Rehab Cell

Physical Medicine and Rehabilitation

Bell’s Palsy – causes, symptoms, diagnosis, treatment, pathology

Bell’s Palsy – causes, symptoms, diagnosis, treatment, pathology


Bell’s palsy, named after the surgeon Charles
Bell who first described it, is when there’s weakness or paralysis of the muscles on one
side of the face, caused by damage to the seventh cranial nerve, which is the facial
nerve. The underlying cause of cranial nerve damage is idiopathic which means it’s unknown,
so when there’s facial nerve a paralysis from a known cause like a stroke, a tumor,
or trauma, it’s not considered a Bell’s palsy. George Clooney had this disorder for
nine months when he was a teenager. Broadly speaking, the nervous system has two
parts: the central nervous system, which consists of the brain, brainstem, and spinal cord,
and the peripheral nervous system, which consists of all of the nerves that fan out from the
central nervous system. Peripheral nerves that emerge from the brain and brainstem are
called cranial nerves, and there are a total of 12 pairs of cranial nerves. The seventh cranial nerve, the facial nerve,
emerges from the brainstem, and then enters the temporal bone where it travels through
a narrow, Z-shaped canal, called the facial canal. The facial nerve exits the skull through
a tiny hole called the stylomastoid foramen. From there, the facial nerve branches off
to different facial muscles that help with facial expression, like the ones you use while
whistling to your favorite song. Ultimately, control of each side of the face
comes from a region of the brain called the motor cortex. For example, let’s start with
the lower half of the right side of the face. An upper motor neuron extends down from the
left motor cortex, goes across the midline in the brainstem to the right side, and then
meets with a right lower motor neuron which hitches a ride on the right facial nerve.
For the upper half of the right side of the face, things begin similarly. There’s another
upper motor neuron that extends down from another region of the left motor cortex, also
goes across the midline in the brainstem to the right side, and meets with another right
lower motor neuron which also hitches a ride on the left facial nerve. The one huge difference
is that there’s another upper motor neuron that extends down from a region in the right
motor cortex, and stays on the ipsilateral or same side to meet with same the lower motor
neuron. In other words, there are two upper motor neurons, one from each side of the brain,
giving input to one lower motor neuron. The left half of the face is similarly innervated.
So that means that each facial nerve contains motor information for the lower face coming
from the contralateral motor cortex, and motor information for the upper face coming from
both motor cortices. The facial nerve also innervates the sublingual
and submandibular glands, which secrete saliva, the lacrimal gland which produces tears, and
mucous membranes of the nose, mouth, and nasopharynx. In the ear, it innervates the stapedius muscle
which dampens the vibration of the stapes, a small bone that help transmit vibrations
from the eardrum; this protects you from loud noises. The facial nerve also carries sensory
information about taste from the anterior ⅔ of the tongue. So if you lick an ice cream
cone – that’s the facial nerve registering the flavor! Bell’s palsy occurs when the facial nerve
gets damaged, and although the precise cause is unknown, it’s often associated with viral
infections like herpes simplex virus, Epstein-Barr virus, and varicella-zoster virus, as well
as the bacteria Borrelia burgdorferi which causes lyme disease. Regardless of the cause,
when the facial nerve isn’t able to conduct the brain’s signals, the result is that
there’s weakness or paralysis of the facial muscles. Now, it’s important to distinguish Bell’s
palsy from other causes of facial palsy like a stroke. If the underlying problem is in
the brain or brainstem before the upper motor neurons cross the midline, it’s called an
upper motor neuron lesion. This causes paralysis of only the lower half of the face on the
contralateral side as the lesion, since the upper half of the face is still receiving
some information from the ipsilateral motor cortex. However, if there’s a lower motor
neuron lesion like in Bell’s palsy where the facial nerve is damaged, information from
the contralateral and ipsilateral motor cortex is lost for the upper face, as well as information
from the contralateral motor cortex for the lower face. This results in the paralysis
of all the muscles on the side of the affected nerve. The main symptoms of a Bell’s palsy can
be seen by looking at a person’s face. There’s an absence of the nasolabial fold, which is
the skin fold that runs from the side of the nose to the corner of the mouth. There’s
also drooping of the eyelid and drooping of the mouth. In some people, there’s also
dryness of the affected eye or mouth because the facial nerve innervates the lacrimal,
submandibular, and sublingual glands. Sometimes there’s also hypersensitivity to loud noises
and a loss of taste sensation on the anterior ⅔ of the tongue. The diagnosis of a Bell’s palsy is based
on identifying that the problem is with the facial nerve and not finding an alternative
explanation like a stroke or brain tumor. Bell’s palsy affects each person differently.
Most people recover within 6 months after the onset, but some people develop permanent
facial weakness or paralysis. Treatment isn’t needed in all cases of Bell’s palsy, but
in some severe cases, corticosteroids can help reduce the nerve inflammation and speed
up the recovery. All right, as a quick recap. Bell’s palsy
occurs when there’s a disruption of the facial nerve from an unknown cause. The most
common symptoms are weakness or paralysis of both upper and lower facial muscles on
one side of the face due to the loss of all lower motor neurons. Bell’s palsy is treated
with corticosteroids, but in most cases, symptoms usually subside on their own.

99 thoughts on “Bell’s Palsy – causes, symptoms, diagnosis, treatment, pathology

  1. Thanx! Woke up,……thought,….my face feels odd,….brushed my teeth,….face was numb! Like a trip to the dentist. WOW! You think,..is this a stroke? Went to hospital,….was reassured,..can happen any time any age. I’m very healthy and this is quite a surprise! A reminder of good health perhaps. July 31st 2018. It’s now September,……I’m my smiling self again! Thanx!

  2. My cheekbones have become very protruding and a bit wide I look older than my age and I have numbing feeling in my face

  3. You’re amazing bro, You made my review easier more power to you dude keep up the good work. Can you make a videos about immunization, Thanks.

  4. I had this for like two weeks, I'm glad I didn't have it for as long as other people at first I thought I had a mini stroke I was shook

  5. Why did I get this disease. I am suffering this for 2 years. I cannot even study or memories anything. Not even making friends or hanging around with them. I am frustrated

  6. What if the entire side of the face is paralyzed, except the eye does start closing a few hours after onset? A ct scan ruled out stroke.

  7. I got Bell's Palsy 3 weeks ago, I also uploaded a video showing it – but I felt insecure and ashamed 🤔😰🤕

  8. Can someone please tell me what did you do when you get the first time feels like that your having bell's palsy what did you do firstly for it plz

  9. I just had to take my dad to the urgent care tonight because his face looked like it was melting off. Turns out it was just this, thankfully.

  10. someone tell me why the contralateral side affected in Bells palsy?? it should be normal because lower levels not related with contralateral side!

  11. I just recovered from this. Took exactly a month.
    It sucked because i hate multiple pet birds and for a month i couldn't whistle to them.

    Everyone make sure to get eye drops and to massage your face daily.

  12. I have bells palsy…it was shocked me…im going to takes 25 days for therapy treatment n 5 times of injections….

  13. I also have my bell's palsy for one year and I'm not healed anymore what should I do to improve my face and what is the right procedure in my face

  14. I have bell's Palsy
    It's my 5th day and I just went to a doctor today and that's the time I knew that I'm suffering for bell's palsy
    I cried while my doctor explains my condition

  15. I was diagnosed with multiple sclerosis 1 month after I turned 45. My grandma is 96 and had it since she was in her 20s. I have been on Copaxone, the first year was daily and now I am on 40 mg, 3 times a week. It made a tremendous difference for me. Although the fatigue is what really gets to me. When I do too much, I do start to feel weak. My MS got significantly worse and unbearable Last year, a family friend told me about Organic Herbal clinic and their successful MS TREATMENT, I visited their website ww w . organicherbalclinic. co m and ordered their MS Formula, i am happy to report the treatment effectively treated and reversed my Multiple Sclerosis(MS)), most of the symptoms stopped, I'm able to walk and eat well, sleep well and exercise regularly., I'm pretty active now and my attitude is extremely positive.

  16. can someone explain why bells palsy affects contralateral on lower side . i ithink it shall affect ispi.
    also on upperside why shall there be any effect on the contralateral side of the lesion

  17. I am recovering from Bell's Palsy (end of week 2) and I started having acupuncture. There is no way to know if the acupuncture is making the difference or if I'm recovering on my own. However, I feel that I experienced a huge improvement directly after the acupuncture sessions, so I would encourage others to try it. I was a skeptic, but I feel so strongly that it helped that I'm commenting so that other people can consider it as an option. This has been upsetting and scary. If you have Bell's, stay positive, rest a lot, listen to your doctor, and consider acupuncture.

  18. I might not remember anything from this lesson but I will always remember that George Clooney had Bells palsy

  19. Four things you could have mentioned: Current Treat,1) Acyclovir and Predisone, 2) Physical Therapy Exercises, (What???)
    3) Surgery maybe needed, (What???)… Anybody can get this disease at almost any age… Great video, move videos please…

  20. I’m 36
    My Right Side Of My head has been numb for 5wks now (Partial Lobe to my eyebrow) no facial side effects tho, but I nod off A lot, had a nerve test done and couldn’t feel anything, I can’t fee a col
    MRI comes up as a stroke but under no treatment. I can’t handle the light or loud noises n seams to be getting worse.sometimes I think I’m typing something but typing just random letters etc
    Iv officially stumped my GP

    I need help

  21. I was diagnosed with Lyme disease which lead to a mild case of Bell's Palsey. 1 week on Prednisone and 3 weeks on Doxycycline Cyclate.

  22. Hey question. When I had Bell’s palsy it seemed like my tooth was hurting then slowly felt like my jaw hurt then a bunch of pressure on my cheek . Anyone else have that?

  23. people with bells and facial palsy your face looks so nice so beautiful im jealous of you not much having a orinary comman straight lip

  24. Sir my daughter was born on Dt.26/11/2019. She has facial palsy on her left side of face from birth. When I consulted from child neurologist for my daughter, he says that my daughter may be recovered Within 3 month without any treatment.
    So, Sir please tell me will my daughter be recovered Within 3 month or should I take advice from other neurologist. And also tell me reason of facial paralysis from birth

  25. I had Bells palsy after an assault. Some kid suckered me in the jaw.
    After i sent him to sleepy time, the next day I noticed tingling in my jaw. By dinner time my face was paralyzed. I thought i may have had a stroke. A quick trip to the Doc gave me steroids & within 12 hours the feeling started to come back. A bit of a scare tho. It was tuff to drink a beer when it falls out of the paralyzed side of your mouth!

  26. Please, someone, make comment on my question if you have any knowledge
    I’m 17 years old and I got bell’s palsy on November 14, 2019.
    My doctor gave me some steroids and Antiviral and after when finish to eat all of them, I suddenly got facial pain on my left cheek, forehead and around my lips. I was so scared, so I went to urgent care and they gave me another more steroid with a lower dosage. And I finished that yesterday, and I started to feel pain on my cheek, forehead, and nose.

  27. Saya punya pasien menderita penyakit bellspalsy. Saat bangun tidur tiba-tiba mukanya kaku, mata tidak bisa berkedip,bibir tidak bisa bergerak dan menjadi miring ke kanan. Beruntung saya perkenalkan produk TIENS yaitu Grape Extract dan Nutrient High Calcium Powder. Hanya dalam 5 hari penyakitnya bisa disembuhkan. Saya berbagi ke orang-orang sekitarnya, dan sudah 2 orang sembuh juga dari penyakit yang sama. Produknya herbal dan khasiatnya bagus untuk penyembuhan dan juga pencegahan. Sudah punya sertifikat halal MUI grade A juga.
    Bagi bapak/ibu saudara/I yang mau konsultasi dan pesan produknya silahkan chat saya via whatsapp atau telepon di nomor 082292025388.
    Pengiriman produk ke seluruh daerah diindonesia dan juga luar negeri.

  28. I had Bell’s palsy almost 2 years ago, but I’ve lost a lot of mobility and sensibility, it’s really annoying because every single time everyone is like wtf happened to your face?! But I guess is something you learn how to live with

  29. I was diagnosed with this today but I don’t have paralysis. I just have numbness on right cheek, mouth, tongue, loss of taste, my eye is dry and irritated. My teeth also feel numb and hurt. Anyone have Bell’s palsy without droop or paralysis?? I’m hoping it won’t get worse 😢

  30. Rest of the world: "And what about physiotherapy, electrical stimulation or face massage? "
    Most of the doctors: "nah,lets just eat pills. "
    Prescribing antibiotics even for a cold…🤷‍♀️i mean…wtf🤦‍♀️

  31. Is there any other information on connection to ear? I've ruptured my eardrum, lost hearing on one ear and got bells palsy due to trauma. Would be nice to know if hearing might start coming back overtime with nerve recovery

  32. I had it with and ear infection soon as i got my ear clean out i felt a little bit better in the morning. The doc gave me anti viral steriods and i took mega does of vit c and b . Yesterday started eating garlic , my bells pasley has nearly cleared up after 10 days. I think its a virus that gives us bells pasley in the ear or the nose .. so take mega doses vit c and b , zinc maybe? And mega of anti viral foods (google it) , garlics suppose to be the best , and it should kill the virus and keep it at bay , hope this helps

  33. beautifully explained in the about bells palsy, even my sister was suffering from the same disease. someone recommended us to visit planet ayurveda and thankfully bells palsy care pack of planet ayurveda helped her in curing the disease. we are extremely thankful to Dr vikram chuhan for giving her best treatment.

  34. I had this when I was 11. I remember not being able to close my eye and slightly feeling my smile shift to one side of my face. Half of my face was temporarily paralyzed and it went away with medication. It mainly went away within the first month, but took a few months for me to fully recover.

  35. I think Dropping eyebrow not eyelip because of Orbicularis oculi muscle(close the eyelip) palsy which receives its intervention from the 7th nerve

  36. I have it for 4 days now..doctor at first suspected that i was having a stroke..it was fucking scary that my pulse got so high about 155/mins. They did ct scan, ecg to make sure i was not having a stroke..thanks god later it came out that it was bells palsy..doctor said my case is mild..you can not see it in my face..i can blink my eyes..but can not close and also can not move upper lips of left side..but there is one thing i am worried about..taking the steroids.. What might be the side effects? How do you keep your immune system at a good level as steroids suppresses Your Own immune system..I am worried because it is a bad time in Singapore with corona virus..any suggestion? I am 25 years old.

Leave comment

Your email address will not be published. Required fields are marked with *.