Bell’s palsy resolves on its own in 70-75% of patients without any treatment.(1)
Bell’s palsy is three times more common in pregnant women than the general population.(2)
How To Stop Bell’s Palsy From Spreading?
To stop Bell’s palsy from spreading it is crucial to diagnose the condition timely at the initial stage and start the management as early as possible.
To reach the correct diagnosis it is important to differentiate Bell’s palsy from another facial paralysis, which mandates detailed history and physical examination. The differential diagnoses include trauma to the facial nerve, Melkersson-Rosenthal syndrome, Ramsay-Hunt syndrome, stroke, CNS tumors, HIV infection, Lyme disease, Guillain-Barre syndrome, multiple sclerosis, otitis media, sarcoidosis, autoimmune diseases (Sjogren’s disease), cholesteatoma, and metabolic diseases (diabetes mellitus). Bell’s palsy is diagnosed when all these causes are excluded(2).
Bell’s phenomenon (the upward movement of the eye due to weakness of the eye muscle, orbicularis oculi, when trying to close the eyelid) is a pathognomonic sign of Bell’s palsy(2).
Usually, the prognosis of Bell’s palsy is good as 70-75% of the patients recover fully without the need for treatment. However, the complete recovery rate increases to 82% with early treatment with prednisolone (within 72 hours of the onset of symptoms)(1).
Since there is no established cause of Bell’s palsy, the management of it revolves around the reduction of inflammation of facial nerve; therefore, corticosteroids for their anti-inflammatory effect have been successfully used to relieve the symptoms. Prednisolone at a dose 50-60 mg/day for 10 days to a maximum of 80 mg is used effectively and safely in adults. In diabetics, more than 120 mg/day dosage has been used safely(1).
Since reactivation of herpes infection is postulated as one of the causes of Bell’s palsy, antiviral drugs (aciclovir at a dosage of 400 mg five times daily for 5 days and valaciclovir 1000 mg/day for 5 days) have been used either alone or in combination with corticosteroids, but no additional benefit of antiviral drugs either alone or in combination therapy has been noted in systemic reviews. Therefore, further studies are warranted to find the efficacy of antiviral drugs in the management of Bell’s palsy(1).
The inability to close the eyelids in Bell’s palsy poses a risk of long-term corneal complications; therefore, it is important to protect the eye with an eye patch and application of eye lubricants on an hourly basis and eye ointment at night to prevent drying of the cornea(1), (2).
Patients start recovering within 3 weeks and sometimes full recovery takes up to 9 months. A delay in diagnosis and management of the disease with medications may lead to residual disease, which warrants timely management(2).
How Does Bell’s Palsy Present Itself?
Bell’s palsy is the weakness or paralysis of the lower motor neuron of the facial nerve. Since the cause of Bell’s palsy is still unknown and it affects the seventh cranial nerve (CN VII), the facial nerve, is also known as idiopathic facial paralysis. The reactivation of herpes virus (herpes simplex virus and herpes zoster virus) is considered the most likely cause of the disease. Other likely causes include inflammation, vasculature, infections, and autoimmune disorders(1).
Bell’s palsy is seen in individuals between 15-50 age groups with equal gender preference. Although it is three times more common in pregnant women (in their third trimester and early postpartum period) it can also be seen in patients with diabetes and hypothyroidism, and elderly individuals(2).
The presenting signs and symptoms of Bell’s palsy may range from mild to severe. The onset of Bell’s palsy is acute and unilateral and usually starts within a few hours. Up to 60% of the patients have a viral infectious history. It starts with partial facial weakness/paralysis, which then extends and leads to complete facial weakness/paralysis within 2 days(2).
The signs show ipsilateral loss of forehead wrinkles, drooping of eyelids, dry eyes/or excessive tearing, loss of ability to close the eye completely, drooping of the corner of the mouth, loss of taste sensation, dribbling of the saliva, pain around the ear, and hyperacusis (increased sensitivity to sound)(1).
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