Understanding Bell’s Palsy: Causes, Symptoms, and Treatment Options

Bell’s palsy is the leading cause of facial paralysis in the United States. The average person has about a 1 in 5,000 chance of developing the condition at some point during a lifetime. Often affecting people between the ages of 15 and 60, this condition was discovered by Scottish neurologist and anatomist Sir Charles Bell and refers to facial paralysis or weakness that occurs on one side of the face. There is no known prevention for this type of facial paralysis. Bell’s palsy causes are not fully understood, but many treatment options are available to help patients dealing with this condition, including Botox and surgery.

 

How Does Bell’s Palsy Differ from Facial Paralysis?

Facial paralysis and Bell’s palsy are not interchangeable. Facial paralysis may occur for a number of reasons, including tumors, trauma, and salivary gland inflammation. Comparatively, recent studies have indicated that Bell’s palsy can occur if a viral infection of the herpes simplex virus (HSV), which also causes cold sores, gets reactivated in the bone behind the ear (temporal bone). When this happens, the nerve becomes swollen and “shuts down” rapidly.

However, this is just one of the potential causes for the disorder, which is also known as “acute peripheral facial palsy of unknown cause.” In other cases, the reason for this condition is not known, but researchers have noted that the paralysis is a result of damage to the 7th cranial nerve, also known as the facial nerve.

Bell’s palsy generally results in noticeable weakness or facial paralysis that worsens in the 48 hours after symptoms are first noticed. It affects one side of the face at a time, resulting in facial features that are drooping on one side but not the other. Patients may notice that on the affected side, the lips are unable to smile and the eyes do not close all the way. This is because the muscles on one side have been affected by the damaged nerve.

This condition is often associated with a feeling or sensation that face movement may be inhibited. If an individual experiences this issue, it is vital to consult with a doctor immediately. In many instances, symptoms disappear on their own within three months of an initial diagnosis. However, if Bell’s palsy symptoms linger for eight months or longer, Dr. Babak Azizzadeh and The Facial Paralysis Institute team can help.

Dr. Azizzadeh is a globally recognized facial plastic and reconstructive surgery expert. He possesses comprehensive knowledge of the facial nerve and associated conditions and is happy to share his Bell’s palsy treatment insights with patients.

Bell’s Palsy Symptoms

If patients are unsure whether or not they have developed Bell’s palsy, it is helpful to know the most common symptoms. These include:

• Facial drooping
• Drooling
• Facial paralysis or weakness on one side of the face; these issues may occur over the course of a few hours or days
• Jaw pain
• Pain in or behind the ear on the paralyzed side of the face
• Headache
• Sensitivity to sound on the paralyzed side
• Altered taste
• Changes in saliva and tear production

People who experience one or more of the aforementioned symptoms should consult with a doctor immediately. Some of these symptoms can also be indicative of a stroke, which requires immediate medical care. If a doctor does determine that a patient has acute peripheral facial palsy of unknown cause, early treatment can help alleviate symptoms, slow paralysis, or encourage a shorter recovery time.

If patients are diagnosed within two to three days of symptom onset, they may be prescribed steroids, which can bring swelling down and help bring about a full recovery from the paralysis. For cases in which viral infections are suspected, doctors may also prescribe antivirals.

By meeting with a doctor, a patient can take the first step to correct Bell’s palsy symptoms. A patient can also work with a doctor to explore additional ways to lower their risk of long-term facial paralysis.

Bell’s Palsy Diagnosis

Patients who experience sudden facial paralysis should go to the emergency room immediately and be evaluated for Bell’s palsy. A healthcare provider should first rule out serious conditions, such as a stroke, and then ask several questions to help determine the extent of the paralysis. The provider may ask a patient to raise their eyebrows and close their eyelids to visually assess facial muscle function. In addition, patients may be asked if they are having problems hearing sounds or chewing foods, as well as whether they have recently recovered from a cold or infection.

Additional studies that need to be performed include laboratory testing for Lyme disease, a thyroid function test, and testing for HIV and hepatitis. A complete neurologic and ear, nose, and throat evaluation needs to be done as well. If the initial provider has any concerns, an ENT specialist or a facial nerve specialist needs to be consulted to make sure that there is no other underlying cause of the facial paralysis.

Occasionally, a tearing test function, computed tomography (CT scan), and magnetic resonance imaging (MRI) exam may be completed to identify the root causes of facial paralysis. An electromyography or electroneurography (ENoG) may need to be performed in patients with severe cases of facial paralysis who are believed to have Bell’s palsy.

Patients should be aware that facial paralysis and Bell’s palsy are rare and complex conditions, and many physicians and internists lack the expertise and knowledge to perform sufficient testing. Therefore, an individual will want to consult with a facial nerve specialist or ear, nose, and throat specialist within the first three weeks of facial paralysis. By doing so, they can receive the necessary tests to identify and address facial paralysis as close to symptom onset as possible.

In approximately 85% of cases, Bell’s palsy will go away on its own and the patient will regain full facial movements. However, if after 8 months the patient is still suffering from paralysis symptoms, it is time for them to meet with Dr. Azizzadeh to explore the broad range of Bell’s palsy treatment options. Dr. Azizzadeh will evaluate each patient and work with him or her to find the best way to deliver the optimal results.

Please contact the Facial Paralysis Institute on the right-hand side of this page if you have any further questions about finding a specialist in your area.

What Are the Different Types of Bell’s Palsy Testing?

1. Complete ear, nose and throat evaluation that enables an individual to find out if there is an inner ear infection or a head or neck tumor or malignancy. The test also may be used to help a person identify and resolve dizziness associated with Bell’s palsy.
2. Neurologic assessment to examine an individual’s movement, reflexes, cranial nerves and level of consciousness.
3. Hearing test to examine whether an individual has suffered hearing damage or inner ear problems.
4. Vestibular test to see if the nerve balance is intact.
5. Tearing test to assess an individual’s tearing function.
6. CT scan of the neck and temporal bone to evaluate any tumors or trauma.
7. MRI of the internal auditory canal and brain to evaluate acoustic neuroma and other types of tumors.
8. Electrophysiologic test such as ENoG and EMG to study the electrical flow to the face.

Treatment Options for Bell’s Palsy

Bell’s palsy treatment may vary based on time and presentation. If someone develops Bell’s palsy, he or she will need to be evaluated immediately, and other causes of facial paralysis such as tumor, trauma and inner ear infection must be ruled out. A patient may be diagnosed with Bell’s palsy after all other causes of facial paralysis have been ruled out.

Every case of Bell’s palsy is unique. Therefore, it is important for each patient to receive a custom treatment tailored to his or her condition. After an individual receives a Bell’s palsy diagnosis, the initial treatment often involves high-dose steroids (prednisone) and antiviral medications (Famvir or Valtrex). However, if the patient does not recover completely from Bell’s palsy symptoms, surgery may be required.

At the Facial Paralysis Institute, we recommend that patients who have complete facial paralysis upon presentation obtain EMG/ENoG testing in addition to CT scan and MRI. If the ENoG reveals significant dysfunction of the facial nerve, then one of our neuro-otologists will evaluate the patient to see if they are candidates for facial nerve decompression surgery.

Facial nerve decompression surgery is a complex procedure that reduces pressure on the 7th cranial nerve. It involves removing parts of bone that is squeezing the facial nerve, which travels in a labyrinthine manner from the brainstem to multiple parts of the the face, chin, and neck. Because of the complicated nature of the surgery, it must be performed by a neuro-otologist, a Bell’s palsy specialist who specializes in treating the nerves that affect the neck and face.

When completed within two weeks of symptom onset, this treatment can go a long way toward aiding in complete Bell’s palsy recovery.

After the initial Bell’s palsy treatment, a patient should follow-up with a facial nerve paralysis expert for the first year. It is also important for a Bell’s palsy patient to seek eye protection and take special care of the eye. Patients who are dealing with total facial paralysis sometimes struggle to close their eyes completely (lagophthalmos). Patients who present with an inability to close their eyes risk ulcerations and cornea damage.

Seeking care from an ophthalmologist, a medical doctor who specializes in issues of the eye, can help patients reduce eye damage from facial paralysis. An ophthalmologist may prescribe eye drops, gel, or ointment to help prevent the eye from drying out. The opthamologist may also give patients instructions for taping the eye shut or wearing an eye patch during Bell’s palsy recovery.

Additional treatments offered by Bell’s palsy specialists may include selective neurolysis surgery or facial nerve powering surgery.

Selective Neurolysis Surgery For Bell’s Palsy

Selective neurolysis, also known as modified selective neurectomy, is a groundbreaking surgical procedure performed by Dr. Azizzadeh. It is the first permanent Bell’s palsy treatment and has been shown to help patients achieve a natural-looking smile. Some patients do not fully regain normal function of the facial muscles and still have a droopy smile eight months or more after the onset of facial paralysis. They may also experience synkinesis, or the involuntary contraction of the facial muscles, which can cause disruption and discomfort throughout the day. In selective neurolysis, certain parts of the facial nerves are suppressed to help restore lost function.

During selective neurolysis, Dr. Azizzadeh uses intraoperative electromyography (EMG) to map out a patient’s facial nerves. Next, he decreases the activity of the facial nerves that hinder the smile mechanism. Dr. Azizzadeh then releases the platysma muscle that pulls the corner of the mouth down, resulting in spontaneous reanimation of the face and a natural-looking smile.

Selective neurolysis is performed at an outpatient surgery center, and the downtime and risks associated with the surgery are minimal. In fact, many patients see results one day following surgery.

Powering the Facial Nerve

Patients who have partial paralysis either from Bell’s palsy or other etiologies, such as acoustic neuroma or temporal bone fractures, may also be candidates for a “supercharging” or “signal upgrading” procedure. This type of surgery can increase the power of the facial nerve and help the facial muscles work more effectively. The concept is to use surrounding nerves and muscles to help strengthen weak smile muscles while preserving basic function. The masseteric nerve is the most common nerve utilized to help strengthen the facial nerve, and the surgery is performed as an outpatient procedure.

Bell’s Palsy After Surgery

Bell’s palsy recovery time varies, but regardless of which type of surgery a patient receives to treat paralysis, Dr. Azizzadeh prepares his patient for the period after surgery.

Following surgery, Dr. Azizzadeh wants each of his Bell’s palsy patients to achieve a balanced, natural-looking appearance and regain the ability to smile, frown, and make other facial expressions. To accomplish his goal, Dr. Azizzadeh works directly with his patient throughout the recovery cycle. He offers tips and recommendations to ensure a patient can fully recover from Bell’s palsy surgery. Patients may need therapy to help them learn how to use their altered or reconstructed facial muscles, and Dr. Azizzadeh can help point patients in the direction of excellent therapists.

It may take many months or even years before a patient sees the full results of Bell’s palsy surgery. By following Dr. Azizzadeh’s post-surgery instructions and attending follow-up appointments and therapy sessions, a patient can boost the likelihood of making a full recovery.

Botox for Bell’s Palsy

Botox injections are one of the most effective treatments for patients with Bell’s palsy, partial facial paralysis and synkinesis. The neuromodulator relaxes the hyperactive muscles and can temporarily restore some facial symmetry and improve appearance. With Botox injections, patients can relax hyperactive muscles in the face. The injections help patients temporarily restore facial symmetry and enhance their facial appearance.

Below is an image of a Bell’s palsy patient before and after Botox for Bell’s palsy treatment with Dr. Azizzadeh.

Which Is Better: Surgery or Botox for Bell’s Palsy?

Whereas some patients can benefit from surgery for Bell’s palsy, others may be able to treat their facial paralysis symptoms with Botox injections. To determine the safest and most-effective treatment option, a patient should consult with Dr. Azizzadeh.

Dr. Azizzadeh is a leading facial plastic and reconstructive surgeon who understands the intricacies of facial paralysis. Before deciding on a treatment plan, he takes the time to learn about a patient, and then crafts a custom treatment plan based on their symptoms. With his in-depth approach to Bell’s palsy and other forms of facial paralysis, Dr. Azizzadeh can provide a treatment that matches his patient’s expectations.

What Are the Causes of Bell’s Palsy?

Bell’s Palsy Risk Factors

While Bell’s palsy causes may not be well understood, there are several known risk factors associated with the condition. The main risk factor for developing Bell’s palsy is pregnancy. Women who are pregnant are more prone than others to Bell’s palsy. Furthermore, research indicates the risk of Bell’s palsy during pregnancy increases during the third trimester or one week after giving birth.

Increased incidences of Bell’s palsy have also been found in patients who

• Are pregnant
• Are of Japanese descent
• Have a family member who has suffered Bell’s palsy
• Have suffered Bell’s palsy in the past

In addition, some of the most common risk factors for patients who suffer facial paralysis include:

• Lyme disease
• Typhoid fever
• Guillain-Barré syndrome
• Temporal bone fracture
• Tumors such as acoustic neuroma
• Various types of viruses

Although Bell’s palsy is a form of facial paralysis, it again is important to remember that Bell’s palsy and facial paralysis can have very different causes. Certain types of strokes, for example, can cause facial paralysis, but this type of paralysis is unrelated to Bell’s palsy. Thus, the causes of Bell’s palsy and the causes of facial paralysis vary. The Facial Paralysis Institute is happy to teach individuals about Bell’s palsy and its risk factors. We also provide a wide range of treatment options to help patients address Bell’s palsy symptoms.

Recovery from Bell’s Palsy

When discussing recovery from Bell’s palsy, there are three groups of patients recovering from Bell’s palsy:

• Full Recovery: 85 percent of Bell’s palsy patients will recover from Bell’s palsy without any lingering health issues.
• Partial Recovery: 10 percent of Bell’s palsy patients will suffer synkinesis and partial facial paralysis.
• Complete Facial Paralysis: The remaining 5 percent of Bell’s palsy patients will require comprehensive Bell’s palsy treatment.

Numerous factors may increase a patient’s risk of complications during Bell’s palsy recovery, including:

• Failure to receive immediate Bell’s palsy treatment after initial diagnosis
• Pregnancy
• Severe symptoms such as facial droop and paralyzed face

The extent of facial nerve damage associated with Bell’s palsy can impact the recovery time after treatment. Meanwhile, Dr. Azizzadeh works closely with a patient during the recovery period to help him or her quickly and safely achieve the desired treatment results.  

Due to great advancements in facial nerve treatments over the years, Bell’s palsy patients can rest assured that there is hope to smile again! In fact, Dr. Azizzadeh is a Bell’s palsy specialist and dual board-certified facial plastic and reconstructive surgeon who has helped many patients throughout his career. He is Harvard-trained and happy to assist Bell’s palsy patients who are not experiencing any or full movement eight to nine months after the onset of their facial paralysis.

Bell’s Palsy FAQ

What is the difference between Bell’s palsy and a stroke?

Bell’s palsy is a neurological condition that causes facial paralysis on one side of the face. It is not life-threatening. Also, in most Bell’s palsy cases, the condition’s symptoms disappear on their own within about three months of onset.

Comparatively, a stroke refers to a sudden disruption to the brain’s blood supply. A stroke occurs due to a blockage of arteries connected to the brain or bleeding into brain tissue related to a burst blood vessel.

Bell’s palsy patients sometimes display unilateral facial paralysis, drooping of the mouth on one side of the face and other stroke-like symptoms. However, stroke patients generally do not display forehead or eyelid weakness commonly associated with Bell’s palsy.

Is Bell’s palsy contagious?

No, Bell’s palsy is not contagious.

Does Bell’s palsy hurt?

Bell’s palsy causes a unique sensation in the face. The condition inhibits facial movement, but it typically does not cause pain due to facial nerve damage. In some instances, Bell’s palsy patients experience minimal pain in and around the ears in the first days after onset.

Is Bell’s palsy permanent?

Bell’s palsy is usually not permanent. In rare instances, Bell’s palsy symptoms do not disappear on their own.

If a person is dealing with prolonged Bell’s palsy symptoms, consulting with Dr. Azizzadeh is ideal. Dr. Azizzadeh can offer a personalized treatment to help this individual achieve long-lasting Bell’s palsy symptom relief.

Is Bell’s palsy preventable?

Bell’s palsy is not preventable. Certain viruses cause facial nerve swelling, which sometimes results in Bell’s palsy. Or, in other instances, a person’s genes may make him or her susceptible to Bell’s palsy.

Is acupuncture an effective Bell’s palsy treatment?

Research indicates that acupuncture sometimes helps treat Bell’s palsy symptoms. But acupuncture alone is unlikely to help a Bell’s palsy patient correct all of his or her symptoms, at all times.

For those who want to perform acupuncture in conjunction with a Bell’s palsy treatment, it generally is a good idea to consult with a doctor beforehand. That way, a Bell’s palsy patient can ensure that acupuncture won’t interfere with his or her treatment results.

Are there ways to speed up Bell’s palsy treatment recovery?

Physical therapy sometimes helps Bell’s palsy patients treat their facial paralysis symptoms. A physical therapist may provide facial exercises that a Bell’s palsy patient can use to strengthen the facial muscles and improve facial muscle coordination.

Additionally, foods rich in B vitamins may help speed up Bell’s palsy treatment recovery. These foods include whole grains, eggs and fruits and may help repair facial nerve damage caused by Bell’s palsy.

Is a Bell’s palsy treatment consultation necessary?

Dr. Azizzadeh requires a consultation to determine the best course of action to treat a Bell’s palsy patient’s symptoms. The consultation is a learning experience for both Dr. Azizzadeh and his patient. For Dr. Azizzadeh, he uses the consultation to analyze a patient, learn about his or her medical history and craft a custom treatment plan. Meanwhile, for a Bell’s palsy patient, the consultation allows him or her to explore different treatment options.

Why do Bell’s palsy patients choose Dr. Azizzadeh for treatment?

The ideal Bell’s palsy treatment often varies from patient to patient. As such, it is essential to partner with a facial plastic and reconstructive surgeon who understands all aspects of Bell’s palsy. This surgeon can work with a patient to determine a safe, effective way to treat his or her Bell’s palsy symptoms. The surgeon can also ensure that a Bell’s palsy patient receives extensive support throughout all stages of treatment.

When it comes to Bell’s palsy treatment, Dr. Azizzadeh is in a class all his own. For years, Dr. Azizzadeh has helped Bell’s palsy patients overcome their symptoms. Dr. Azizzadeh empowers patients to mitigate their Bell’s palsy symptoms, as well as prevent these symptoms from recurring. Furthermore, if a patient ever has concerns or questions about Bell’s palsy treatment, Dr. Azizzadeh is happy to respond to them.

Schedule a Bell’s Palsy Treatment Consultation with Dr. Azizzadeh

Dr. Azizzadeh is an expert facial plastic and reconstructive surgeon who understands Bell’s palsy diagnosis and treatment. He recognizes that there are many causes of Bell’s palsy, and each treatment must be tailored to a Bell’s palsy patient. Thus, Dr. Azizzadeh works diligently to help a Bell’s palsy patient address facial droop, a paralyzed facial and other partial face paralysis symptoms.

For individuals who have been dealing with Bell’s palsy symptoms for a minimum of eight months, Dr. Azizzadeh is available for a consultation. To schedule a Bell’s palsy treatment consultation with Dr. Azizzadeh, please contact us online or call us at (310) 657-2203.