‘’Please doctor, I want my face back”. These were the exact words of Aderonke (not her real name), during a consultation at our oral medicine clinic a few weeks ago. She was startled by the sudden facial disfigurement which came on 2 days earlier, and feared she might have developed a serious ailment that had no cure. Her concerns were valid as a young and vibrant undergraduate with dreams and aspirations.
Following history and examination, a diagnosis of Bell’s palsy was made and we proceeded to discuss her management in detail.
WHAT IS BELL’S PALSY?
Bell’s Palsy is an acute, idiopathic, and often unilateral peripheral nerve palsy involving the facial nerve. The facial nerve is the seventh cranial nerve that supplies all muscles of facial expression. The facial nerve also contains parasympathetic fibres to the lacrimal and salivary glands and sensory fibres to the anterior two-thirds of the tongue. The disorder is named after Scottish anatomist, Sir Charles Bell.
It can affect persons of all ages with peak incidence noted at 40 years of age. There is no predilection for either side of the face.
The aetiology is not completely understood but is believed to be caused by inflammation of the nerve at the geniculate ganglion, resulting in compression, possible ischemia, and demyelination. The herpes simplex virus type 1 (HSV-1) has been implicated in this process.
THE ANATOMY OF THE FACIAL NERVE
WHAT TO LOOK OUT FOR
The onset of Bell's palsy is typically sudden, with patients complaining of unilateral facial weakness or complete inability to voluntarily move facial muscles on the affected side. Prominent facial changes include an inability to close the eyelid, drooping of the corner of the mouth (which may be accompanied by salivary or food incontinence), inability to blow out the cheek, absence of facial creases and nasolabial fold, eye irritation, increased tear production. Other symptoms include pain around the ear, tinnitus, and loss of taste sensation. Bilateral Bell’s palsy is rare with few cases reported in the literature. The sudden onset of facial disfigurement and inability to perform facial movements is often of grave concern to patients, sometimes limiting social interaction and depleting self-esteem and confidence.
TREATMENT
Although spontaneous recovery is possible, early presentation of cases is key to achieving satisfactory outcomes. Corticosteroids (typically prednisolone) are usually prescribed to reduce nerve inflammation. Antivirals such as acyclovir or valacyclovir may also be given because of the possible role of HSV-1 in the aetiology of Bell’s palsy. Other useful interventions include facial exercises, and transcutaneous electric nerve stimulation (TENS). Surgical techniques such as facial nerve decompression, nerve grafts, and gold-weight eye procedures have also been advocated.
FAMOUS CASES
Famous people who have had Bell’s palsy include Angelina Jolie, Sylvester Stallone, George Clooney, Roseanne Barr, and Katie Holmes.
References
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