ASK THE EXPERTS: BELL'S PALSY

Neurology Now
February/March 2011
Volume 7(1)
p 36
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QWhat if anything can be done to regain facial nerve function years after having Bell's palsy? Can facial exercises or surgery reactivate facial nerves?

DR. STEVEN L. LEWIS RESPONDS:

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A Although the cause of Bell's palsy is unknown, it's suspected to be related to a viral infection, which causes inflammation and swelling of the nerve that controls facial muscles. Patients with Bell's palsy have weakness affecting their ability to raise the eyebrow, close the eye, and smile on one side of the face. During periods of severe weakness, the main medical concern is keeping the eye protected from being scratched or irritated, since it's not protected by blinking.

Treatment typically involves a short course of corticosteroids (usually prednisone) started as soon as possible, since there is some evidence that this may improve the chances of recovery. Antiviral medications are sometimes prescribed, although there is no clear evidence that these are helpful for Bell's palsy.

Most patients improve considerably whether or not they receive steroids, with most fully or almost fully recovering within a few weeks to months. However, even patients who almost completely recover may experience mild though bothersome problems related to unusual patterns of nerve regrowth. These problems can include subtle involuntary closure of the eye when smiling or tearing of the eye when eating (crocodile tears).

I often tell my patients with Bell's palsy that massaging their face makes sense in helping the outcome, although this is unproven. I doubt this would be beneficial years after the onset of Bell's palsy, and no medications or surgical procedures are known to be effective for patients with incomplete recoveries. However, if a patient has severe persisting cosmetic problems or continued inability to protect their eye long after any further improvement would be expected, a referral to a facial plastic surgeon may be appropriate.

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