Quite often our patients tell us that when facial palsy happens, it’s very difficult to find information on the Internet. It’s pretty much fragmented and often controversial.
So we have decided to share with you our experience, our knowledge, and to consolidate the information here about:
- what happens when Bell’s palsy occurs
- what to do
- what not to do
- what to expect, for the patients who are confronted with the acute Bell’s palsy
You can watch the video below or read this article to gain some better understanding of what you’re going through and what you can expect.
What is Bell’s palsy and how does it happen?
Bell’s palsy is a unilateral paralysis of facial muscles. It happens when the facial nerve that connects the brain and facial muscles sustain damage.
This damage often happens when the nerve is subjected to compression. This compression is mostly a result of swelling of surrounding tissue. The facial nerve runs in the temporal bone through a very long and curved channel, where it is quite vulnerable.
So if the swelling happens, the facial nerve sustains compression. The swelling can occur for various reasons, one of which could be a bacterial or viral infection in the area surrounding the nerve. The infection can cause swelling and lead to a compression which will damage the facial nerve.
How does the length of Bell’s palsy recovery affect the function of facial muscles?
There are two possible scenarios for the recovery after facial palsy:
1. Quick recovery
If the damage to the nerve tissue was only superficial, then the electrical insulation, myelin sheath, can be recovered quite quickly. We can expect that the facial movements will return within 2 to 5 weeks completely. It will be a full spontaneous recovery and the functions of facial muscles will be as before.
2. Long recovery
The less favourable scenario is when the nerve sustains more severe damage. We can compare a facial nerve with a thick telephone cable, which consists of many, many, many insulated wires. The myelin sheath is the insulation, protecting the “wire”. The “wire” is the axon – the nerve fibre that transmits electrical signals from the brain to the muscles.
So when only the insulation is damaged – it is the first case of damage, more light. When the second, more severe damage happens, then not only the insulation (myelin sheath) becomes damaged, but the “wire” (axon) becomes damaged as well. When the axon is damaged, the brain loses its physical connection with the facial muscles. There is no more “wire” that connects the brain with the face. So, of course, to recover this kind of damage takes much more time. Also, it takes more resources from our body.
In this scenario, the recovery can take a longer time. It could take one, two, three months or more before the first signs of the return of facial movements will appear. Then, there is a quite high probability that the recovery will be incomplete. There will be some residuals and complications after long-standing facial palsy.
What are the causes of facial palsy that may lead to a more or less favourable recovery prognosis?
Depending on what kind of cause has resulted in facial palsy, the prognosis for quick recovery may be more or less favourable.
To a more favourable situation, we can assign the “classical” Bell’s palsy. Bell’s palsy is essentially a diagnosis of exclusion. When no particular cause can be established, then the functional disorder gets the name Bell’s palsy.
To more severe cases of damage we can assign:
- Ramsay Hunt syndrome (herpetic eruption),
- post-operational facial palsy,
- post-traumatic facial palsy,
- other causes which result in heavy swelling of surrounding tissues.
In all these cases there is a heavy swelling of the surrounding tissues which lead to quite a heavy compression. Since this kind of swelling doesn’t go away that quickly, the facial nerve is compressed for a longer time. This leads to more severe damage to the nerve fibres.
What you should and should not do when facial palsy happens.
What you should do: You should immediately see a doctor.
You should see either ENT doctor or a neurologist. See a specialist that has a good understanding of facial palsy. They can prescribe you proper medication and also research what has caused your facial palsy:
- a bacterial or viral infection,
- or a tumour that is slowly developing somewhere in the cerebellopontine angle.
So please, do your best to see a good specialist. That specialist will prescribe you medication and give you good advice about what you should do during the acute phase. We need to reduce compression and we need to get rid of swelling as soon as possible.
Most of the time, the medication of choice is Prednisone, which is a steroid. Its main purpose is to reduce the swelling. If there is a viral infection or infection by bacteria, then, of course, we should take medications against bacteria or anti-virals.
What you should NOT do: You should not panic.
I perfectly realize that when half of the face doesn’t want to move, when you cannot blink, when the mouth corner is hanging, when you cannot hold in your mouth liquids or food, when the speech becomes slurry, it has a very big impact. Especially emotional impact. But please, do not panic and do not despair.
The regeneration starts to happen at the same very moment when the damage happened. So your nerve is regrowing. It is regenerating. It is going to reconnect to your facial muscles. So the facial movements will return.
It may take some time. If the favourable scenario is in place it may take a couple of weeks. If the damage to the nerve was more severe it may take a longer time. Maybe 2 months, maybe 3 months. But the movements will return to your face. So please, do not panic, do not despair.
There is no way to quickly “switch back” your facial nerve. The damage has happened and your body needs time to regrow, to repair the damage. It is the same as if you cut the grass in your garden. You do not expect the grass to regrow overnight or even within two or three days. It takes time as determined by the laws of nature. The same is with our body. If you cut your finger, you do not expect it to be completely healed the next morning. So please, realize that all processes in our body take time.
There is another very important aspect. When we panic or despair, when we feel hopeless, we suppress our immune system. We need our immune system and all the resources of our body in order to recover quicker.
Therefore, please, stay calm. Maintain your emotional balance. Do nice things. Take a lot of rest. Your body and your emotions have been subjected to quite a heavy impact. So take rest. If you feel like sleeping, go to sleep. If you feel like doing nothing, do nothing. Do good, positive things and maintain your positive state of mind. This is very, very important. It will improve and facilitate your recovery.
What can you do to improve your chances for recovery after acute Bell’s palsy?
Please keep in mind that there is no way to improve the recovery dramatically. But you can do something from your side to make the task for your body easier. Our suggestions are applicable both for the patients who are suffering from acute facial palsy and for those suffering from residuals and complications of long-standing facial palsy.
Five suggestions that can help your body to recover after acute Bell’s palsy.
- Please do NOT try to force your face into facial expressions.
To the contrary. Try to find some time a couple of times per day, and sit quietly for about 10 minutes. Listen to your face and try to restore the sensory balance between the affected and the healthy side. Try to perceive your face as one whole unit. Not as a combination of two separated halves.
- We do not recommend to our patients to use any facial exercises.
Such as pronouncing letters, pronouncing sounds, making some facial expressions, forcing your muscles into making some faces. From our point of view and also based on our experience, doing active, voluntary movements may facilitate formation of synkinesis. It may also lead to contractures of facial muscles as well as create some sensation of tension in your face. Which, of course, we want to avoid.
- Do a conscious relaxation of your facial muscles.
Find a couple of minutes, a few times per day, sit quietly and focus on conscious relaxation of your facial muscles, one by one. Learn the facial muscles that we have in our face, so you can “feel” them under your skin. Try to focus your attention on relaxing them one by one.
This exercise will help your brain to maintain good background relaxation of facial muscles. We want your brain to avoid developing a habit of over-amplifying your facial muscle contractions. It will help you to move your muscles, to move your face, in a more proportional manner. Especially if you find a couple of times per day 2, 3, 5 minutes, as much as you can allocate to this task.
- Please do a gentle massage of your face with both hands, both sides at the same time.
Three or four minutes each time. Put a few drops of massage oil or gel on your face, so you don’t pull your skin unnecessarily. Please bear in mind that you should do your self-massage with slow, gently stroking movements. There is no need for any special techniques. The general direction of the movements: from midline – outwards, and from lower face – upwards.
- Please, do not use force when you’re doing your facial massage.
The idea behind self-massage is to create a calm, tranquil state of mind and emotions and to restore the sensory balance between both sides of your face.
I hope that this information will help you to have a clear picture of what to do, what not to do, and what to expect if the facial palsy happens to you.
And I hope that you will recover fully and very soon.
Please do not worry. In the absolute majority of cases, the recovery is complete, and only a small fraction of patients who have suffered facial palsy develop some residuals and complications. If that is the case in your situation, please feel free to write to us or speak with our specialists in a video diagnostic session. Together we will decide how to proceed and how to bring back the balance to your face, to restore the symmetry of your facial movements and how to bring back your smile.
– Alex Pashov
Crystal Touch Bell’s palsy clinic