Lori: Feeling a Little 'Down in the Mouth'

Lori called me at work Thursday with an odd question: "What does it mean if, when I smile, only half of my face moves?" She had been struggling with a touch of the flu for a few days, and, knowing that, my heart sank. I have seen a few cases of Bell's palsy in my practice; it is not a fun condition at all and it is often preceded by a viral illness like the one she had.Sure enough, when I got home that night Lori described how she had felt a little weird in that side of her face all day, and then had developed actual weakness on the right side. She had also noticed that she was having a hard time tasting anything at all, and that she had a vague pain in and behind her right ear. By the next morning, she couldn't take a drink without half of it running out that side, and she couldn't shut her right eyelid all the way.

As it turns out, the eye symptoms are the worst part of the whole illness. The affected eye dries out quickly and has to be lubricated constantly. The irritation and burning are driving her to distraction, and the eyelid on that side is inflamed from all the various tapes and patches she has been trying to keep the darn thing shut. This seems to be the most comfortable method she has found so far; unfortunately, it isn't exactly inconspicuous!As long as she isn't trying to move her face, she looks pretty normal.
But, when she tries to smile, or talk, or eat, or drink, the right side of her face won't move. The left side gets pulled over to the left, since there isn't anything to oppose the contractions of the muscles on that side. When she blinks, her eye rolls back in her head, but the eyelid doesn't close, so that looks kind of creepy.Medically, Bell's palsy is interesting because it helps teach the neuroanatomy of the facial nerve. When the nerve signals are interrupted after they leave the brain, the entire side of the face is affected, including the forehead; if the nerve fibers are interrupted inside the brain (such as with a brain tumor or certain strokes, the forehead often works normally because the signals from the other side of the brain compensate for the loss of signal to that area. Here is an illustration of how that works.The second diagram here shows which types of nerve fibers run through the facial nerve. This explains why she can't taste things very well, and why she has to use lubricating drops in the eye even when she has it constantly patched and closed; the tear glands don't work well when denervated. Some people get dry mouth because the salivary glands are affected. She hasn't had that symptom, thank goodness. There is a muscle in the ear called the "stapedius." This muscle helps dampen loud noises, and it gets taken out of commission by the palsy. This explains why everything sounds loud to Lori right now.Bell's palsy is almost always temporary, but the time it takes for the damaged facial nerve to regain function is variable; it can return in 2 weeks, or it can take up to 6 months. My ENT friend says that, in most cases, even severe ones, most function has returned within 2 months. We're certainly hoping for a quick recovery, and our family had a special fast today for her. This is no fun for her and we feel bad! She is a trooper, though, and besides, if she cries it is only out of one eye anyway, so what would be the point of that? We all think she is beautiful no matter what!