Medical Questions » Nerves Questions » Question No. 722
| Question: | I awoke last week with half my face paralysed. I am very scared, but my doctor says it will get better in a few weeks and she won' t give me any treatment. She says it is a Bell paralysis. What should I do? |
| Answer: | You should not worry. Your GP is doing just the right thing—nothing!
The muscles of the face are controlled by the facial nerve, which comes out of a hole in the skull just below and in front of the ear. From there it spreads like a fan across the face, with branches going to each of the many tiny muscles that control our facial expressions. Damage to this nerve causes all these facial muscles to stop working, because the nerve tells the muscles when to contract and when to relax. The patient can no longer smile or close the eye properly.
By far the most common cause of this type of paralysis is Bell' s palsy. Bell' s palsy is caused by an inflammation of the facial nerve as it leaves the skull. The exact reason for this inflammation, and subsequent paralysis, is unknown. When the condition starts, the patient develops a sudden paralysis of the face muscles on one side only. There may be some mild to moderate pain at the point where the nerve leaves the skull beside the ear, but this settles after a few days. There may also be a disturbance to taste sensation.
Two-thirds of patients recover completely within a few weeks with no treatment. Most of the others obtain partial recovery, but 10% are significantly affected long term by facial paralysis. No treatment is necessary for most patients, but if the victim is elderly, the paralysis is total, or if there is severe pain, treatment may be tried. High doses of prednisone, a steroid, to reduce the inflammation in the facial nerve, is the usual medication. It is important that the treatment start within five days of the onset of the condition. Unfortunately, there is varying evidence about the value of any treatment, but at least it rarely causes any harm.
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