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Bell’s Palsy

Bell’s Palsy is a condition that affects up to 1 in 5000 people and causes sudden weakness or paralysis of the muscles on one side of your face. This happens when the facial nerve (cranial nerve 7), which controls those muscles, becomes inflamed or compressed while the nerve is still inside a very long bony tunnel. It may cause your face to droop, and you may have trouble smiling, closing your eye, or eating and drinking. The recurrence rate of Bell’s Palsy is around 7%. Bell’s Palsy usually affects just one side of the face. You will usually be checked for a stroke when you present to your GP or ED, as the 2 conditions can look similar. It is important to know that complete flaccid paralysis (drooping of the face) is normal, not necessarily reflective of degree of damage and is usually at its worst at 3 days in, irrespective of medication.

What Causes Bell’s Palsy?

The exact cause isn’t always clear, but it’s often linked to:

– Viral infections (in the family of chicken pox or herpes simplex)

– Inflammation of the facial nerve

– Some people who have this multiple times have different anatomy or an underlying cause that makes the nerve naturally a bit more susceptible to inflammation

*There was nothing that you did wrong or could have done to prevent it from happening. 

What Is the Prognosis?

The outlook for Bell’s Palsy is generally very good:

– Most people (70–90%) recover fully within 3 to 6 months.

– Some may have lingering symptoms like facial weakness or tightness.

– A small number may have ongoing symptoms or develop synkinesis (tightness of facial muscles and possibly some involuntary movements).

Medical Management

You need to see a doctor! And depending on your recovery, we may send you to a facial nerve specialist for extra help. 

Treatment often includes:

– **Steroids** (such as prednisone): Help reduce nerve inflammation and improve recovery.

– **Antiviral medications** (in some cases): If a virus is suspected.

– **Pain relievers**: To ease discomfort or ear pain.

– **Early treatment (within 72 hours)** gives the best chance for full recovery.

 

Eye Care Is Very Important

When you have Bell’s Palsy, your eye on the affected side may not close completely. This puts it  at risk of dryness, irritation, or injury. To protect it:

– Use **Eye drops** during the day to keep your eye moist. These should be preservative free 

– Apply **lubricating ointment** at night.

– You can use an eye patch, glad press and seal or tape your eyelid shut at night if it doesn’t 

close. Your physio will show you how to do this

– Wear **sunglasses** during the day to protect from wind and the sun. The bigger the better!

Pharmacists can help you with drops, optometrist and ophthalmologists can check on your eye  health 

The Role of Physiotherapy

**Physiotherapy** can be very helpful in your recovery. A specially trained physiotherapist can:

– Teach **gentle facial exercises** to help facilitate quality of movement return 

– Guide you in **massage techniques** to reduce tightness.

– Help reduce or manage synkinesis

– Ensure we have you recovering in the correct time frames and facilitate referrals at appropriate

times.

It’s important to start physiotherapy usually once the facial nerve has started to recover. Doing exercises too early or incorrectly can sometimes cause harm.

Things to Avoid: 

– Overzealous exercise when your face doesn’t move

– Taking pictures daily – try for once every week to 2 weeks if this is something you would like to do 

– Electrical stimulation

Other Resources: 

– http://facialpalsy.org.uk/

– @facialphysio on Instagram

This information sheet was prepared by Dr Ellie Seckold, the principle physiotherapist at The Facial Physio. Reviewed by Associate Professor Catherine Meller (MBBS, FRACS(OHNS), MCL, MBA, BAppSc)