What Is Bell’s Palsy?
Bell's palsy is a one-sided (unilateral) paralysis of the facial muscles. It occurs when the facial nerve that connects the brain to the facial muscles sustains damage. With Bell’s palsy, the affected individual is unable to move one half of the face or perform a blinking action with the eye on that side. The corner of the mouth tends to droop down, and one cannot hold liquids or food inside the mouth. The speech becomes slurred too. When the underlying cause behind an acute occurrence of facial nerve paralysis is not apparent at the time of diagnosis, one may call it Bell’s Palsy.
What Is the Cause Behind Bell’s Palsy?
The facial nerve coming out of the brain takes a rather long and curvy channel through the bone till it reaches the face. And along this path, it is quite vulnerable to compression injuries. Facial nerve damage often happens when the nerve is subjected to compression. And the compression can be a result of some swelling in the surrounding tissue next to the nerve. If a bacterial infection or viral infection is there, it can also lead to inflammation and damage to the facial nerve.
How Long Does the Recovery Period Last for Bell’s Palsy?
The recovery after facial paralysis can have two possible scenarios:
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Superficial Nerve Damage - It involves a light injury and a more favorable outcome. That is when the damage to the nerve is only on its outer layers, and the electrical insulation (myelin sheath) on the nerve can be recovered and restored rather quickly. And one can expect facial movements to return within two to five weeks. It is probably a spontaneous and complete recovery. And the functions of facial muscles will be just as they were before.
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Severe Nerve Damage - This is a less favorable scenario, where the nerve sustains more severe damage. One may imagine the facial nerve as a thick phone cable with many insulated wires inside. When only the insulation (outer-covering of the nerve made of myelin) is damaged, the damage tends to be lighter. But if there is more severe damage, not only is the insulation affected, the so-called tiny wires there will be damaged too. With facial nerves, the individual wires are called axons, and they form the long nerve fibers. With axonal damage, the brain loses its physical connection with the facial muscles. And there are no more wires to connect the brain to the face.
A quick recovery is less likely as this kind of damage takes much more time. It also takes more resources from the body. And if it takes a long time, say around one to three months, for the facial movements to reappear, there is a high probability that the recovery may be incomplete. There are chances one may sustain some residual complications after the long-standing Bell’s palsy. One of the complications is synkinesis which are typical involuntary muscle movements that cannot be controlled. For instance, when one tries to smile, the eye on that side may shut automatically.
Depending on what kind of cause has resulted in Bell’s palsy, the prognosis or recovery outcomes may involve a longer period of time. The causes can be:
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A severe type of nerve damage occurs from Ramsay Hunt syndrome, which is related to herpetic eruptions on the path of the nerve.
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Nerve compression from a tumor - When there is a rather heavy swelling that leads to heavy compression on the nerve, especially when the swelling does not go away very quickly.
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Post-operational facial palsies essentially occur after surgeries.
How Is Bell’s Palsy Diagnosed and Managed by the Doctors?
One needs to meet a doctor immediately after an episode of facial paralysis. A specialist with a good understanding of facial palsy may prescribe proper medication and determine what the underlying cause of facial palsy is. Based on the underlying reason for nerve damage:
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Most of the time, the drug of choice is Prednisone which is a steroid. Its main effect is to reduce the swelling. So that one can bring down the compression on the nerve. It is important to get rid of the swelling as soon as possible for a speedy recovery.
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If it is a bacterial or viral infection, one should take antibiotics or antiviral medications.
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If there is a tumor that is slowly developing on the path of the nerve, one may conduct the necessary evaluations and plan appropriate treatment. It may be surgery, medication, or other modalities.
What Is the Pattern of Recovery From Bell’s Palsy?
If the damage to the facial nerve is more severe, the lengthier will be the period of recovery. The following details are to be kept in mind:
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The regeneration of the nerve repair process starts on its own as soon as the damage happens. The nerve will regrow spontaneously and reconnect with the facial muscles at some point. The facial movements are sure to return, though it may take some time. If it is a favorable scenario, as in a superficial nerve injury, it may only take a couple of weeks.
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If the damage to the nerve is more severe, it may take longer, maybe two months or three months. But the movement will return to the face. One should realize that there is no way to switch back the facial nerve to its originality sooner.
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For those who have confronted residual complications of long-standing Bell’s palsy, including rigidity of facial muscles, pulling sensations in the face, contractures, and synkinesis, try to relax the facial muscles from time to time. This helps prevent the brain from developing a habit of exaggerating facial muscle contractions. This way, the muscles can be trained to move in a more proportional manner.
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Do not perform any facial exercises like pronouncing letters and sounds or making facial expressions forcing the muscles into activity. Forcing the muscles to perform active voluntary movements may lead to the formation of synkinesis. And it leads to contractures of facial muscles. This may create some abnormal sensations and tension in the facial region.
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Massage the face gently with both hands, on both sides of the face simultaneously from time to time with some gel or oil. Use gentle strokes starting from the midline of the face to outwards and from below upwards.
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One may opt for facial reanimation surgery to bring back the muscle movements and appropriate facial expressions. It may alleviate residual complications of long-standing Bell’s palsy.
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More importantly, one should not panic or fall into despair when an episode of Bell’s palsy hits them. Recovery rates have a very big impact on one’s emotional state. Maintain proper emotional balance and take adequate rest to recover from the heavy impact the nerve has suffered. Get adequate sleep and keep a positive mental attitude.
Conclusion:
In the majority of cases, the recovery from Bell’s palsy is complete. Only a small fraction of patients suffer complications and residual effects. If the nerve has suffered an injury that requires repair, the doctors recommend undergoing surgery at the earliest as the muscles may lose their ability to contract and relax after a while. This may be followed by rehabilitation involving rest and physiotherapy exercises. Ideally, Bell’s palsy takes about six months to reach a full-fledged recovery. And count on the doctor to prescribe medication and provide good advice on what to do and what one should not do in the acute phase of Bell's palsy.
