A 40 Year Old Woman Presents With Sudden Facial Asymmetry

A 40 year old woman woke up in the morning and felt her left side of the face being peculiar and heavy. On looking in the mirror she saw that the corner of her mouth on the left side was drooping and her left lower eyelid seemed to be lower than her right. When she attempted to smile her left side of the face remained immobile and broad like. On eating her breakfast she felt the food to stick on the left side of her cheek. She was terrified and came to the emergency department for a checkup.
On examination she has paralysis of the entire left side of her face.
The picture of the lady is shown below:

Diagnosis: Bell's Palsy ( Caused by a lesion of the left facial nerve that supply the muscles of facial expression).

Case Discussion:
Bell's palsy is a paralysis or weakness of one side of the face caused by a damage to the facial nerve. The condition comes on suddenly usually overnight and fortunately gets better on its own over a few weeks.



Cause:
The cause of Bell's palsy is not clear. Although stroke and transient ischemic attack may cause similar sign and symptoms of facial paralysis there is no link between Bell's palsy and either of these conditions. Most cases are supposed to be caused by an inflammation of the facial nerve in response to herpes virus that may be present in a dormant stage.

Clinical features: The patients may present with:

• Sudden weakness or paralysis of one side of the face that cause it to droop.
• Difficulty in closing the eye on he affected side of the face.
• Drooling of the saliva
• Pain in or behind the ear.
• Increased sensitivity to sounds
• Loss of facial expressions like smiling, frowning etc on the affected side.
• Inability to pucker the lips and whistle. 
• Numbness on the affected side of the face. 
• Loss of ability to taste.

Diagnosis: is usually clinical but in some cases CT scan or MRI may be advised.

Treatment:

1. Steroids have been shown to be effective and improves recovery and are thus recommended. Early treatment within 3 days of onset is necessary for good benefit.

2. Physiotherapy may be helpful for some patients in order to maintain muscle tone and stimulate the facial nerve. 

3. to reduce pain, heat may be applied to the affected side of the face.

4. Anti virals like acyclovir may or may not help in shortening the duration of the disease. 

5. Eye protection to avoid dryness and damage is very important. Lubricating eye drops and a covering eye pad are helpful.