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A paralyzed face ...

MY friend recently had a very frightening experience. One side of his face, including his mouth, was suddenly paralyzed. He thought he was having a stroke, but when he was rushed to the hospital, they diagnosed the condition as Bell's palsy? What is Bell's palsy?

Bell's palsy is a condition that is caused by trauma to the 7th cranial nerve, which innervates the facial muscles. There are two 7th cranial nerves, one on your left side and right side. One out of every 5,000 people will get it. Bell's palsy affects either the right side or left side, and men and women equally.

The 7th cranial nerve controls the muscles of your forehead, face, and neck. It stimulates the salivary glands, your tear glands and controls taste in the front 2/3 of your tongue. It also controls the sensations experienced by your outer ear.

It should be noted that in Bell's palsy, the entire side of your face is affected. If only one part of your face is affected, such as only your mouth or your forehead area, this is NOT Bell's palsy.

What are the symptoms then? My friend just had facial paralysis. He didn't have altered taste sensation or impaired hearing.

The symptoms and severity of Bell's palsy differ from patient to patient. It all varies according to the degree of nerve damage.

In Bell's palsy, most patients wake up to find one side of their face drooping. They may have a dry eye or a tingling sensation around their lips initially, which will then progress to facial droop within the same day. Some people take several days to manifest all the symptoms. And in other people, the paralysis may be preceded by neck pain or pain behind the ear.

These are some things you may notice as well:

Your forehead wrinkles may disappear, your brow may droop

Difficulty in blinking, difficulty in closing your eyes, lack of tears or too much tears

Runny or stuffy nose

Difficulty speaking, eating or drinking

Sensitive to sound, pain in the ear

A swollen face, excessive or reduced salivation, diminished or distorted taste, drooling

My friend is quite young. I thought this kind of thing only happens to old people.

Bell's palsy usually happens in older people, but children are not excluded either. If you have diabetes, you are four times more likely than the general population to have it. Women in their last three months of pregnancy are also prone to getting it.

Can it affect both sides of the face? How can I tell the difference between Bell's palsy and stroke? I understand stroke also causes facial paralysis.

Bell's palsy can affect both sides of your face, but in less than 1% of all cases. Unlike stroke, Bell's palsy usually affects only the face. In stroke (or cerebrovascular accident), the body as well as the face is affected too.

It is always best to go to the hospital in all cases to rule out stroke.

You mentioned Bell's palsy is caused by trauma to the nerve. What causes this trauma? A blow to the side of your head?

Most commonly, facial palsy is caused by a virus. The Herpes Simplex virus 1 (HSV-1) has been identified as the most frequent culprit. A 1995 study suggests this HSV-1 virus causes as much as 60 to 70% of all Bell's palsy!

Don't think that HSV-1 is just a sexual virus. Most people get HSV-1 in childhood because of kissing from relatives! It can also be spread through sharing towels, eating implements and others.

HSV-1 can enter a dormant state where it lives quietly in the 7th cranial nerve tissue. When there are certain triggers, such as infections, lack of sleep or stress, the virus reactivates and inflames the nerve.

Other viruses such as rubella, mumps and HIV can also cause Bell's palsy.

And yes, anything that can hurt the nerve, such as a blow to the face, facial bone fracture, surgery to the face and facial tumors can also cause Bell's palsy.

Is there any hope for recovery?

Of course there is hope. Most people take about two weeks to recover, depending on the damage to the nerve. Basically, your 7th cranial nerve needs to repair and regenerate itself. When the damage is small, complete recovery is fast.

But with more damage, other cranial nerves may try to "rewire" and take over for the damaged 7th nerve. These other cranial nerves might then creep into the pathways formerly occupied by the 7th nerve. The 7th nerve might itself regenerate incorrectly, and occupy other paths.

Some residual effects of Bell's palsy include your facial muscles becoming overactive (this is seen as a squinty eye, a mouth pulling up, deepened creases.) Your face may by asymmetrical for a while. Eating, drinking and speaking require a different "effort" than what you've been used to.

But physical therapy can help immensely.


A paralysed face ...

Persistent itching on the face and neck

Tic douloureux













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