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Learning about Bell's Palsy
Bell’s palsy is the most common type of facial nerve paralysis, though it’s not clear what causes it. Experts think it may result from a viral infection that leaves your facial nerve inflamed. Facial muscles — usually on just one side of your face — become weak or unable to move.
With time, symptoms usually resolve, but they can be alarming, and should be evaluated quickly. Other more serious conditions can cause similar problems and must be ruled out. If you do have Bell’s palsy, early treatment can increase your chances of a full recovery.
Symptoms and diagnosis
Quick evaluation is key
Seeing a doctor within 72 hours of the earliest signs of Bell’s palsy is important.
Symptoms come on suddenly over one to three days. Because your facial nerve has many different functions, these symptoms can be varied. They may include:
Weakness or paralysis on one side of your face which can cause difficulty closing your eye or smiling
Change in sense of taste on one side of your tongue
Change in tear production
Decreased saliva production
Pain around the ear on the affected side
Sensitivity to loud sounds
It’s important to get medical attention within 72 hours of the onset of symptoms. Doctors will review your medical history and perform a physical exam. They will look for other possible causes of facial paralysis. If they don’t find another cause, it’s likely Bell’s palsy.
Treatments and research
Early treatment, better results
Bell’s palsy often resolves on its own within three months. Certain treatments can still be beneficial if they’re given soon after your symptoms develop.
New onset Bell’s palsy treatments
Your doctor may prescribe an oral steroid to help reduce inflammation and irritation of the facial nerve. Studies have shown this can improve the chances for recovery when prescribed within 72 hours of symptom onset.
If you cannot be seen by your doctor for new facial weakness, you should go to the nearest emergency room so the emergency doctor can look for other serious causes and discuss medications with you.
Getting eye care as soon as you notice any facial drooping is extremely important. If you can’t close your eyes, they may become dry and scratched. Without proper care, the damage may be permanent. Your doctor can advise you on how to care for your eyes and may refer you to an eye specialist.
These home-care tips can help, with proper follow-up with an eye doctor:
Use eye drops such as “artificial tears” frequently during the day.
Use over-the-counter eye ointment at night. Within seven to 10 days of starting the ointment, be sure to see an eye doctor.
Use a moisture chamber at night.
Use an eye patch or eye taping when sleeping after discussing this with your eye doctor.
Wear wraparound sunglasses when outside.
Facial nerve decompression relieves pressure on your facial nerve. Sometimes the nerve is so inflamed that it gets squeezed near your inner ear. Ask your primary care doctor about seeing a neurotologist (ear surgeon), because this surgery should take place less than two weeks after the paralysis starts. The surgeon will help you determine if this treatment is right for you.
Eyelid weight surgery may be possible for people who find it difficult to close their eyes completely. This surgery involves placing a small weight in your eyelid. We may recommend it if you’ve had facial paralysis for longer than a few months. If you recover, we can remove the weight.
Chronic Bell’s palsy treatments
If your paralysis doesn’t go away after three months, we recommend scheduling an appointment at our Facial Nerve Clinic. The clinic offers a full line of treatments that may help patients with no recovery within three months for flaccid facial paralysis. We also treat patients with synkinesis.
Flaccid facial paralysis after Bell's palsy treatments
In flaccid paralysis (a chronic type of facial nerve paralysis), all muscle tone is lost and no movement exists, resulting in eyebrow and lower eyelid droop, inability to close eye, midface sagging, nasal twisting and obstruction, lower face droop with sagging at the corner of the mouth, difficulty eating, and inability to smile. For rare cases when flaccid paralysis occurs from Bell's palsy lasting longer than three month, the following treatments are available.
We use nerve input from the working side of your face to animate the paralyzed side. This procedure involves taking a sensory nerve (the sural nerve) from your lower leg. We use that nerve to wire new connections between branches of the facial nerve on the working side of your face and nerve branches of facial muscles on your paralyzed side. Surgeons tunnel the nerve across your face under your nose. The cross-face nerve graft can be combined with a muscle transfer from the upper leg to achieve smile function.
We may use dynamic procedures when you’ve had paralysis for a long time. After one to two years, your facial muscles won’t be able to move on their own. These procedures involve moving muscles and nerves from other parts of your body (free tissue transfer) to reanimate your facial movements. The cross-face nerve graft can be combined with free tissue transfer. The primary muscle used in free tissue transfer facial reanimation is the gracilis muscle. This is a thin muscle on the inside of the upper leg that can be transferred to your face with no significant changes to leg function. We can also use the temporalis muscle (muscles on the sides of your head) to restore facial tone and a dynamic smile. This can be done in a few different ways and involves connecting the temporalis muscle, which is activated with biting, to the corner of the mouth. When the muscle contracts with biting down, the corner of the mouth will move in a smile direction.
We use part of the nerve that normally helps you move your tongue. We connect it to your facial nerve to stimulate facial nerve muscles. This procedure is particularly useful in restoring the muscle tone of the face so that at rest the face has a symmetric appearance. A portion of the hypoglossal nerve (40%) is divided and connected to the facial nerve and fortunately this division of the hypoglossal nerve rarely causes any changes in tongue function.
We connect your masseteric nerve to your paralyzed facial nerve to restore your smile. The procedure utilizes the nerve from one of the muscles involved in chewing (the masseter muscle on the side of the cheek). However, this doesn’t cause significant problems with eating or mouth opening. Over time and with the use of neuromuscular retraining physical therapy many patients can smile without having to bite down to activate the nerve.
Some people with facial drooping have a lot of trouble closing one eye. In certain cases, surgery to place a small upper eyelid weight can improve this function. This can be combined with tarsal strip tightening or lateral canthopexy to repair a loose or floppy lower eyelid.
If you’ve had facial paralysis for one to two years, your muscles begin to break down. Movement may not return on its own. Static procedures lift sagging or drooping parts of your face and restore a more natural appearance.
Static procedures include:
Lower lip wedge resection/removal
Nasal surgery to hold the nose in an open position
Static sling to raise the corner of the mouth at rest
Brow lift to raise drooping eyelids
Synkinesis after Bell’s palsy treatments
Although many patients with Bell’s palsy will see improvement, sometimes the facial muscles can "over-correct" causing the face to become tight, stiff or "heavy." The eye may appear smaller. The crease between the side of the nose and corner of mouth (nasolabial fold) may seem deeper than the unaffected side. In some cases, the facial nerve can heal improperly causing muscles to contract out of sequence or at the same time. For example, the eye may close during a smile or pucker, or the cheek may pull up when the eye closes. This improper movement, called synkinesis, can result in uncoordinated or distorted facial expression.
Facial retraining uses specific techniques to improve the way you control your facial muscles. The goal is to retrain your brain and nerves. A specially trained physical therapist guides you through the program.
Botox relaxes the muscles that have become too dominant in synkinesis. This creates a better, more balanced appearance. Your insurance may require an alternative to Botox that works equally well.
Meet our team
The expertise you need
At UW Health, we have a complete team of experts who specialize in facial nerve paralysis. Team members include ear, nose and throat specialists, ear surgeons, head and neck surgeons and others. If your doctor thinks you need further evaluation, we’re here to help. We’re also available to assist if you’re living with symptoms that did not improve.
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Patient and support services
Answers for your questions, resources to help
The following resources may help you better understand your condition. They can help prepare for your visit to the Facial Nerve Clinic.
Evaluating facial paralysis and synkinesis
Our quick reference tools assist providers in evaluating facial paralysis and synkinesis in their patients and also include referral information to the Facial Nerve Clinic.