Sports injuries like sprains and strains or more chronic issues like osteoarthritis are commonly associated with Physiotherapy treatment. As Physio’s, we see community members with other issues also including torticollis, post-stroke and Parkinsons disease. One less common issues we treat as Physiotherapists is Bell’s Palsy. Jean Chretien is a famous Canadian you may know of who experienced Bell’s Palsy as a youth.
What is Bell’s Palsy?
Bell’s Palsy is the temporary weakness or paralysis of the facial muscles, caused by inflammation of the seventh cranial nerve.
The seventh cranial nerve supplies the muscles of facial expression and taste to the front 2/3 rds of the tongue.
Bell’s Palsy occurs on one side of the face only. It causes eyelid drooping and dryness, increased sensitivity to sound, changes in taste, difficulty blinking and closing the eye, difficulty smiling, raising the eyebrows, flaring the nostrils and other facial movements.
What causes Bell’s Palsy?
It is unknown what causes Bell’s Palsy. There is some evidence linking the varicella-zoster virus and Epstein-Barr virus, both of which are of the herpes family.1 It has been suggested that trauma, stress, metabolic and emotional disorders could trigger reactivation of a previously dormant viral infection. Bell’s Palsy has a higher occurrence in those that are pregnant, with Type II Diabetes or a family history of the condition.
What is the treatment for Bell’s Palsy? Can Physiotherapy help?
Initially, you should see your family physician. They may be able to prescribe medications to help progress the recovery. Corticosteroids such as Prednisone have been shown to be helpful, as well as Antiviral medication. Eye drops and an eye patch can be used initially to help with the dryness caused by Bell’s Palsy, and to help protect the cornea.
Physiotherapy should be started within a few days of onset to begin facial exercises, facial massage, acupuncture and relaxation techniques. Treatments are generally designed to improve facial function and ease recovery. There are several treatment options, and some controversy exists regarding the effectiveness of several of these options since the research is often poor.
Most people will recover from Bell’s Palsy spontaneously without any intervention. This makes research studies difficult to get high quality evidence. In a systematic review, there was evidence to suggest that tailored facial exercises can help to improve facial function, reduce synkinesis (involuntary muscular movements associated with voluntary movements, for example, smiling causes the eye to squint) and improve recovery time, mainly for people with moderate to severe paralysis and chronic cases.2 This usually includes goofy facial exercises such as wrinkling the forehead, winking, flaring the nostrils and any other impairments that are unique to the individual.
There is not enough evidence to decide whether electrical stimulation works or whether the addition of acupuncture to facial exercises could produce improvement. In a Cochrane review that analyzed 6 randomized control trials, poor quality research caused by flaws in study design and clinical differences between trials produced unreliable conclusions about the efficacy of acupuncture.3
However, clinical practice and first-hand experience has shown that acupuncture can have benefits in improving facial muscle function, speeding recovery and reducing stress and anxiety. More research with higher quality evidence is needed.
How long does it last?
Bell’s Palsy is a temporary condition, most people experience an improvement in facial expression within 14 days, with complete recovery occurring by 3-6 months. A small percentage of people experience partial recovery, with some residual symptoms remaining (think Jean Chretien!). Residual symptoms may include facial drooping and synkinesis.
In conclusion, tailored facial exercises, acupuncture and facial massage can help to improve facial function, mainly for people with moderate paralysis and chronic cases. Early facial exercise may reduce recovery time and long term paralysis in acute cases.
- Furuta Y, Ohtani F, Chida E, Mesuda Y, Fukuda S, Inuyama Y (2001). “Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy”.Auris Nasus Larynx. 28 (Suppl): S13–7
- Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews2011, Issue 12.
- Chen N,Zhou M, He L, Zhou D, Li N. Acupuncture for Bell’s palsy. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: