University of São Paulo: Bell’s Palsy May Have Metabolic and Infectious Causes
Suddenly you feel, all of a sudden, that your mouth is crooked, or that, when you wake up, your face is crooked and you can’t speak properly, your eyes won’t close. These symptoms, without any specific cause, could be Bell’s palsy. Miguel Angelo Hyppolito, professor at the Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery at the Faculty of Medicine of USP in Ribeirão Preto, explains that, within the spectrum of peripheral facial palsy, there is Bell’s palsy, which has that name when not there is a specific cause for idiopathic peripheral facial palsy.
Although many have never heard of the disease, it is more common than you might think around the world and can occur in anyone, regardless of gender or age. In most cases, your recovery is usually complete. Dr. Hyppolito explains that, “in peripheral facial palsy, the person has a disfigurement of the face. There is a paralysis of the muscles of the face, which compromises half of the face, what we call a hemiface. In cases where there is involvement on both sides of the face, which can happen, it is important to diagnose the causes, which are called the more central causes of peripheral facial palsy”.
disease incidence
Peripheral facial paralysis usually appears in an incidence of 13 to 34 cases per 100,000 inhabitants, it can affect any side of the face, and is less frequent in children. Pregnant women and the elderly over 70 are more likely to have the problem, which is less frequent in children under 10 and newborns. Bell’s palsy can have metabolic causes such as diabetes mellitus, pre-eclampsia, stroke, infections such as otitis media, ear infections, mastoid infections such as mastoiditis, viral infections such as the influenza virus and other infectious diseases. It can also occur after surgeries, such as the removal of tumors such as the auditory nerve and brain. Trauma such as mastoid fracture during childbirth, autoimmune diseases such as lupus and myasthenia gravis, and the use of medications such as interferon can also cause the problem.
Paralysis of the muscles of the face can start suddenly and progress, taking weeks to months to recover. The paralysis can be total or partial. A medical evaluation can identify facial paralysis, often requiring complementary tests such as imaging, tomography, magnetic resonance, in addition to electrophysiological tests also called electromyography, which will also help in identifying the problem and in the patient’s recovery. Audiometry and impedance testing can also be requested, as a branch of the facial nerve is related to the auditory system.
Due to the fact that the facial nerve is closely related to the ear, one of the specialties that can assist in cases of partial peripheral paralysis is the otorhinolaryngologist. He is capable not only of making the diagnosis, but also of monitoring and indicating the appropriate treatment, as well as a neurologist.
Treatment
Treatment can be carried out with medications such as corticosteroids and antivirals. Eye care is needed because the eye does not close on the paralyzed side and this can cause corneal dryness and lead to corneal ulcer formation. Facial motor physiotherapy is indicated and, in some cases, surgery for facial nerve decompression may be necessary. Even so, some patients may not fully recover, requiring botulinum toxin application, plastic or ophthalmic surgery. Other adjuvant treatments are not consecrated by the literature, because there is no evidence that physical therapy with shock, such as electrostimulation, and therapies such as acupuncture can help. There is no clinical evidence, but there are reports of patients using these forms of treatment,
He reports that, after undergoing surgery to remove the wisdom tooth, the paralysis began. “A week after the wisdom tooth extraction I started to feel the symptoms. Spasms in the mouth and chin. The dentist recommended I fly to the hospital because she thought I was having a stroke. I rushed to the emergency room, the doctor interviewed me and, as I had no other symptoms, such as dizziness, mental confusion, difficulty walking or speaking, he ruled out a stroke. I had a CT scan. That’s when the doctor said I had Bell’s palsy. I went to find out what it was. I took antibiotics, the only medication used. I did some muscle stimulation exercises on the right cheek. With 15 days I started to do an acupuncture treatment and, after the third session, I already had my face completely normalized. In a month of Bell’s palsy, I was calm, normal.”