Carolina Facial Plastic Surgery

Bell’s Palsy and George Clooney

Why is half of my face paralyzed this morning?

Almost everyone has had a friend or a family member who woke up in the morning and suddenly could not move half of their face.  People typically notice facial paralysis while brushing their teeth.  This can be a frightening experience, but rest assured that most people will fully recover.

A young George Clooney with Bell's Palsy

Can you tell who this is?   A young George Clooney, recovering from Bell’s palsy on his left side!

What are the typical symptoms of Bell’s palsy?

Unilateral facial paralysis

What is the cause of sudden facial paralysis?  

The most common cause of sudden paralysis in the face is Bell’s palsy.  Bell’s palsy is a condition where the nerve that moves the muscles of the face becomes inflamed and swollen.  The swelling causes pressure on the nerve and prevents it from working.  There are many hypotheses for the causes of Bell’s palsy, but the most accepted cause is that it is a secondary result of a herpes simplex virus.

There are at least 20 other causes of facial paralysis that will be discussed in future blogs.  Bell’s palsy is only diagnosed if the doctor cannot identify another cause of sudden facial paralysis.  Some of the causes of facial paralysis may be serious, including cancer, so it is important that all patients with new facial paralysis be examined by a qualified physician, ENT, neurologist, or facial plastic surgeon that specializes in facial paralysis.

How common is Bell’s palsy?

Bell’s palsy is relatively uncommon, as it affects approximately 40,000 people in the United States per year.  Both men and women have an equal chance of having Bell’s palsy.  It is more rare in patients under 15 and more common in people older than 60.

If I am diagnosed with Bell’s palsy in Charlotte, how should I treat it?

Early treatment is imperative.  The doctor will likely prescribe two medications. Typically, patients are given steroids and an anti-viral medication.  The steroid is a strong anti-inflammatory that will help with the swelling around the nerve to speed up the recovery.  It is not the same type of steroid that athletes take to build muscle.  The anti-viral medication will help fight the possible virus that is causing the paralysis.  Pain medication can be taken if necessary.

The most important part of treatment is educating the patient about the possible risk to the eye.   When the face is paralyzed the eye may not be able to close.  This can cause the eye to dry out and this may cause a corneal ulceration, which may lead to vision loss and ultimately blindness.  All patients are required to keep the eye lubricated by placing eye drops and a thicker moisturizing gel on the eye at night.  Some doctors will recommend taping the eye closed at night to protect it.

What is the prognosis of Bell’s palsy?

The overall prognosis for Bell’s palsy is very good.  To discuss the prognosis, I place the patient into one of two categories:

1)      Patients that retain some movement in the face

2)      Patients that have total loss of movement in the face

 

Patients that still have some movement in the face have a chance of full recovery that is greater than 95%.  Patients that have lost all movement of the face have a 60%-70% chance of a full recovery.  An incomplete recovery means that the person has residual weakness of the facial muscles or the development of synkinesis.

When will a patient begin to see recovery from Bell’s palsy?

Patients will begin to see a recovery in 2-3 weeks and generally experience full recovery in 3-6 months.  The nerve will continue to improve over the next full year.

What is synkinesis?

Synkinesis is loss of coordinated movement of the face.  When the nerve recovers, it has lost the ability to precisely move muscles.  When patients try to smile, it may cause their eye to narrow or the muscles in the neck to contract.  There are many different presentations of synkinesis.

Is synkinesis treatable?

Yes!  It is treated with Botox or Botox-like medications.  This will be fully discussed in future blogs.

Why is a facial plastic surgeon in Charlotte talking about Bell’s palsy?

I have special interest and training in facial nerve disorders including facial paralysis, facial weakness, and facial synkinesis.  There are many treatment options, both non-surgical and surgical, to improve the function and appearances of patients with these issues.

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