Bell’s palsy is a form of facial paralysis that is thought to occur after a viral infection. Symptoms like facial drooping, difficulty closing the eye on the affected side, drooling and loss of taste can appear suddenly. Symptoms generally resolve on their own within a few weeks but can also be permanent. Physiotherapists are trained to assess your condition and provide a customized Bell’s palsy treatment plan.

In this article we will look at the symptoms, causes and treatment of Bell’s palsy. We detail some of the stretching and strengthening techniques we use with some of our clients to help them regain the healthy pattern of movements needed for facial expressions and function.

What is Bell’s Palsy?

Bell’s palsy, also known as idiopathic facial palsy, is a form of temporary facial paralysis or weakness of the face. Generally, it affects only one side of the face; however, in rare cases, it can affect both sides. Bell’s palsy is believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face, which may occur after a viral infection.

This facial nerve (cranial nerve 7 of 12) directs the muscles on one side of the face, including those that control eye opening and closing and facial expressions such as smiling. The facial nerve also carries nerve impulses to the tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear. It also transmits taste sensations from the tongue.

Facial nerve diagram. Bell's palsy treatment Propel Physiotherapy

For most people, Bell’s palsy is temporary. Symptoms appear suddenly over a 48 – 72-hour period and generally start to improve with or without treatment after a few weeks. Recovery of some or all facial function typically occurs within six months. In some cases, residual muscle weakness lasts longer or may be permanent.[i] In rare cases, Bell’s palsy can re-occur after the initial episode has resolved.

Bell’s palsy is the most common cause of facial paralysis. It affects about 40,000 people in the United States every year. Anyone can be affected regardless of age or gender, but its incidence seems to be highest in those in the 15- to 45-year-old age group.

Bell’s palsy occurs more often in people who:

  • Are pregnant, especially during the third trimester, or who are in the first week after giving birth
  • Have preeclampsia
  • Have an upper respiratory infection, such as the flu or a cold
  • Have diabetes
  • Obesity
  • Hypertension
  • Upper respiratory ailments

Recurrent attacks of Bell’s palsy are rare. But in some of these cases, there’s a family history of recurrent attacks — suggesting a possible genetic predisposition to Bell’s palsy.

Symptoms of Bell’s Palsy

Because the facial nerve has so many functions and is so complex, damage to the nerve can lead to a range of problems. Symptoms of Bell’s palsy can vary from person to person and range in severity from mild weakness to total paralysis of the facial muscles.

Signs and symptoms of Bell’s palsy appear suddenly and may include:

  • Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days
  • Facial droop and difficulty making facial expressions, such as closing your eye or smiling
  • Asymmetrical smile
  • Difficult closing the eye on the affected side causing dryness of the eye
  • Drooling
  • Pain around the jaw or in or behind your ear on the affected side
  • Increased sensitivity to sound on the affected side
  • Headache
  • A loss of taste
  • Changes in the quantity of tears and saliva you produce[ii]

What Causes Bell’s Palsy?

The cause of Bell’s palsy is unknown. Swelling and inflammation of the cranial nerve 7 is seen in individuals with Bell’s palsy. It is believed that reactivation of an existing (dormant) viral infection may cause the disorder. Impaired immunity from stress, sleep deprivation, physical trauma, minor illness, or autoimmune syndromes are suggested as the most likely triggers.

As the facial nerve swells and becomes inflamed in reaction to the infection, it causes pressure within the Fallopian canal (a bony canal through which the nerve travels to the side of the face), leading to the restriction of blood and oxygen to the nerve cells. In some mild cases where recovery is rapid, there is damage only to the myelin sheath (the fatty covering that acts as insulation of nerve fibers).

How is Bell’s Palsy Diagnosed?

Bell’s Palsy is essentially a diagnosis of exclusion. Once other causes of facial palsy have been eliminated, we call an isolated facial palsy Bell’s Palsy, or Idiopathic Facial Palsy.

Several other conditions can also cause facial paralysis, for example, brain tumor, stroke, myasthenia gravis, and Lyme’s disease. If no specific cause can be identified, the condition can be diagnosed as Bell’s palsy.

Your healthcare provider can usually diagnose Bell’s palsy by looking at your symptoms. There are no specific tests used to diagnose Bell’s palsy; however, your healthcare provider may order tests to rule out other conditions that can cause similar symptoms and to determine the extent of nerve involvement or damage.

These tests may include:

  • Electromyography (EMG) to determine the extent of the nerve involvement.
  • Blood tests to determine if another condition such as diabetes or Lyme disease is present.[iii]
  • MRI scan can be used to exclude other causes of facial nerve dysfunction, such as Facial Schwannoma or Acoustic Neuroma. MRI or a computed tomography (CT) scan can rule out other structural causes of pressure on the facial nerve such as an artery compressing the nerve and examine the integrity of other nerves. iv

How Long Does Bell’s Palsy Last?

The prognosis for individuals with Bell’s palsy is generally very good. Clinical evidence of improvement occurs spontaneously within three weeks in 85 percent of cases.[iv] Most individuals eventually recover normal facial function with no long-term complications.

Some individuals may be left with mild residual facial weakness or show moderate to severe deficits. Among the residual effects include involuntary mouth movements when trying to blink the eyes or incomplete recovery of facial muscle weakness resulting in trouble speaking or forming words (dysarthria).

Bell’s Palsy Treatment

In the first couple of days to a week after the symptoms starts, a physiotherapist will evaluate the client and that includes a review of the medical history, when the symptoms began and what makes them worse or better and conduct a physical examination, focusing on identifying the patterns of weakness that are caused by Bell’s palsy such as:

  • Facial movements of the eyebrow
  • Eye closure
  • Ability to use the cheek in smiling
  • Ability to raise or lower the lips
  • Lip closure
  • Frowning
  • Facial expressions
  • Jaw and mouth movements
  • Forehead wrinkling

After the assessment, the physiotherapist will provide a customised Bell’s palsy treatment plan to help you regain the healthy pattern of movements that you need for facial expressions and function and coach throughout this challenging time, guiding you through special exercises that are designed to help you relearn facial movements based on your particular movement problems.

Eye Care:

During the illness most people with Bell’s palsy are unable to close their eye on the affected side of their face. It is important to protect the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night which helps protect the cornea from being scratched.

In the early stages of facial palsy, the most important thing to do is to check that you are caring for the affected eye in an appropriate way. As the facial nerve is responsible for production of lubrication to the cornea, you are highly likely to suffer from a dry eye in the early weeks and months of facial palsy. This puts you at risk of developing a corneal ulcer, which can cause vision damage in the affected eye.

The therapist will educate you about dry eye management if this has not been done by other medical personnel. If the eye is looking red or you report frequent episodes of redness, an urgent referral to ophthalmology is required. Alternatively, you should be advised to attend an eye hospital emergency department.

Neuromuscular retraining (NMR):

Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to stretch and strengthen your facial muscles to help prevent this from occurring.

Neuromuscular retraining is the process of relearning facial movement using specific and accurate feedback to facilitate facial muscle activity in functional patterns of facial movement and expression and suppress abnormal muscle activity interfering with facial function. [v]

In the early stages, when you have difficulty producing or initiating the movements, physiotherapist will teach you exercises that initiates facial movements. Once you can initiate movement of the facial muscle, physiotherapist will design exercises to facilitate muscle activity which means to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time.

Then movement control exercises will be introduced to:

  1. Improve the coordination of your facial muscles.
  2. Correcting the abnormal patterns of facial movement that can occur during recovery.
  3. Refine your facial movements for specific functions, such as speaking or closing your eye.
  4. Refine movements for facial expressions, such as smiling.

Relaxation exercises will be important during the recovery stage because you might have facial spasms and twitches. Physiotherapist will design exercises to reduce this involuntary or unwanted contraction of certain muscles during other intended facial movements (synkinesis). For example, your neck muscles tightening when you smile or when your eyes closing when you chew.

Physiotherapist will teach you recognize the actual muscle contraction and when the muscle is at rest and guide to improve your ability to forcefully contract facial muscle and then stop which will help to relax the facial muscle and decreased the spasms.

Massage Therapy

Massage helps to stretch and mobilize facial muscles as well as promote circulation. This prevents complications like contractures. Techniques such as using the fingertips to perform a circular motion around the cheeks may help increase muscle movements in the cheeks.

While these exercises can be performed at home, getting professional help is always advisable. They will not only help you in treating the problem effectively through a combination of techniques but will also help in diagnosing the problem further preventing its recurrence. A physiotherapist will ensure you use appropriate facial exercises to achieve the best possible results for your case of Bell’s palsy quickly and safely.

At Propel Physiotherapy, our trained therapists have experience with Bell’s palsy treatment. We can assess your case and guide you through your personalized rehabilitation process. Contact us today to book a complimentary consultation.

Written by

Sahash Marasini
Sahash MarasiniRegistered Physiotherapist
Sahash Marasini strongly believes that physical therapy can add life to years, not just years to life. He has a passion for helping people and a get sense of satisfaction when his clients acknowledge improvements they’ve made as a result of the treatment. He believes that every injury and dysfunction is unique and every patient responds differently to treatment. This is why he is passionate about providing holistic approach to achieve the best possible outcomes.

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