Bells Palsy (Facial Palsy)

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

• Stroke
• Bulbar Palsy
• Trigeminal neuralgia

This condition can lead to:

• Eye drying and corneal ulceration  which can lead to eye infections.
• Speech problems
• Contracture:
  • While the face is paralysed, over time the affected muscles will contract, which can cause a feeling of tightness.
  • Shortening of the facial muscles can make the affected side of the face appear to be slightly lifted compared with the other side and the affected eye can appear smaller than the unaffected eye.
• Eye-mouth synkinesias:
  • The nerve in your face growing back in a different way.
  • It can cause your eye to wink when eating, laughing or smiling.
  • Sometimes it can become so severe that the eye can close completely during meals.
• Facial weakness
• Facial tightness (contracture) – facial muscles are permanently tense. It can lead to facial disfigurement such as the eye becoming smaller, the cheek becoming more bulky, or the line between the nose and the mouth becoming deeper.
• Loss or reduced sense of taste
• Tears when eating, known as ‘crocodile tears’.
• Hunt syndrome
• This condition can cause anxiety, depression and low self esteem.

NHS Choices

Eye protection

• If the eye on the affected side cannot close naturally, the front of the eye is at risk of damage because the tear glands may not be working properly.
• This patient should be given artificial tear drops to be used during the day and a lubricant ointment for use at night.
• Patients can also be advised to wear glasses to protect the eye from dirt and dust during the day and to use an eye patch or surgical tape to keep the eye closed at night.

Additional management

• To prevent contracture, it is important that the patient performs regular facial stretching and massaging, as instructed by a facial palsy specialist.
• However, facial exercise routines should not be started too early because evidence suggests that early exercising of this nature can encourage synkinesis.
• If full recovery does not occur within nine months, it may be that the nerve damage was extensive and additional treatment is required. This includes:

• • Physio- or speech and language therapy (ie, facial retraining, including exercises and relaxation techniques)
  • Botulinum toxin injections may improve the overall appearance of the face and reduce synkinesis
  • Plastic surgery (This will not improve movement or address the extent of the nerve damage but may improve facial symmetry. It is usually only reserved for individuals with severe and permanent problems.)
  • Ensuring, apart from rest, that the body receives adequate nutrition (There has been some suggestion that B group vitamins and fish oils may support nerve regeneration.)
• Another therapy to be considered is acupuncture, the aim of which is to relax contracture and promote movement.
• Psychological therapies, such as counselling and cognitive behavioural therapy, can be helpful if the patient suffers from anxiety or depression as a result of the palsy. Individuals can also seek advice and support patient groups.

The Pharmaceutical Journal, PJ, November 2012;()::DOI:10.1211/PJ.2021.1.72098

Eye test ad Driving authority

Persons over 40 years should have eye test at least every 2 years and you must tell your drivers authority if it affects your driving

This condition may show similar symptoms to:

• Congenital facial palsy – children born with facial weakness
• Injury to the facial nerve in an accident – such as a cut to the cheek or skull base fracture
• Injury from surgery – which is most common during surgery of the parotid gland and neck

NHS Choices 

• Apraxia
• Camurati-Engelmann disease (facial paralysis)
• CHARGE syndrome
• Duane syndrome
• Human HOXA1 syndromes
• Hunt’s Syndrome (Ramsay-Hunt syndrome)
• Melkersson-Rosenthal syndrome
• Moebius syndrome (eyes do not move from side-to-side, facial paralysis or weakness affecting at least one but usually both sides of the face)
• Oral-facial-digital syndrome
• Parry-Romberg syndrome – facial muscles are thin not weak ,slow progressive shrinkage (atrophy) of the skin and soft tissues of half of the face (hemifacial atrophy).
• Riboflavin transporter deficiency (Brown-Vialetto-Van Laere syndrome, Fazio-Londe syndrome)

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice