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Bell's palsy, also known as peripheral facial palsy, occurs when the facial nerve becomes inflamed and the person loses control of the muscles on one side of the face, resulting in a crooked mouth, difficulty in making expressions and even a tingling sensation.
Most of the time, this inflammation is temporary and happens after a viral infection, such as herpes, rubella or mumps, improving between a few weeks and up to 6 months. But it can also be a permanent situation, especially if there is any injury to the facial nerve path.
The ideal is that any type of facial paralysis is evaluated by a doctor, especially because, in an initial phase it can be a sign of a more serious situation, such as a stroke, and must be correctly identified and treated.
Main symptoms
Some of the most characteristic symptoms of Bell's palsy include:
- Paralysis on one side of the face;
- Crooked mouth and drooping eye;
- Difficulty making facial expressions, eating or drinking;
- Slight pain or tingling on the affected side;
- Dry eye and mouth;
- Headache;
- Difficulty holding saliva.
These symptoms usually appear quickly and affect one side of the face, although in rare cases there may also be inflammation of the nerve on both sides of the face, causing the symptoms to appear on both sides of the face.
The symptoms of Bell's palsy are similar with some signs of serious problems, such as stroke or brain tumor, so it is important that there is always a doctor's evaluation.
How to confirm the diagnosis
The diagnosis is usually started with an assessment of the facial muscles and reported symptoms, but the doctor may also order some additional tests, such as CT scans, MRIs and some blood tests. These tests, in addition to helping arrive at the diagnosis of Bell's palsy, also allow to detect other problems that may have facial paralysis as a symptom.
What can cause Bell's palsy
The exact cause that causes inflammation of the facial nerve and the appearance of Bell's palsy is not yet known, however, it is common for this type of change to appear as after viral infections such as:
- Herpes, simple or zoster;
- HIV;
- Mononucleosis;
- Lyme disease.
In addition, it is more common in pregnant women, people with diabetes, patients with lung infections or when there is a family history of paralysis.
How the treatment is done
The treatment for Bell's palsy can be done through the use of medications and physiotherapy and speech therapy sessions, with the majority of people recovering completely within 1 month of treatment.
However, there are several treatment options:
1. Remedies
The drug treatment for Bell's palsy must be indicated by a neurologist and consists of the use of corticosteroids, such as prednisone or prednisolone, and antivirals, such as acyclovir or vanciclovir, which can begin to be used up to 3 days after the onset of symptoms.
As Bell's palsy causes muscle contraction in the face, it can lead to pain, and in these situations, the use of analgesics, such as aspirin, dipyrone or paracetamol, may be recommended to relieve this symptom.
In addition, if paralysis prevents the closing of one eye, it is necessary to apply an ointment directly to the eye before sleeping to protect it, avoiding extreme dryness, and during the day it is important to use lubricating eye drops and goggles. sun to protect from the sun and wind.
2. Physiotherapy
In physiotherapy sessions the person performs exercises that help to strengthen the facial muscles and improve blood circulation in the nerve, such as:
- Open and close your eyes tightly;
- Try to raise your eyebrows;
- Bring the eyebrows together, forming vertical wrinkles;
- Frown, making horizontal wrinkles appear on the forehead;
- Smile hard, showing your teeth and without showing your teeth;
- Give a 'yellow smile';
- Clench your teeth tightly;
- Pouting;
- Put a pen in your mouth and try to make a drawing on a sheet of paper;
- Bring the lips together as if to 'kiss';
- Open your mouth as much as you can;
- Wrinkle your nose, as if smelling bad;
- Make soap bubbles;
- Inflating air balloons;
- Make faces;
- Try to open your nostrils.
These exercises can also be done at home to improve symptoms more quickly, but should always be guided by a physical therapist, according to each case.
During these exercises, the physiotherapist may use an ice cube wrapped in a napkin sheet to slide over the paralyzed area as a form of stimulus for muscle contraction. To help the person make the contraction, the therapist can help the direction of movement by placing 2 or 3 fingers on the face, which are then removed so that the person can maintain the contraction properly.
3. Acupuncture
Some studies have been developed to evaluate the benefits of acupuncture in the treatment of Bell's palsy, and some results indicate that this technique of traditional Chinese medicine can improve the function and reduce the stiffness of the facial nerves, through the stimulation of the nerve fibers in skin and facial muscles. See more how acupuncture is done.
4. Surgery
In some situations, surgery may be indicated by the doctor, especially in cases in which there is considerable involvement of the facial nerve, which is only confirmed after undergoing an electroneuromyography exam.
After surgery, psychotherapy may be indicated for psychological support, because when the face is very different from what it was before, it can be difficult for a person to recognize and accept himself, especially when it is necessary to develop professional activities in which there is contact with other people.
5. Speech therapy
Speech therapy sessions are indicated for the rehabilitation of the person who had Bell's palsy, as it helps to recover the movements and expressions of the face, in addition to helping to stimulate the functions of speech, chewing and swallowing. This type of therapy should be done by a trained professional and the number of sessions per week and the treatment time will be determined by the speech therapist together with the doctor.
How long does recovery take
Complete recovery should take place in approximately 3 to 4 months, and as soon as physical therapy begins, some advances may be noted. About 15% of people who have this peripheral facial paralysis do not recover completely, and there may be a need to use botox or have surgery months later.