Bell's palsy

Bell's palsy is a one-sided facial paralysis that develops suddenly and may be accompanied by pain behind the ear. We assume it arises from inflammation and swelling of the facial nerve in its bony canal through the skull. The root cause is beleived to be a viral infection. The swelling reduces blood supply to the nerve, much as sleeping on your arm makes it temporarily numb and tingling (compression of the median nerve at the elbow).

Bell's palsy is easy to diagnose by simply having the child grimace and show his teeth, or by provoking the younger child to cry. The paralysed side of the face remains mask-like; the face around the mouth does not withdraw and bare the teeth and the eyebrows don't "scrunch" properly. The affected eye will usually not quite close all the way in sleep, and if the child is asked to keep his eyes tightly shut, they can be opened by the examiner without resistance.

Ordinarily, release of the pressure on the nerve produces rapid recovery of function. Steroid therapy is initiated as soon as possible after the onset of the paralysis and is continued for 10 days to minimize the inflammatory reaction. Nerve conduction studies may be performed by a neurologist to predict whether function is likely to be recovered, and whether more aggressive management is advisable. The usual rule of thumb is that 85% of patients are going to get full function back; if the child is not showing signs of improvement by around three weeks, a surgical decompression of the nerve may be suggested.

Bell's Palsy in newborns is rare; it should get better with time and shortly at that. It would be caused by pressure on the facial nerve during passage through the birth canal. However, asymmetric crying facies is a condition more common in newborns, in my experience. It is a congenital birth defect of the nerve that controls the muscles around the mouth ("orbicularis ori") on the side that does not move properly.

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