Bell’s palsy – Stroke of the face

Expression is a miracle. It speaks without any words. Expressions are very much important in communication. Everyone knows that even though a smile costs nothing, its value is enormous in building and maintaining relationship. One can express ecstasy, joy, elation, fear, conflicts, acceptance, anger, etc., with their facial expressions itself. The facial nerve (the VII cranial nerve) is the responsible dynamic nerve behind these without which one cannot smile, laugh or cry.

Facial nerve descends from the brain through the pyramidal tract, temporal bone, middle ear bones, parotid gland, etc., to innervate facial muscles, lacrimal gland, salivary glands, neck, ear, etc. Facial nerve branches and innervations are complex. It runs and works with V and VIII cranial nerves for different functions. The facial nerve controls facial muscles, provides eye care (with blinking and tears secretion) and taste (with saliva secretion). Bell’s palsy is a condition that affects these functions. Bell’s palsy is a type of facial palsy of lower motor neuron type. Here, the sufferings are due to damage to the facial nerve in labyrinthine portion (ear level).

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Bell’s palsy medically means the paralysis of one side of the face. It is named after the doctor who analysed the expressions of the face with facial nerve innervations and functions. It can be considered as stroke of the face. In contrast to stroke, which is due to brain involvement or bleeding or clot in brain, Bell’s palsy is just a lesion in the facial nerve which need not to be feared to be as serious as stroke.

Incidences – Bell’s palsy can occur at any age irrespective of sex, but it is most common in the age group of 20-50 years. It can occur in any of the side but bilateral is very rare. Most commonly, it is accompanied with cold symptoms or cold exposure. Women suffer most commonly around pregnancy.

Causes – Most often causes remain unknown. Scientists commonly correlate its occurrence with viral flu, cold, injury, ear infections (acute or chronic otitis media), herpes infection of pharynx and external auditory canal, diabetes, leprosy and even with inheritance. Irritation / infection / inflammation / compression / demyelination are the possible reasons which can affect nerves. It also can commonly arise with bony tumours of temporal bone, injury to temporal bone during forceps delivery, etc.

Symptoms – of Bell’s palsy may differ from person to person depending upon the intensity of suffering. Most often, it occurs abruptly and sometimes in a slow pace (over a period of days). It can be temporary or permanent depending upon care and approach.

Commonly, sufferers wake up with the complaint – i.e., it occurs overnight. The usual presenting symptoms will be:

• Weakness, altered sensations and loss of functions on one side of the face

• Feeling numbness or tingling or fine needle pricks in paralysed area (especially cheek and lips)

• Pain around ear with altered feeling in hearing loudness

• Facial grimaces will be lost

• Loss of naso labial furrow (fold between nose and upper lip)

• Affected side mouth corner droops – other side corner suffers pull to normal side

• Cannot blow cheek or whistle (air will leak through improper closure of lips)

• Unable to close eyes completely in affected side

• Affected side eye will roll up behind eye lids while attempting to close eyes (natural compensatory mechanism to protect pupil – Bell’s Phenomena)

• Difficulty in eating or drinking (foods get accumulated between cheek and jaw in affected side)

• Disturbances / altered taste especially in front 2/3 part

• Difficulty in speech

• Secretion of saliva and tears may be lowered

• Twitching of facial muscles during healing process / restoration of functions.

• Giddiness and loss of balance when it involves 8th cranial nerve also.

• Due to loss of blinking (closure of eyelids), tears cannot be spread all over the eye – also tears secreted will be streaming down from inner canthi due to sagging lower eyelid.

Complications – usually occur with lack of care and improper treatment. The common complications are

• Corneal ulcerations and Keratitis – in severe case vision loss

• Permanent disfigurement of face

• Loss of perfect facial expressions

• Depression with disfigurement of face

• Blinking of eyes while attempting to smile

• Streaming down tears while chewing or speaking (the sufferer will be thought to be crying)

• Twitching of facial muscles, especially the corners of the mouth, while speaking or trying to show a facial expression

• Tongue fissures due to lack of saliva

• Loss of taste and disgust for food.

Diagnosis – Doctors need not go for any specific test to diagnose Bell’s palsy, - just having a look at the patient can fix the diagnosis – anyhow to confirm or to differentiate it from stroke or other complicated disorders, doctors may go for analysis of disease and its intensity by testing muscle weakness, movements, coordination of muscle movements, sensations in face and other parts and test for hearing and balance. Further, they will go for CT / MRI scan (to find out the compressed or affected part and to rule out brain involvement, bleeding, clots, tumours, etc.).

Management – is more important to avoid recurrence or future complications.

It is better for Bell’s palsy patients to avoid air blowing or coldness directly on the face.

Avoid

• Sitting near the air-conditioner

• Riding in the window seats with open windows

Use

• Ear plug while travelling in the open

• Warm water to take bath

Eye care – it is better to

• Close the eye (by pulling eye lid manually and tape it or tie it with ribbon) at night to avoid dryness and infection

• Use artificial tears to combat dryness

• Close down the affected eye once in a while when feeling dry to spread tears

• Wear glasses while riding

General treatment – Bell’s palsy can go off (get cured) on of its own over time. Commonly, it gets resolved partially over a period of three weeks, sometimes it may take six months to one year. To rule out the possibility of permanent damage or disfigurement or complications or residual sufferings, it is better to address the problem in the start-up itself. After (wasting) one year, hope of getting betterment will be very little.

During the start-up, steroids, anti-viral drugs and eye drops (antibiotic and artificial tear drops) will be prescribed to the sufferers to reduce the infection, inflammation and to speed up the healing process. Later, one will be advised to stick to physiotherapy, exercises and massage. Generally, doctors wait to have the betterment with management of presenting symptoms. In extreme cases, surgery will be opted to relieve the compression of facial nerve to avoid hearing loss.

Homeopathic approach – Homeopathy can really do wonders in case of nervous disorders. Homeopathy will make one raise one's eyebrows by its treatment of Bell’s palsy with its fast action in rejuvenating nerves. In Homeopathy, if sufferers happen to take care of complaints in the start-up itself with the right medicine, then the start-up of Bell’s palsy can be halted and prevented. Also, Homeopathy can terminate Bell’s palsy at the earliest by stimulating the affected nerve to regain its normal functions. Here one should be aware that Homeopathy medicines act through sensitive nerves in the tongue.

In reality, one can become comfortable when he rules out the fear about the disease and when he understands well about the disease. So every physician should educate the sufferer about the disease and provide reassurance to the patients for comfort. They should also be made aware that good recovery is directly proportional to early treatment.

In contrast to all other systems that approach the disease from outside after the initial period, i.e., with massage, oil applications, physiotherapy, electric stimulation and surgical repair, Homeopathy is the only system which gives importance to internal mode of treatment. Homeopathy cares and gives importance to a patient’s feelings and sensations. The well-selected medicine prescribed for the patients to the core of the disease will certainly stimulate the suffering nerve(s) to regain normalcy and remain in endurance. Homoeopathy can ensure better relief / cure from Bell’s palsy at the earliest than any other system of medicine, without any side-effects.

Homeopathic medicines commonly used in cases of Bell’s palsy are Aconite, Agaricus, Arg nit, Belladonna, Bryonia, Cadmium sulp, Cannabis indica, Causticum, Chamomilla, Cocculus, Colocynthis, Cuprum met, Curare, Gelsemium, Glonine, Hypericum, Lachesis, Lathyrus, Lycopodium, Natrum mur, Nux vom, Opium, Phytolacco, Platina, Plumbum met, Pulsatilla, Rhus tox, Sangunaria, Secale cor, Spigelia, Stramonium, Zinc met, etc. These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.