Facial Nerve

What is Bell’s palsy?

Bell’s palsy is a paralysis or weakness of the muscles on one side of your face. Damage to the facial nerve that controls muscles on one side of the face causes that side of your face to droop. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.

Bell’s palsy is not the result of a stroke or a transient ischemic attack (TIA). While stroke and TIA can cause facial paralysis, there is no link between Bell’s palsy and either of these conditions. But sudden weakness that occurs on one side of your face should be checked by a doctor right away to rule out these more serious causes.

What causes Bell’s palsy?

The cause of Bell’s palsy is not clear. Most cases are thought to be caused by the herpes virus that causes cold sores.

In most cases of Bell’s palsy, the nerve that controls muscles on one side of the face is damaged by inflammation.

Many health problems can cause weakness or paralysis of the face. If a specific reason cannot be found for the weakness, the condition is called Bell’s palsy.

What are the symptoms?

Symptoms of Bell’s palsy include:

• Sudden weakness or paralysis on one side of your face that causes it to droop. This is the main symptom. It may make it hard for you to close your eye on that side of your face.
• Drooling.
• Eye problems, such as excessive tearing or a dry eye.
• Loss of ability to taste.
• Pain in or behind your ear.
• Numbness in the affected side of your face.
• Increased sensitivity to sound.

How is Bell’s palsy diagnosed?

Your doctor may diagnose Bell’s palsy by asking you questions, such as about how your symptoms developed. He or she will also give you a physical and neurological exam to check facial nerve function.

If the cause of your symptoms is not clear, you may need other tests, such as blood tests, an MRI, or a CT scan.

How is it treated?

Most people who have Bell’s palsy recover completely, without treatment, in 1 to 2 months.^{footnote 1} This is especially true for people who can still partly move their facial muscles. But a small number of people may have permanent muscle weakness or other problems on the affected side of the face.

Treatment with corticosteroid medicines (such as prednisone) can make it more likely that you will regain all facial movement. They work best if they are taken soon after symptoms start (within 3 days). Sometimes antiviral medicines (such as acyclovir) may be added to corticosteroid medicines to treat Bell’s palsy. But evidence for using antiviral medicines is weak. They may help in some cases, but in general they do not affect recovery.^{footnote 2}

Some people may not be able to take corticosteroid medicines because of other health problems. It’s important to remember that most people with Bell’s palsy recover completely without any treatment.

How can you care for yourself at home?

Facial exercises. As the nerve in your face begins to work again, doing simple exercises-such as tightening and relaxing your facial muscles-may make those muscles stronger and help you recover more quickly. Massaging your forehead, cheeks, and lips with oil or cream may also help.

Eye care. If you can’t blink or close your eye fully, your eye may become dry. A dry eye can lead to sores and serious vision problems. To help protect the eye and keep it moist:

• Use your finger to close and open your eyelid often throughout the day.
• Use eyedrops (“artificial tears”) or ointment. Those that contain methylcellulose are a good choice and don’t require a prescription. You may want to use drops during the day and ointment at night while you sleep. Ask your doctor how often to use the drops.
• Wear an eye patch while you sleep, and wear glasses or goggles the rest of the time.

Mouth care. If you have no feeling and little saliva on one side of your tongue, food may get stuck there, leading to gum disease or tooth decay. Brush and floss your teeth often and well to help prevent these problems. To prevent swallowing problems, eat slowly and chew your food well. Eating soft, smooth foods, such as yogurt, may also help

Overview

What is Hemifacial Spasm?

Hemifacial spasm, also known as a facial twitch, is characterized by frequent involuntary twitching of one side of the face. This twitching or spasm usually starts around the eye and slowly progresses to involve the lower face. Muscles in the forehead and neck are usually the last to be affected.

UPMC neurosurgeons are among the most experienced in the U.S. in treating hemifacial spasm with microvascular decompression, which alleviates the spasms by moving the blood vessel away from the nerve.

Our doctors have refined this procedure since first implementing it nearly 40 years ago.

Today, UPMC neurosurgeons perform approximately 100 microvascular decompressions for hemifacial spasm each year, with 92 percent of people experiencing complete relief or dramatically improved symptoms. Surgery causes significant complications in fewer than 5 percent of cases.

Causes of hemifacial spasm

Several factors may cause hemifacial spasms:

• A blood vessel pressing on a facial nerve
• Injury to the facial nerve
• Bell’s Palsy
• A tumor placing pressure on the facial nerve

The most common cause of hemifacial spasm is excessive pressure on the facial nerve by the anterior inferior cerebellar artery, where the nerve begins in your brainstem. This pressure causes the nerve to misfire and make your facial muscles contract and spasm.

Diagnosing Hemifacial Spasm

Your doctor will perform a physical exam and will ask about any symptoms you are having.

Hemifacial spasm symptoms

Symptoms may include:

• An intermittent twitching in the eyelid muscle, which can lead to forced closure of the eye.
• This spasm may gradually spread to the muscles of the lower face, which may cause the mouth to be pulled to one side.
• In rare cases, doctors may see individuals with spasm on both sides of the face.

Hemifacial Spasm Treatment

Surgery is the preferred treatment for hemifacial spasm.

Microvascular decompression surgery

At UPMC, the treatment of choice for severe hemifacial spasm is microvascular decompression. Advances in instruments and techniques have made this treatment option more effective in recent years.

Microvascular decompression is a surgical procedure that relieves abnormal compression of a cranial nerve. The surgery consists of a linear incision behind the ear followed by a craniectomy (bony opening) the size of a silver dollar.

Under the view of a microscope or endoscope, the doctors detect the area where the blood vessel is affecting the nerve and then separate them, leaving a Teflon “pillow” in between.

During surgery, the doctors monitor facial nerve irritability to identify the blood vessel causing the nerve compression, making cure more likely. Monitoring also helps doctors to avoid damaging hearing and facial nerves.

Our neurosurgeons sometimes use endoscopes that allow them to look around corners as they operate, identify hidden blood vessels, and minimize the impact on sensitive brain tissue.

Medications

UPMC Centers for Rehab Services

Outpatient Therapy at More Than 70 Locations

We cover a lot of ground when it comes to providing physical, occupational, and speech therapy. There are more than 70 UPMC Centers for Rehab Services located throughout western Pennsylvania with convenient office hours, so it’s easy to find one that’s close to where you live or work.

With a wide variety of specialized therapy programs, some of the region’s most experienced rehabilitation professionals, and residency programs that attract talent from across the country, you can be sure that you’ll receive the highest quality treatments available.

BOTOX^®/DYSPORT^®

Overview

Botulinium toxin, commonly known as BOTOX or DYSPORT, is a relaxing agent that is injected into facial muscles to temporarily block function of the muscle. These injections change the muscle’s impact on the skin and stop its ability to wrinkle, giving the face a more relaxing appearance.

BOTOX typically is used to treat:

• Frown lines between the eyes
• Forehead wrinkles
• Laugh lines around the eyes (crow’s feet)
• aAs well as other areas

Plastic surgeons can use it to reshape the face to a minor degree: for example, it can be used to slightly lift the corner of the eyebrow to enhance the eyes’ appearance.

BOTOX is also used to treat excessive sweating in the:

• Armpits
• Palms of the hands
• Soles of the feet

The injections take only 10 or 15 minutes in the Aesthetic Plastic Surgery Center. The effect can be seen in three to four days and, on average, lasts for three to four months. In most cases, patients have minimal pain.

Who is a Candidate?

Patients can range in age from 20 to 80, and the injections can be performed during the initial visit after the physician has explained the procedure in greater detail.

Before the Procedure

Your plastic surgeon will perform a detailed analysis of your face and discuss your expectations. Over-the-counter blood thinners (including aspirin and vitamin E) should be stopped for a period of time before and after the procedure to limit the amount of bruising and swelling to your face. All prescription blood thinners should be managed by your prescribing physician.

Procedure Details

In the office, the facial area(s) to be treated are numbed through the use of topical agents or ice.

Where Will the Procedure be Performed?

The procedure is performed in a doctor’s office.

Type of Anesthesia

Your plastic surgeon may use ice, a topical anesthesia, or a nerve-blocking agent to numb specific parts of your face before the injection.

Immediate Postoperative Recovery

You can resume normal activities immediately after the procedure. In most cases, there is little or no bruising, especially if regular use of aspirin or blood thinners is avoided. You should avoid massaging the face the night of the injections to prevent unwanted spread of the relaxing agent.

Risks

The risks associated with BOTOX injections typically are minimal. There may be some bruising and mild facial asymmetry. These complications are very unusual, however, and will stop as the medication’s effects lessen. Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to the procedure.

Anticipated Results

While every patient’s experience is different, BOTOX/DYSPORT is an effective way to reduce wrinkles in certain parts of the face, and to make a refreshing change to facial expression. By altering the fine balance of facial muscles, it can produce a subtle and attractive reshaping which can enhance your overall appearance.

BOTOX is a registered trademark of Allergan, Inc.

DYSPORT is a registered trademark of Medicis.

Minimally invasive surgery