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Bell's palsy is a disorder of the seventh nerve of the cranial nerves of the face, which results in a lack of movement of the muscles of the face and paralysis of one side of the face. The nerve is generally inflamed but can be damaged for other reasons, such as trauma.

Bell's palsy affects up to 40,000 individuals per year in the US, making it a common disorder. As mentioned, it is the 7th cranial nerve or facial nerve that is affected. The seventh cranial nerve affects the movement of the muscles of the face on one side only. The nerve can become inflamed for many reasons. One type of inflammation can occur due to an infection by herpes zoster. Other things that can inflame the nerve include an HIV infection, a middle ear infection, Lyme's disease and sarcoidosis.

The symptoms of Bell's palsy can begin with a slight cold that affects your mucus membranes. Symptoms of Bell's palsy start after that. It may occur suddenly or take two to three days to fully develop. Only one side of the face is affected and the condition may be mild weakness or severe, as in paralysis of the face.

The face looks different on that side and it may feel stiff or pulled to one side when you have Bell's palsy. You can have drooling due to a lack of ability to control the muscles of the mouth; you may have difficulty eating and drinking; you may have a bit of facial drooping with drooping of the mouth or the eyelid. You cannot close one eye and can have problems making facial expressions. You can have twitching of the face along with the weakness of the muscles. Your eye or mouth can become dry and you may have a headache or loss of sense of taste. You may have a louder sound in one ear than in the other and twitching of your facial muscles.

Tests for Bell's palsy often aren't necessary because the history and physical examination are completely clear that the situation is Bell's palsy. A CT scan of the head can rule out a stroke or tumour as can an MRI of the head. An EMG or electromyogram of the face can show the weakness as can a nerve conduction study.

Treatment of Bell's palsy is often not necessary and once you get the symptoms it begins to gradually improve. It may take several weeks or even many months before you get complete resolution of muscle weakness. You may need eyedrops to lubricate the eyes because the affected eye does not close properly. The eye may need to be taped shut during the sleeping hours so that it doesn't get scratched in your sleep. You can tape it shut or wear a patch, depending on your comfort level.

If medications are used, they need to be used right away so that they can be of benefit. Medications include corticosteroid medications that reduce inflammation and swelling around the seventh cranial nerve. Antiviral medication can be used to fight the virus causing the inflammation, although this may not really work if a virus was not the cause of the Bell's palsy. In rare cases, doctors may need to perform surgery to relieve the pressure off the nerve. The surgery is called decompression surgery and is only reserved for severe cases that don't get better with other measures.

The prognosis of Bell's palsy is fairly good. It can spontaneously resolve itself within a week to several months. If you didn't lose your nerve function completely and the symptoms begin to improve within three weeks, you will not likely have permanent residual damage. If it takes many months, you may have some residual dysfunction of the seventh cranial nerve. You can have long term changes in your sense of taste, eyelid or other muscle spasms or residual weakness of the facial muscles. Complications include getting a corneal abrasion of the eye because of a lack of ability to close the eye completely.

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