Bell's Palsy & Other Facial Nerve Problems: Symptoms, Causes, Treatments, and Prognosis
Danette C. Taylor, DO, MS, FACN
Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
- Facial nerve problems and Bell's palsy definitions and facts
- What is the facial nerve?
- What are symptoms of a facial nerve problem?
- What conditions affect the facial nerve?
- How are the causes of facial nerve dysfunction diagnosed?
- What is Bell's palsy?
- How does a person get Bell's palsy?
- Bell's palsy symptoms
- Who gets Bell's palsy? How long does it last?
- How is Bell's palsy treated? How is facial nerve paralysis treated?
- Treatment options for eye problems
- Surgical reconstruction options
- Is there a cure for Bell's palsy? What is the prognosis for other facial nerve problems?
- Can Bell's palsy and other facial nerve problems be prevented?
- Find a local Neurologist in your town
Facial nerve problems and Bell's palsy definitions and facts
- Facial nerve disorders affect the muscles of the face.
- There are many causes of facial nerve disorders.
- A number of tests can be helpful to diagnose the cause of a facial nerve disorder.
- The treatment of a facial nerve disorder depends on the cause and severity.
What is the facial nerve?
The facial nerve is a nerve that controls the muscles on the side of the face. It allows us to show expression, smile, cry, and wink. Injury to the facial nerve can cause a socially and psychologically devastating physical defect; although most cases resolve spontaneously, treatment may ultimately require extensive rehabilitation or multiple procedures.
The facial nerve is the seventh of the twelve cranial nerves. Everyone has two facial nerves, one for each side of the face. The facial nerve travels with the hearing nerve (the eighth cranial nerve) as it travels in and around the structures of the middle ear. It exits the front of the ear at the stylomastoid foramen (a hole in the skull base), where it then travels through the parotid gland. In the parotid gland it divides into many branches that provide motor function for the various muscles and glands of the head and neck.
What are symptoms of a facial nerve problem?
Facial nerve problems may result in facial muscle paralysis, weakness, or twitching of the face. Dryness of the eye or the mouth, alteration of taste on the affected side, or even excessive tearing or salivation can be seen as well. However, the finding of one of these symptoms does not necessarily imply a specific facial nerve problem; the physician needs to make a careful investigation in order to make a precise diagnosis. Symptoms of a facial nerve problem can vary in severity depending upon the extent of the injury to the nerve. Symptoms may range from mild twitching to full paralysis of the muscles on one side of the face.
What conditions affect the facial nerve?
There are numerous causes of facial nerve disorder:
- Trauma such as birth trauma, skull base fractures, facial injuries, middle ear injuries, or surgical trauma
- Nervous system disease including stroke involving the brain stem
- Infection of the ear or face, or herpes zoster of the facial nerve (Ramsay Hunt syndrome)
- Tumors including acoustic neuroma, schwannoma, cholesteatoma, parotid tumors, and glomus tumors
- Toxins due to alcoholism or carbon monoxide poisoning
- Bell's palsy, which is also called idiopathic facial nerve paralysis (see below); this condition is sometimes associated with diabetes mellitus or pregnancy
How are the causes of facial nerve dysfunction diagnosed?
Causes of facial nerve disorder vary from unknown to life threatening. Sometimes, there is a specific treatment for the problem. Accordingly, it is important to investigate why the problem has occurred. The specific tests used for diagnosis will vary from patient to patient, but include:
- Hearing tests: Hearing tests are done to assess the status of the auditory nerve. The stapedial reflex test can evaluate the branch of the facial nerve that supplies motor fibers to one of the muscles in the middle ear.
- Balance tests: Will help find out if part of the auditory nerve is involved.
- Tear tests: The loss of the ability to form tears may help to locate the site and severity of a facial nerve lesion.
- Taste tests: The loss of taste in the front of the tongue may help locate the site and severity of a facial nerve lesion.
- Salivation test: Decreased flow of saliva may help locate the site and severity of a facial nerve lesion.
- Imaging studies: These tests help determine if there is infection, a tumor, a bone fracture, or any other abnormality. These studies usually include a CT scan and/or a MRI scan.
- Electrical nerve stimulation tests: Stimulation of the nerve by an electrical current tests whether the nerve can still cause muscles to contract. It can be used to evaluate progression of the disease. For example, if testing indicates equal muscle response on both sides of the face, the patient can be expected to have complete return of facial function in three to six weeks without significant deformity.
What is Bell's palsy?
Bell's palsy (sometimes referred to as Bell palsy) is paralysis of the facial nerve of unknown cause. The diagnosis is made when no other cause can be identified. Although Bell's palsy is thought to be caused by a viral infection of the facial nerve, this hasn't been proven. Other names for this condition are "idiopathic facial palsy" or Antoni's palsy.
How does a person get Bell's palsy?
While the actual mechanism of injury of the facial nerve in Bell's palsy is unknown, one proposed mechanism of injury includes:
- Primary viral infection (herpes) sometime in the past.
- The virus lives in the nerve (geniculate ganglion) from months to years.
- The virus becomes reactivated at a later date.
- The virus reproduces and travels along the nerve.
- The virus infects the cells surrounding the nerve (Schwann cells) resulting in inflammation.
- The immune system responds to the damaged Schwann cells, which causes inflammation of the nerve and subsequent weakness or paralysis of the face.
- The course of the paralysis and the recovery will depend upon the degree and amount of damage to the nerve.
Next: Bell's palsy symptoms
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