Bell's Palsy (Facial Hemiplegia)
Introduction:
Facial Hemiplegia (the seventh nerve inflammation) is a sudden weakness in the facial muscles that makes one side of the face to droop. This weakness is caused by a malfunction of the facial nerve (the seventh cranial nerve responsible for the control of facial muscles) affecting facial motor expressions.
Facial hemiplegia develop often as a reaction to a viral infection. Usually it is temporary and symptoms begin to improve within a few weeks, while full recovery often takes less than a year. Thankfully, 80% of those who develop this disease recover.
Causes:
Although the cause of the main disease is not yet clear, it is associated with exposure to viral infections (such as: oral or genital herpes, chicken pox, rubella virus, mumps virus, etc.)
Symptoms:
Mild symptoms begin to appear quickly until one side of the face is totally paralyzed. This occurs within hours to days or may take 6 to 8 months. Symptoms vary in severity from one person to another, including:
- Relaxed facial muscles and difficulty making expressions, such as smiling or closing one's eyes.
- Inability to control saliva.
- Pain around the jaw or behind the ear on the affected side.
- Increased sensitivity to sound on the affected side.
- Headache.
- Impaired taste.
- Change in the amount of tears.
Complications:
Approximately one in ten patients will develop complications, including:
- Permanently weakened facial muscles.
- Contraction of facial muscles.
- Problems with language and communication.
- Dry eye and corneal ulcers.
- Involuntary eye movements, such as winking when eating. This sometimes develop to a stage in which the eye closes completely when eating.
- Impaired taste.
- Shedding tears when eating.
Tests and Diagnosis:
There is no specific test, but the doctor will conduct a physical examination. If the symptoms are not of clear origin, the doctor may recommend other tests, including:
- Electromyography (EMG): This test can confirm whether or not the nerve is damaged and assess the severity of damage.
- Scans: Sometimes it may be necessary to exclude other potential causes of pressure on the facial nerve, such as tumors or skull fractures.
Treatment:
Most patients recover fully with or without treatment and the nerve function gradually returns to normal. Symptoms usually begin to improve after two to three weeks and may disappear within two months. However, some people may take up to twelve months to fully recover.
In some cases, symptoms do not completely resolve and some of the effects of facial muscle relaxation may remain permanently.
There is no one-size-fits-all treatment, but your doctor may suggest taking some drugs in addition to physiotherapy to help speed healing. Surgery is rarely an option.
- Corticosteroids: are powerful anti-inflammatory drugs. They may work best if the patient begins treatment within several days of the onset of symptoms.
- Antivirals: are sometimes given in addition to corticosteroids in case of severe facial hemiplegia.
- Eye Protection: if the patients cannot close their eyes completely, the front of the eyeball becomes at risk of damage. Also, the tear glands may not work properly for some time, causing dry eyes and thus damage to the eye. Therefore, eye care is needed to keep eyes moisturized. Your doctor may recommend one or more of the following:
- Dressing the eye or wearing protective glasses.
- Using eye drops to moisturize the eye during the day.
- Using eye ointments to moisturize the eye during the night.
A physiotherapist trains the patient on how to properly massage facial muscles to help prevent contraction.
In the past, decompression surgery was used to relieve pressure on the facial nerve. Today, it is not recommended. But in rare cases, cosmetic surgery may be needed to correct permanent facial nerve problems.
- Lifestyle and home-care therapy:
In cases of permanent facial hemiplegia, some techniques can be considered, such as:
- Physiotherapy: Some physiotherapy may help with recovery in addition to “facial reshaping" exercises.
- Botox Injection: This may help if facial muscles contract.
- Various surgical techniques: it can help improving the cosmetic appearance.
Frequently Asked Questions:
- What are the common names for facial hemiplegia?
People use other names such as: Abu Al-Wajih, Abu Wajeh, Bell's Palsy, the Seventh Nerve.
- Is the use of alternative medicine useful in the treatment of facial hemiplegia?
Although there is little scientific evidence to support the use of alternative medicine in the case of facial hemiplegia, it is best to consult your physician before anything.
- Does it happen only once, or might it recur?
In most cases it occurs only once. However, it may recur after several years in rare cases.
- Do alternating cold and hot air flows cause facial hemiplegia?
Studies have not proved or demonstrated that exposure to cold is a risk factor for facial hemiplegia, since it is primarily an idiopathic neurological disorder. However, there is a link to viral infections, but the role of viruses in the disease remains unclear.
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