PRAMILAS DENTAL CENTRE

Bell’s Palsy-
Bell’s Palsy is a disease, which causes a sudden, temporary weakness in the facial muscles. It is facial paralysis that makes patients unable to control his facial muscles on either side of his face. This disease can occur at any age.

There is no known reason for its cause. However, the disease is believed to be caused because of swelling and inflammation of the nerve that controls the muscles on the affected side. The risk factors include diabetes and upper respiratory tract infection. This is caused due to the malfunction of the cranial nerve.

Bell’s Palsy affects millions of people worldwide. For most of them, the disease is temporary. The symptoms usually start to improve within a few weeks from the first appearance. The complete recovery takes close to six months. There are a few people who continue to have the Bell’s Palsy for their complete life. The disease rarely affects someone twice. People who recurrently face the disease are often found to be a victim of diabetes or viral infections.

People, often, unknowingly interpret the disease as a stroke. It, however, is not a stroke. A stroke affecting the facial muscles would also affect the body muscles and cause weakness in other parts of the body too.

Bell’s Palsy Causes-
The causes that trigger Bell's Palsy in the human body are still unknown. Often researchers associate it with an exposure to a viral infection. The facial nerve passes through a narrow bony area in the skull and when it swells, it pushes against the hard surface of the skull when there is a viral infection. Apart from the facial muscles, the disease also affects tears, saliva, taste and a small bone positioned in the middle of the ear. At other times, researchers also associate it with physical damage to the facial nerve that causes a similar swelling of the face.

Mostly the disease occurs due to viral infections. The infections play an important role in the development of the disease. The viruses that are linked to the development of the disease are:

1. Cold sores and genital herpes, also known as herpes simplex

2. Chickenpox and shingles, which are also known as herpes zoster

3. Infectious mononucleosis, which is also known as herpes zoster

4. Cytomegalovirus infections

5. Respiratory illnesses or adenovirus

6. German measles or rubella virus

7. Mumps or the mumps virus

8. Flu or the influenza B virus

9. Hand-foot-and-mouth disease or the coxsackievirus

Some Risk Factors of Bell’s Palsy-
It has often been noticed that Bell ’s palsy follows a pattern when affecting people. These include:

1. The disease often occurs in females who are pregnant and are in the third trimester of the gestation period. It can also affect the mother after the first week of the birth.

2. People having an upper respiratory infection, such as the flu and the cold, are commonly affected.

3. People having diabetes are also frequently affected.

As mentioned before, the disease rarely affects the same person recurrently. If there is a family history of the disease recurring repeatedly, it suggests a genetic trait or predisposition of the disease.

Bell’s Palsy Symptoms-
There are a few symptoms which constantly recur when Bell’s Palsy strikes a person. These symptoms include:

1. Inability to move the eyelid or blinking.

2. The eye on the affected side of the face waters more or less than it occurs usually.

3. Drooling even in a conscious state.

4. A reduced sense of taste in the mouth.

5. Twitching of the facial muscles.

6. Pain or numbness behind the ear.

Of all the symptoms drooling and facial weakness, reach their peak in a day or two. These symptoms then begin to reduce, which helps people to recover within a couple of weeks. Complete recovery happens within 3 months. Some of the patients may show neurological symptoms, which are defined as mononeuritis. This is what causes the tingling, headache, memory and balance problems. Other symptoms, which are unexplained by the facial nerve dysfunction, are ipsilateral limb weakness, ipsilateral limb paresthesias, and clumsiness.

Bell’s Palsy Diagnosis-
Bell’s Palsy is a disease which requires the diagnosis of exclusion. As there is no specific test for the disease, the doctor observes the diseased person’s face and asks him to move various parts of his face, including the facial muscles, for instance, closing the eyes, lifting the brow, showing the teeth and various other movements. Observing these parts, the doctor eliminates various other possibilities and tries to determine a reasonable cause for the disease.

As the disease is treated on the basis of exclusion, there is no routine testing or imaging test that can help in the diagnosis process. However, the degree of the nerve damage can be assessed using the House-Brackmann score. There are many studies, which have revealed that 45% of patients are not referred to a specialist. This simply suggests that the disease requires a straightforward diagnosis and is easy to manage.

Differential Diagnosis of Bell’s Palsy-
As there is no particular diagnosis in the treatment of the disease, doctors make use of the differential diagnosis technique in the treatment of Bell’s Palsy. In differential diagnosis, doctors distinguish a particular disease from other diseases that present similar clinical features. The technique finds its usage while diagnosing a particular disease to eliminate imminently life-threatening conditions.

During the differential diagnosis of Bell’s Palsy, there are various diseases which are easily eliminated such as a stroke. However, it is very difficult to eliminate the involvement of the facial nerve with the herpes zoster virus. In order to understand the major difference between the two, one must look for the small blisters on the external ear.

The Lyme’s disease also produces facial palsy, which occurs at the same time as the classic erythema migraine rash. Other times, it occurs at a later stage. In cases where the Lyme disease is common to the Bell’s Palsy disease, it may lead to facial palsy.

Bell’s Palsy Treatment-
As mentioned before, a vast majority of people have shown improvement in health and recovered completely from the disease with and at certain times, without treatment. There is no designated treatment for the disease. Doctors may suggest various medications or physical therapies that help to speed up the recovery of the patient. The medicines may vary from doctor to doctor. However, these medications may differ in accordance with the doctor. Surgery is rarely a solution or option in case of Bell’s Palsy.

Having said that, there are various procedures for the treatment of Bell’s Palsy. They include usage of the following:

1. Steroids

2. Antivirals

3. Physiotherapy

4. Surgery

5. Alternative Medicinal Therapies

1. Steroids – Various steroids such as corticosteroids, improve recovery of the patient within 6 months. Due to this, early administration of corticosteroids such as prednisone is recommended. The early treatment is necessary as it provides the patient with around 14% higher chances of recovery.

2. Antivirals –Various tests and reviews have shown that antivirals are not as effective in treating the disease as steroids. In fact, they are only beneficial in cases that display some form of mild diseases. There is another review, which stated that antivirals combined with corticosteroids were advantageous for the duration of the treatment. There is a huge amount of speculation when it comes to using antivirals for the treatment. However, antivirals still result in a benefit, which is slightly less than 7%, and therefore this course of treatment is not ruled out.

3. Physiotherapy – Physiotherapy helps in maintaining the tone of the impacted facial muscles and stimulating the facial nerve. Because of this, physiotherapy can be beneficial to some individuals.

4. Surgery – Surgery may help patients recover from facial nerve palsy. There are various techniques that exist to assist with the process of surgery. A form of surgery is a procedure that is beneficial in restoring the smile of patients suffering from facial nerve paralysis. However, this is a surgery that can be as harmful as it is beneficial. There are various side effects associated with the surgical technique. One may experience total hearing disability. In fact, around 3-15% patients experience hearing loss after the surgery.

5. Alternative Medicinal Therapies – Alternative Medicinal Therapies include various techniques such as acupuncture on the affected region. Paralyzed muscles often tend to shrink and shorten causing permanent contractures and pain. Physical therapies can guide the patient to prevent such an incident from occurring.

However, the efficiency of such techniques still remains unknown to the doctors. This is due to the fact that the studies conducted are available in a low quality. Another therapy is the hyperbaric oxygen therapy. However, the evidence available for the therapy is quite tentative.

Myths related to Bell’s Palsy
Bell’s Palsy disease often confuses people leading them to believe various myths. The most prominent myths include:

Myth #1: Bell’s Palsy Causes Permanent Facial Paralysis

Bell’s Palsy is a form of temporary facial paralysis. The facial nerve that is on one side of the face is disrupted. Due to this, the message, which is received from the brain, is interfered. However, in a majority of cases, the disease is temporary. The paralyzed area of the face starts to cure within a few weeks and within three to six months; the paralysis completely disappears on its own. In a few percentages of cases, the nerve function does not return to normal. The nerve function may return but the full function does not return.

Myth #2: There is No Treatment Which Ensures the Treatment of Bell’s Palsy

There are various techniques which are available for the treatment of Bell’s Palsy. As mentioned above, the disease can be defeated using steroids, antivirals, physiotherapy, surgery and alternative medicinal therapies. These are the most effective treatments for the disease. Apart from this, selective neurolysis and botox can be used to treat the disease.

Selective neurolysis involves releasing a platysma muscle downward and reducing the activity. The selective neurolysis is very useful for a patient to regain his ability to smile. The botox treatment is a non-surgical treatment. When injected by a nerve expert, it helps patients to regain some symmetry into their faces and improve their facial appearance.

Myth #3: Prognosis of the Disease is not Very Good

There are many people who are under the impression that prognosis for Bell’s Palsy is not very good and hence they hesitate in using it for the treatment. However, doctors state that prognosis is generally very good for the patients.

After making use of the prognosis method, a person starts to improve on his symptoms within the first two weeks. The duration for complete recovery remains the same, i.e. three to six months.

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