Imagine waking up one morning and looking in the mirror, only to realise that the face that once stared back at you is now drooping on the left. You look closely and find that your left eye cannot close and your lips would not finish your smile to the left. Your heart starts to race, you begin to panic. Your eye is tearing up. What is this? You remembered your ears paining last night. Could this be an infection? Your face feels like you have just been shot with a numbing agent at the dentist's office. Now terrified, you pick up a phone and call your doctor's office, "Help, I cannot feel my face". It is literally one of the scariest symptoms for patients.
Today, I will briefly explore what is this phenomenon of sudden paralysis of the face in an otherwise healthy person.
To begin this discussion, let us explore what is normal. In our everyday activities we don't usually stop to think about what is happening when we smile or frown. But let us examine it a little. Smiling and facial expressions are initiated in our brains and this action is transmitted to our face muscles via chemicals along the Facial nerve. If this Facial nerve is blocked, compressed or injured in some way then we will lose the ability to move our face. Apart from the rare condition of congenital absence of the facial nerve, we are all born with two Facial nerves- a left and right. Both of these supplies the left half and the right half of our face respectively. Therefore, if one nerve is affected then the entire side of our face would be weakened or paralysed. This is medically called Facial nerve palsy.
Facial nerve palsy can have many causes and if you experience this, I recommend you see a doctor immediately. Now there are certain things your doctor would do to identify what is the root cause of the Facial Nerve Palsy.
Just as a note- the following information could sound a bit technical.
Facial nerve palsy are divided into 2 types- upper motor lesions and lower motor lesions. This is usually distinguished by your physician examining your face. If on asking to raise the eyebrows the forehead does not wrinkle on the paralysed side, then that is a complete lower cranial nerve 7 palsy on that side. If however, the forehead frowns and only below the eyelid is paralysed, then it is considered an upper motor lesion. Don't worry if you get too confused. This is often brought for candidates for examinations for that very said purpose. But this differentiation is important for physicians to identify the cause of the problem.
Some of the causes of upper motor neuron lesions include:
Intracranial tumors
Cerebral Palsy
Mobius Syndrome (born without part of facial nerve)
Some causes of lower lesions include:
Head trauma/ Fractured skull
Infection/ Meningitis
Ramsay Hunt Syndrome
Lyme disease
Chronic Otitis Media
Mastoiditis
Bell's palsy
Your doctor would go through a list of symptom to exclude as much as possible from the history. Then examine your general and nervous system including cranial nerves, the ear and skin.
Once all the potential causes are eliminated then it is considered Bell's Palsy.
What's Bell's palsy?
The phenomenon of cranial nerve 7 paralysis in an otherwise healthy individual with no known cause. It is named after Sir Charles Bell in 1821, although reports have shown that ideas of facial nerve palsy can be traced back to the works of the Persian physician ibn Razi (865–925 ce).
Bell's Palsy is usually temporary. The majority will resolve by six months, but rarely some can persist. Treatment involves eye care- lubricants and patching, and also oral steroids.
With regards to steroid use, the current evidence states that over the age of sixteen, steroids is highly effective if started within 72 hours of onset of symptoms. In younger children, steroid use is debatable. Once steroids are started it is usually tapered down over a 1 to 2 week period.
Bell's palsy is frightening but not as sinister as you think. It is diagnosed by your physician after a detail history and examination. The symptoms will generally resolve and your facial expressions shall return to normal. It is just a matter of time.
Dr. Zafir W. Latchan
BMedSci., MBBS (UWI),
PGDip. Paediatric Emergency Medicine (Edin),
MRCPCH (Lon)
Disclaimer: This information is for educational purposes only. If you are concerned about your health or the health of your child please see a qualified health care professional for further advice and treatment.
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