A few weeks ago a family brought their son in to the clinic because one side of his face including his eye and lips were not moving symmetrically with the other side.  Of course they were worried about the possibility of him having a stroke.  He’d had an upper respiratory infection that started about one week before and had a slight fever with runny nose.  He’d never had any neurological problems before.  He had a condition called Bell’s Palsy. Bell’s Palsy is a problem with the nerves on one side of the face and it causes the muscles of the face to have decreased ability to move.  The muscles of the face can become weak or even paralyzed.  Patients often complain that one of their eyelids starts drooping or they drool out one side of their mouth.  When they smile, one half of the mouth doesn’t seem to move. Most people who get Bell’s palsy recover entirely but a small number of patients have symptoms for the rest of their life. Causes:  Inflammation of the facial nerve on one side of the face is the cause of Bell’s palsy.  A virus is the cause and there is some evidence that it’s the virus that causes cold sores (Herpes Simplex Virus – HSV) that causes the condition.  Other viruses may cause Bell’s palsy however including the viruses that cause Chicken Pox and Mononucleosis. Symptoms:  When the facial nerve because inflamed from the virus, and the nerve may swell and get pinched as it travel’s through some tight spaces in the face.  If this happens it can cause weakness and even paralysis of the muscles of the face so you may see: 1)   Drooping of one eyelid 2)   Eyebrow that sags 3)   Corner of the mouth that does not move or sags 4)   One eye might not close completely 5)   Loss of taste in the front of the tongue 6)   Loud noises may cause pain on the side of the dysfunction If your eye is not able to fully close, this can lead to dryness of the eye, so it’s important to seek treatment to prevent eye damage. Treatment:  We don’t have any specific treatments for Bell’s palsy, but seeing a medical provider may be helpful to: 1)   Ensure the proper diagnosis, because the symptoms may be confused with a stroke or other neurological problems which can be dangerous if not treated appropriately 2)   Prevent damage to the cornea of your eye from dryness 3)   Steroids such as prednisone may be given to reduce the swelling of the affected facial nerve – this works better when started within the first 2-3 days of symptoms 4)   Antiviral medications such as acyclovir are sometimes given in hopes that they will help the body overcome the virus more quickly, however studies have not found any added benefits from using antiviral medications for Bell’s palsy Recovery/Prognosis:  People who have less severe symptoms seem to recover more rapidly and have a better chance of full recovery.  If you are getting better within the first three weeks, the chances are better that you will totally recover.  A small group of people however have permanent moderate to severe muscle weakness in their face from Bell’s palsy. Rare effects:  If there is severe damage to the facial nerve, it may heal in a disorganized fashion.  I have one patient who was bothered by tears coming from their eye when they salivate (before eating).   I’ve also had a patient whose eye would close whenever he smiled.  Fortunately this is not common with Bell’s palsy.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.