is unusually severe, the fibers may be irreversibly damaged. Another complication can arise from misdirected regrowth of nerve fibers, which can result in involuntary contraction of certain muscles when you're trying to move others. For example, when you smile, the eye on the affected side may close.
Most people with Bell's palsy recover fully — with or without treatment. But your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.
Medications
Study results have been mixed regarding the effectiveness of two types of drugs commonly used to treat Bell's palsy — corticosteroids and antiviral medications.
Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. If Bell's palsy is triggered by a virus, then an antiviral drug — such as acyclovir or valacyclovir — may stop the progression of the viral infection.
Some clinical studies show benefit from early treatment with corticosteroids, antivirals or a combination of both types of drugs. Other studies do not. Evidence of the effectiveness of corticosteroids appears to be stronger than that for antiviral drugs.
Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent contractures. Massaging and exercising your facial muscles may help prevent this from occurring. Moist heat may help relieve pain.
Surgery
One way to relieve the pressure on the facial nerve is to surgically open the bony passage through which it passes. This decompression surgery is controversial and rarely recommended. In some cases, however, plastic surgery may be needed to make your face look and work better.
If you can't close your eye, you'll need to keep the eye moist with hourly eyedrops during the day and an eye ointment at night. If the clear protective covering of the eye — called the cornea — becomes too dry, it can cause permanent vision loss. Your doctor may want you to wear glasses or goggles during the day and an eye patch at night to protect your eye from getting poked or scratched.
Some people with Bell's palsy may benefit from:
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