Condition guide
Bell’s palsy is a sudden weakness of one half of the face, caused by the facial nerve being affected. Most people recover within weeks or months. The two most important steps are steroid treatment started within the first three days and protecting the eye; working the face hard, on the other hand, does not speed up recovery.
The facial nerve (the seventh cranial nerve), which works the muscles of the face, is affected; one side of the face becomes weak or does not move at all. Symptoms come on suddenly, over 48–72 hours.
The exact cause is not known. The reactivation of a virus lying dormant in the body (such as the cold sore or chickenpox virus) is counted among the possible triggers. Pregnancy, diabetes, high blood pressure, obesity and upper respiratory infections raise the risk.
Steroids. A ten-day course of steroids is usually given, sometimes with an antiviral medicine. In the Cochrane review of seven trials (895 people), the face did not recover fully in 17% of those who took steroids and 28% of those who did not; in other words, for every ten people treated, one incomplete recovery is avoided. There was no meaningful difference in side effects between the two groups. Because treatment is more effective when it starts within the first 72 hours, it is important not to wait.
Protecting the eye. When the eye does not close, its surface dries out and can be damaged. Eye drops are used during the day and eye ointment at night; during sleep the eye is kept closed with the tape your doctor recommends. Outdoors, wraparound glasses help protect the eye from wind and dust. If blinking is difficult, you can gently close the eyelid with the back of your finger.
Soft foods with extra sauce are easier to eat. After eating, check the inside of your cheek for leftover food and brush your teeth. If drinks spill, use a straw or a cup with a spout; supporting your lower lip with a finger also helps.
The first instinct is to “work” the face hard. Yet specialist organisations in facial palsy recommend the opposite in the early stage. According to Facial Palsy UK, there is no need to exercise the face in this period; it does not speed up recovery. Forcing movements, trying to squeeze the eye shut and chewing gum can cause unintended side effects. The charity sums it up like this: if you use your face as gently as possible rather than as hard as possible throughout your recovery, you are likely to get a better recovery with fewer side effects.
Things change once movement starts to return. According to the Cochrane review of physical treatments (12 trials, 872 people), tailored facial exercises can improve facial function, mainly in moderate and long-standing palsy; the quality of the evidence is low. In the same review, electrical stimulation was no better than a sham treatment.
During recovery some people develop involuntary linked movements; for example, the eye narrows when smiling. This is why movements are done in front of a mirror, slowly, small and equal on both sides. Before starting exercises, it is best to be assessed by a physiotherapist experienced in facial rehabilitation.
The Cochrane review of six trials (537 people) could not reach a conclusion on whether acupuncture works for Bell’s palsy, because the quality of the trials was inadequate; no side effects were reported, but the trials had not recorded them systematically. Facial Palsy UK advises avoiding acupuncture that passes electrical stimulation through the needles in the early stage.
My personal clinical observation
In my own clinical observation, I have seen acupuncture be seriously effective in Bell’s palsy. I share this as my own observation, not as a research finding; not everyone may respond in the same way.
In Turkey, acupuncture may only be performed by doctors certified in the field, in units authorised by the Ministry of Health. Think of acupuncture as an addition to medical treatment and rehabilitation, not a replacement for them.
Care at home
The first three are for the first weeks: they protect the eye and keep the muscles soft. The last three are done only once movement starts to return, and preferably after your physiotherapist has agreed. The rule is the same for all of them: slow, small, without forcing.
If your eye does not close on its own, with a clean hand place the back of your index finger on your upper eyelid; gently bring the lid down and keep it closed for a few seconds. This helps the surface of the eye stay moist. Do not try to squeeze the eye shut.
Often through the dayWith your fingertips, make slow, small circles on your forehead, temple, cheek, chin and neck. Do not press; there should be no pain or discomfort. This helps the muscles stay soft and flexible.
A few minutes, several times a daySit comfortably; relax your shoulders and jaw, with your teeth not touching. Take a calm breath in through your nose and let it out slowly. Feel both sides of your face soften. Tension makes you strain the face; relaxing is part of the care too.
5–10 breaths, several times a dayIf movement has started to return, stand in front of a mirror. With your lips closed, smile very slightly; the aim is not a big smile but for both corners of the mouth to move equally. If the unaffected side takes over, make the movement smaller. Hold for 2–3 seconds and release slowly.
5 repetitions, 2–3 times a dayLooking in the mirror, raise both eyebrows together, slowly and only a little. If an unwanted movement starts around your eye or mouth, stop and make the movement smaller.
5 repetitions, 2–3 times a dayLooking in the mirror, slowly gather your lips forwards as if giving a kiss; watch that both sides move equally. Hold for 2–3 seconds and relax. Do not use force.
5 repetitions, 2–3 times a dayThese practices are for facial nerve palsy. If the weakness in the face is due to a stroke, the programme is different; ask your rehabilitation team.
Video
Two videos made for the early stage of the palsy, from the YouTube channel of Queen Victoria Hospital, a UK hospital specialising in the treatment of facial palsy.
A video showing how the eye is taped for the night when it does not close.
A video showing the massage applied to the facial muscles in the early stage.
In most people symptoms start to improve within a few weeks and clear within six months; for some it can take longer, or lasting effects may remain. Steroid treatment started within the first 72 hours improves the chance of full recovery. If there is no improvement at all within three weeks, see your doctor again.
In the first weeks, working the face hard does not speed up recovery and can also cause unwanted effects; eye care and gentle massage are enough in this period. Once movement starts to return, and preferably after assessment by a physiotherapist, you begin with small movements in front of a mirror, equal on both sides.
In the Cochrane review of four trials (313 people), electrical stimulation was no better than a sham treatment for recovery at six months; in one low-quality trial the results were worse. It is therefore not routinely recommended.
Research cannot say for certain: the Cochrane review of six trials could not reach a conclusion because the quality of the trials was inadequate. In my own clinical observation, however, I have seen acupuncture be seriously effective in Bell’s palsy. In Turkey only certified doctors may perform acupuncture; it does not replace steroid treatment or eye care.
See a doctor without delay if you have any of the following:
Sources
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