Bell’s palsy

Diagnosis

Bell’s palsy has no specific diagnostic test. Based on the symptoms, a healthcare provider can make a diagnosis. Facial paralysis can also be brought on by other illnesses, such as Lyme disease, sarcoidosis, and stroke. Patient might undergo one or more tests to rule out those causes.

• Physical examination: The healthcare provider will examine the face and may request that the patient make certain facial motions, such as frowning, showing teeth, elevating the brow, and closing their eyes.
• Blood tests: No specific blood test exists for Bell’s palsy. However, blood testing can be performed to rule out illnesses such sarcoidosis and Lyme disease.
• Imaging test: In some cases, it may be necessary to rule out additional potential sources of pressure on the facial nerve, such as a tumor or skull fracture, using magnetic resonance imaging (MRI) or computerized tomography (CT).
• Electromyography (EMG): The test can evaluate the extent of nerve injury and confirm its presence. A muscle’s electrical reaction to stimulation is captured by an EMG. A nerve’s ability to conduct electrical impulses is also measured, along with their nature and velocity.

Treatment

The majority of Bell’s palsy patients experience a full recovery, regardless of whether they receive treatment or not. While there is no universally effective treatment for Bell’s palsy, healthcare professionals may recommend medication or physical therapy to expedite the recovery process. Surgery is rarely effective in treating Bell’s palsy.

Taking measures to protect and care for the affected eye is crucial due to the inability to fully close it in Bell’s palsy. Maintaining adequate moisture can be achieved by using lubricating eye drops during the day and applying an eye ointment at night. To prevent accidental injury, wearing glasses or goggles during the day and an eye patch at night can help shield the eyes from being poked or scratched. In severe cases of Bell’s palsy, an eye doctor may need to closely monitor the eye’s condition.

• Medications: Medications frequently used to treat Bell’s palsy include:
  • Corticosteroids: Example is prednisone. These anti-inflammatory medications work effectively. The facial nerve will fit more comfortably in the bone channel surrounding it if they can minimize the swelling. If corticosteroids are administered within a few days of the onset of symptoms, they may act more effectively. Early steroid administration increases the likelihood of a full recovery.
  • Antiviral drugs: Antivirals’ role is yet unclear. Antivirals by themselves have not demonstrated any advantage over a placebo. Bell’s palsy patients may find some relief with antivirals combined with corticosteroids, but this has not yet been proven.
    Nevertheless, in patients with severe facial palsy, a combination of prednisone and an antiviral medication, such as valacyclovir or acyclovir, may be administered.
• Eye care: The care of the eyes is important. Artificial tears and other eyedrops can relieve dry, itchy eyes. To protect the eye from irritants and injuries, patient might need to wear an eye patch if their eyelid won’t close.
• Physical therapy: Muscles that are paralyzed can become permanently shorter and smaller. A patient can learn how to massage and exercise their facial muscles from a physical therapist to help avoid this from happening.
• Surgery: Decompression surgery, which involves widening the bone channel that the facial nerve travels through, was once employed to release pressure on the nerve. Decompression surgery is not advised today. This operation may come with hazards like permanent hearing loss and facial nerve damage.

In rare instances, persistent facial nerve issues may necessitate correction by plastic surgery. Facial reanimation surgery can help achieve a more balanced facial appearance and potentially restore facial movement. Procedures such as brow lift, eyelid lift, face implants, and nerve grafts are examples of surgical interventions used in these cases. It is worth noting that certain treatments, like a brow lift, may need to be repeated after a few years.