Old diagnosis, new options

You go to bed early, worn out from a lingering head cold and stressed from a long day at work. The next morning, your head remains heavy with congestion, and you go to wash your face. You look in the mirror and see that one side of your face is drooping.

Did you have a stroke overnight without realizing it?

While a stroke is a possibility and should not be ruled out, your facial paralysis may also be a symptom of Bell’s palsy. Bell’s palsy is best understood to be caused by a swollen facial nerve within the skull base. It affects approximately 40,000 people in the U.S. each year.

What is Bell’s palsy, and how can it be treated?

Bell’s palsy is a disorder of the facial nerve that controls movement in the muscles of the face. It may be caused by a virus called herpes simplex that leads to inflammation of the facial nerve within the tight bony canal of the skull base.

William “Walsh” Thomas, MD, an otolaryngologist and head and neck surgeon at Baptist MD Anderson Cancer Center, said after ruling out other neurological conditions or skin cancer, Bell’s palsy should be treated promptly with oral steroids. If the facial droop has not improved within three to six months, that’s when he may be able to help.

“With Bell’s palsy, timing is everything,” said Dr. Thomas, who specializes in facial reconstruction. When I’m brought in to help a Bell’s palsy patient who has not recovered with oral steroids, I prefer to meet with them sooner rather than later.”

If Dr. Thomas sees patients three to six months after their diagnosis, he may recommend surgery to help the patient blink more easily since the most imperative complication of facial paralysis to avoid is eye dryness that leads to scratches on the cornea.

Simpler steps, including taping the eye shut and using eye drops, will also help protect the eye and should be used immediately upon diagnosis of Bell’s palsy.

Dr. Thomas said that in some cases, the facial nerve may regrow incorrectly. For example, a patient who has recovered from Bell’s palsy could smile, and their eye may twitch or they could blow a kiss, and their neck could spasm. This can be treated fairly easily with botulinum injections.

Multidisciplinary treatment options, including a combination of physical therapy, facial nerve rehabilitation, speech language therapy and counseling can also be used in combination to help Bell’s palsy patients, according to Dr. Thomas.

“The good news is that most patients with Bell’s palsy do get better, and facial nerve function returns spontaneously, without any long-term treatment required,” Dr. Thomas said. “For the rare patient who doesn’t recover facial nerve function, a muscle from the thigh can be transferred to the face to restore the ability to smile.”

If you are experiencing facial paralysis or drooping, talk to your primary care doctor about your symptoms. If you need help finding a Baptist Health primary care doctor, call our care navigator team at 904.202.4YOU.