Facial Nerve Problems (cont.)
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.
In this Article
- 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
Bell's palsy symptoms
The typical symptoms of Bell's palsy include:
- Acute unilateral paralysis of facial muscles is present; the paralysis involves all muscles, including the forehead.
- About half the time, there is numbness or pain in the ear, face, neck or tongue.
- There is a preceding viral illness in a majority of patients.
- There is a family history of Bell's palsy in some of patients.
- Very few patients have bilateral problems.
- There may be a change in hearing sensitivity (often increased sensitivity).
Who gets Bell's palsy? How long does it last?
Bell's palsy is usually a self-limiting, non-life-threatening condition that resolves spontaneously, usually within six weeks. There is no predominant age or racial predilection; however, it is more common during pregnancy and slightly more common in menstruating females. In general, the incidence increases with advancing age. Children under the age of 13 seem less at risk of developing Bell's palsy than older individuals.
How is Bell's palsy treated? How is facial nerve paralysis treated?
There are no medications specifically approved to treat Bell's palsy. Underlying medical conditions that lead to facial nerve disorder are treated specifically according to the specific condition that is responsible for the damage to the nerve. Steroid medications (corticosteroids) are the best treatment for Bell's palsy, and it is recommended that all patients be treated. The usual amount is one milligram per kilogram body weight of prednisone (or steroid alternative) per day for 7 to 14 days. Recently, antiviral medications like acyclovir (Zovirax) given in conjunction with steroids have been demonstrated to increase recovery. Doses of the antiviral agent will vary with the drug chosen.
Although physical therapy and electrotherapy probably have no significant benefit, facial exercises can help prevent contractures of affected muscles. Surgical facial nerve decompression is controversial in Bell's palsy. Some physicians recommend surgical decompression during the first two weeks in patients showing the most severe nerve degeneration; however, there can be a substantial risk of hearing loss with this surgery.
Treatment options for eye problems
Patients with facial nerve paralysis have difficulty keeping their eye closed because the muscles which close the eye cannot work. Serious complications can occur if the cornea of the eye becomes too dry. Treatment consists of:
- protective glasses which can prevent dust from entering the eye;
- manual closure of the eye with a finger to keep it moist -- patients should use the back of their finger rather than the tip to insure that the eye is not injured;
- artificial tears or ointments to help keep the eye lubricated;
- taping or patching the eye closed with paper tape while asleep; and
- in cases in which recovery is incomplete, a temporary or permanent narrowing of the eye opening (tarsorrhaphy) may be necessary.
Surgical reconstruction options
Reconstructive options for patients with facial muscle weakness or paralysis include one or more of the following:
- Nerve repair or nerve grafts: Facial nerve regeneration occurs at a rate of one millimeter per day. If a nerve has been cut or removed, direct microscopic repair is the best option.
- Nerve transposition: Often the tongue nerve (hypoglossal nerve) or the other facial nerve can be connected to the existing facial nerve. For example, the patient can then train themselves to move their face by moving their tongue.
- Muscle transposition or sling procedures: The temporalis muscle or masseter muscle (some of the only muscles on the face not supplied by the facial nerve), can be moved down and connected to the corner of the mouth to allow movement of the face.
- Muscle transfers: Free muscles from the leg (gracilis) can be used to provide both muscle bulk and function. Often a cross facial nerve transposition is done to provide similar nerve supply to the donor muscle flap.
- Ancillary eyelid or oral procedures: In addition to one of the above, often it is necessary to include a brow lift or facelift, partial lip resection, eyelid repositioning, lower eyelid shortening, upper eyelid weights, or eyelid springs in reconstructive surgery following severe facial nerve palsies.
Is there a cure for Bell's palsy? What is the prognosis for other facial nerve problems?
The prognosis for facial nerve damage depends on the underlying cause. Many patients who have required surgery to remove tumors may have unavoidable permanent injury to the facial nerve, whereas a majority of persons who experience Bell's palsy will have complete recovery. The best outcomes occur with rapid diagnosis and treatment.
Can Bell's palsy and other facial nerve problems be prevented?
At one time it was thought that exposure to cold air or a strong wind were predisposing factors leading to idiopathic facial nerve palsy (Bell's palsy); we now know that these ideas were incorrect. As the majority of causes for idiopathic facial nerve problems are unknown, it is difficult to predict with any accuracy specific items to avoid. Choosing a healthy lifestyle to decrease the risk of diabetes, cancer, or infection may help prevent some cases of facial nerve palsy.
Marsk, E., et al. "Prediction of nonrecovery in Bell's palsy using Sunnybrook grading." Laryngoscope 122.4 (2012): 901-906.
Peitersen, E. "The natural history of Bell's palsy." The American Journal of Otology 4.2 (1982): 107-111.
Sullivan, F. M., et al. "Early treatment with prednisolone or acyclovir in Bell's palsy." The New England Journal of Medicine 357:16 (2007): 1598-1607.
Sullivan, F. M., et al. " A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell's palsy: the BELLS study." Health Technology Assessment 47:iii-iv, ix-xi (2009) 1-130.
Teixeira, L. J., et al. "Physical therapy for Bell s palsy (idiopathic facial paralysis)." Cochrane Database of Systematic Reviews. 3 (2008): CD006283.
Previous contributing author: Standiford Helm II, MD.
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