Bell's Palsy

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Treatment

There is no curative treatment for Bell's palsy. Symptoms, especially in the eyes, are treated to prevent permanent damage. Treatment also attempts to reduce inflammation of the facial nerve.

Eye Care

Bell's palsy usually affects the eye on the affected side of the face. Continuous eye care is required until the condition resolves. Patients are often unable to blink or close their eyelid completely, which can lead to eye problems and permanent damage, if the eye is not cared for properly.

Blinking and closing the eyelid helps move tears across the eye and into its drainage channels. Tears are continuously produced to maintain moisture in the eye, remove metabolic waste products and environmental debris (e.g., dust, ash), keep the eye's outer surface smooth, and deliver nutrients to underlying tissues.

When the eyelid is unable to blink or close, tears are not moved across the eye surface and the eye dries out. The closed eyelid holds moisture in and on the surface of the eye during sleep. If the lid does not close during sleep, the uncovered cornea is exposed to the environment. This causes dryness and possibly injury because of exposure to foreign bodies. Patients experience a gritty feeling in their eye, dryness, and burning.

Daytime treatment of the eye is relatively simple. Artificial tears are instilled about every 2 hours to keep the eye moist and patients can manually close the affected eye to keep moisture in and debris out. Sunglasses can help protect the eye from injury and reduce dryness by decreasing exposure to wind.

At night or during sleeping, a heavy lubricant is usually placed in the eye and the eyelid is taped shut to reduce dryness and the risk for injury.

Medication

Corticosteroids, such as prednisone, are used to reduce swelling and inflammation of the facial nerve. Whether or not this treatment speeds up healing and improves the chances for complete recovery has not been determined. Once the decision has been made to use corticosteroids, they should be started within 2 days after symptoms develop. Treatment is continued for 1 to 2 weeks.

Treatment with antiviral agents such as acyclovir may be beneficial. Acyclovir and prednisone used together are more effective than prednisone alone. The acyclovir-prednisone combination is most effective when begun as soon as possible after the onset of symptoms. One recent study found that patients had a 100% recovery rate when treated within 3 days of symptom onset, compared to an 84% recovery rate when treatment was delayed 4 days or longer.

Surgery

The role of surgery as a therapy for Bell's palsy is controversial. If patients do not completely recover, surgical treatment may be indicated. These complex procedures are performed on the facial nerves and muscles in order to reduce distortion of facial features and help restore function (e.g., eye closure).

The three main procedures are facial nerve repair and nerve graft, nerve substitution, and muscle transposition. These procedures are not able to completely restore normal function, but they can significantly improve facial function and appearance.

Facial nerve repair is the most effective procedure to restore facial function in patients who have suffered nerve damage from an accident or during surgery. It involves microscopic repair of a nerve that has been cut. A nerve graft replaces one that has been removed.

Nerve substitution is indicated when the nerve cannot be repaired in the conventional manner. In this procedure, another cranial nerve involved in facial movement is connected to the damaged nerve and takes over its function.

Muscle transposition is used in patients who have had facial paralysis for at least 2 years and are unlikely candidates for nerve repair or substitution. This procedure involves the transfer of a muscle with its original nerve supply (a neuromuscular unit) to the affected area. The temporalis muscle or masseter muscle (two muscles in the face that are not controlled by the facial nerve) are moved and connected to the corner of the mouth to provide movement in the lower part of the face. In free muscle transfer, muscles from the leg are moved to the face to provide bulk and function.

In addition to these procedures, a brow or facelift may be necessary to reduce facial drooping. The lower eyelid, which may begin to droop and turn outward (called ectropion) because of the lack of muscle tone, can be tightened with corrective surgery. Weights can be implanted into the eyelid to help the eye blink and close.

Surgical removal of the bone near the nerve, known as decompression surgery, is performed in severe cases when the facial nerve is seriously deteriorating. These patients are at risk for permanent paralysis and have a poor prognosis without aggressive intervention. Research has shown that this procedure is effective in improving outcomes in a select group of patients. To be effective, the surgery must be performed within 2 weeks of the onset of symptoms.

Physical Therapy

A special form of physical therapy called facial retraining can help minimize the asymmetrical appearance of the face that occurs when one side is weakened. It improves muscle mobility, even when therapy is initiated years after the onset of Bell's palsy. Hemifacial spasm may be relieved with botulinum toxin injections (BOTOX® Cosmetic).

Other Therapies

Many patients incorporate alternative health care remedies such as acupuncture, traditional Chinese medicine (TCM), and homeopathy regimens into their treatment. Facial exercises may improve muscle tone and help the facial nerve recover. Exercises for Bell's palsy patients have been developed by physical therapists and other specialists.

Prevention

Currently, there is no way to prevent Bell's palsy.

Bell's Palsy, Treatment, Prevention reprinted with permission from neurologychannel.com
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