The elderly lady above demonstrates a case I saw in my clinic recently, but my patient was way younger in her early 30s. She developed this weakness over the left side of the face which was rather sudden in onset 3 days prior. She was otherwise very well and there was no history of trauma, infection or ear symptoms. There was neither any headaches nor any weakness associated to the upper limbs and lower limbs. She was otherwise well.
She had all the findings as the picture above, actually exactly like the elderly lady above. So what was wrong?
Well, this condition occurs when the nerve which is responsible for the control of facial muscles becomes swollen or inflammed causing the muscles to paralyse or weaken. It is usually abrupt with no apparent cause. This syndrome was first described in 1821, by the Scottish anatomist and surgeon Sir Charles Bell. From then, this condition was called Bell’s palsy. It is an interesting disease but a scary phenomenon for patients.
The nerve involved is called the facial nerve. The path of the facial nerve is complex; this may be the reason the nerve is vulnerable to injury. Two portions of the facial nerve leave the brain at the cerebellopontine angle, traverse the posterior cranial fossa, dive into the internal acoustic meatus, pass through the facial canal in the temporal bone, then angle sharply backwards, where they pass behind the middle ear and exit the cranium at the stylomastoid foramen. From here, the facial nerve bisects the parotid gland, and then terminal branches extend from the parotid plexus to innervate the muscles of facial expression.
Though the cause is still yet unknown, many believe that majority of them are due to viruses. The most common being the herpes simplex virus, which also causes cold sores and genital herpes. Other viruses that have been linked to Bell’s palsy include the herpes zoster (chickenpox and shingles) and Epstein Barr (infectious mononucleosis).
Bell’s palsy occurs more often in people who:
* Are pregnant, especially during the third trimester, or who are in the first week after giving birth
* Have diabetes
* Have an upper respiratory infection, such as the flu or a cold
Like my patient, there is also a genetic predisposition where most of them have recurrent attacks of Bell’s palsy but this is rare.
For most people, Bell’s palsy symptoms improve within a few weeks, with complete recovery in three to six months. About 10 percent will experience a recurrence of Bell’s palsy, sometimes on the other side of the face. A small number of people continue to have some Bell’s palsy signs and symptoms for life.
Eye care, steroids, pain control and reassurance are the main essence in the treatment of Bell’s palsy.