Medically Speaking: Article 12

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Articles and Publications: Medically Speaking

Medically Speaking: Archives

Facial Droop
By Beverly K. Dolberg, M.D.

Facial droop is a very frightening occurrence for patients and their loved ones. The first concern is always “Is this a stroke?” Bell’s Palsy is a facial nerve paralysis – which occurs suddenly and can look very much like a stroke.

Characteristics of Bell’s Palsy are facial paralysis – usually one sided. This usually involves a droop to the cheek muscles, and one side of the mouth. It results in unequal facial movements when the patient bites down, raises the eyebrows or closes their eyes tightly. There can be loss of taste and increased or decreased tearing of the eye. There can be some discomfort around the ear. There is no weakness of the arms or legs from Bell’s Palsy. There is no loss of consciousness or confusion.

Bell’s Palsy is the most common cause of facial paralysis. About 40-60,000 Americans are affected each year – and approximately 8,000 of these individuals are left with a persistent, easily observed facial droop. It appears equally in men and women and in all races and age groups (although rare in children under 15 years). It is more common in winter. Up to 75% of patients with Bell’s Palsy report a recent upper respiratory infection. Pregnant women, diabetic patients and those with a family history of Bell’s Palsy are at increased risk.

The cause of Bell’s Palsy is often unknown. It is currently believed to be a facial nerve inflammation which results in swelling and then nerve compression with dysfunction. Some think the Herpes virus (which causes cold sores) may be the culprit. In other cases, Bell’s Palsy may be associated with Lyme Disease.

There is no lab test available to make the specific diagnosis of Bell’s Palsy – but lab tests and CT Scan or MRI may be done to rule out other causes for the paralysis, such as stroke and/or infection.

Unfortunately, there is no definite treatment recommended for Bell’s Palsy. Since it may be viral, an anti-viral medication may be given. Some medical studies show that steroids may be helpful for some patients early in the disease. Surgery for nerve decompression in very severe cases is still controversial. Acupuncture, relaxation techniques, facial massage, moist heat packs, and B vitamins have not been rigorously studied and therefore have no proven benefit.

Due to the risk of damage to the cornea of the eye from incomplete closure and decreased blinking, eye protection is recommended. The eye may need to be taped to close it at night. Evaluation by an ophthalmologist (eye doctor) is often recommended.

Recovery is good to excellent in about 90% of patients. 5-10% of patients are left with ongoing symptoms. The majority of patients notice gradual improvement within 2-3 weeks of the start of symptoms. The recovery progresses over 2-3 months and full nerve function may not return for 6 months. Some patients recover – a few are left with permanent facial paralysis. Coping with the uncertainty of the recovery process and cosmetic issues can be very distressing. The deformity, drooling, eye-tearing and slow recovery can significantly alter a patient’s self-image and sense of well-being. Fortunately, most patients will and in time, have significant improvement.

If you, or someone you know is experiencing a facial droop, it’s very important to seek medical attention so an appropriate diagnosis can be made and treatment can begin.

Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only; the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.

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