Bells’ Palsy is the most common cause of facial nerve paralysis. Affecting about 1 in 10 000 people is is rare yet common!
But what the heck is it?
Bell’s Palsy is essentially a transient idiopathic unilateral mononeuropathy of the facial nerve.
One more time in English !?
It is a transient (usually resolvable) idiopathic (sneaky) unilateral (one sided) mononeuropathy (injury affecting 1 nerve).
How do I know if I have a Bell’s Palsy?
Usually people have a change in taste and or pain behind their ear in the days leading up to the Bell’s palsy coming on… but without the paralysis this could be literally anything! A Bell’s can’t be diagnosed until the paralysis starts and it MUST be diagnosed by a Doctor - please present immediately to your GP or local emergency department. It is a diagnosis of exclusion, which means that they need to rule out everything else before arriving at the conclusion that it is a Bell’s Palsy.
What causes it?
TBC. Best rationale is that for some reason your immune system was a bit low, maybe you were run down. Your body then decided it was time to get sick, you just got super unlucky that instead of a cold you most likely had a reactivation of a virus related to the shingles/chicken pox/ or cold sore family. It chose your facial nerve. When a virus attacks a nerve it has to swell. The facial nerve after it exits the brain travels through the longest bony canal in the body this is where it gets squished. Its in a bony tunnel so the inflammation has no where to go, it squishes the nerve, the nerve cant get messages past... nothing works. This is why medication is incredibly important very early and why you must see a doctor.
What else could it be?
Not to scare anyone but the reason you need to see a doctor is that they need to assess and rule out shingles, tumours, strokes and a host of other nasties to make sure you are all ok!
Ok I have just been diagnosed with a Bell’s Palsy. What next?
You will be prescribed Prednisone and maybe antivirals. The prednisone or prednisolone is the most important thing to do in the first 2 days of onset. If you get it in time there is a tonne of research to say it increases your chance of a full recovery. It is a hard core steroid that will help remove the swelling quickly and take away the squish, so hopefully the nerve will be ok! Don’t skimp out on your prednisone if it has been prescribed to you!!!
What to expect:
Your face will worsen to a complete paralysis for the first 3 days even with the meds- don’t panic this is normal and expected.
We expect the first flicker of movement at around 3 weeks after onset.
On average we expect 80% of people who got prednisone to be about 90% better at 3 months after the paralysis. The stats are slightly lower if you didn’t get the right meds at the right time.
My face was TOTALLY paralysed… I must have had a really horrible case.
Incorrect! Most Bell’s palsy SHOULD be completely flaccid within a couple of days of it starting. This is normal!
Will I be totally normal again?
80% of people have a complete recovery. The 20% who don’t have very variable degrees of residual injury and we will go through these in other posts. These people receive the most benefit from face physiotherapy.
Ok when do I stress about not having a perfect recovery?
Your health care provider or face physio will help keep track of where you are up to and make sure you are within normal recovery times. Any variation from the theme we should have you present early to a facial nerve specialist or to one of the two wonderful facial nerve clinics in Sydney for early assistance.
Is there a way of predicting if I will have a good recovery?
The Prince of Wales public hospital has the only ENOG machine in NSW - it is a super cool nerve testing machine that give us a comparison of the ok and cranky nerve. If this is done within the first week and reassessed at around 3 weeks post they can check how your nerve is recovering and predict how smooth your recovery will be.
How do I get one of these? Present to ED at POWH :)
When should I see a physio?
Whenever you like!
I find that I generally see patients very early (in the first week or 2) mostly for education, checking eye care routines, answering questions and coming up with a clear treatment plan. We can start exercise therapy ect when you start getting movement. There is no evidence to suggest massage, acupuncture or electrical stimulation will help at this stage. Electrical stimulation can do damage DON’T go there please. Massage and acupuncture won’t do damage and if it helps you to feel better and have a nice stage of mental and physical being for recovery feel free to go for it - that’s an optional extra. They are yet to be proven to directly physically heal the nerve.
I was told I’ll be right in 6 weeks.
The research says 3 months on average . If you are a lucky unicorn who is better is a couple of weeks… Fantastic! we will high five you are the exception to the rule! Go you :)