Bell's Palsy

What is Bell's palsy?

Bell's palsy is an unexplained episode of facial muscle weakness or paralysis that begins suddenly and worsens over three to five days. This condition results from damage to the 7th (facial) cranial nerve, and pain and discomfort usually occurs on one side of the face or head.

It can strike anyone at any age, but it occurs most often in pregnant women, and people who have diabetes, influenza, a cold or another upper respiratory ailment. According to the National Institute of Neurological Disorders and Stroke, this nerve disorder affects about 40,000 U.S. adults and children each year. Bell's palsy strikes men and woman equally. It is less common before age 15 or after age 60.

Bell's palsy is not considered permanent, but in rare cases it does not disappear. Currently, there is no known cure for Bell's palsy; however, recovery usually begins two weeks to six months from the onset of the symptoms. The majority of people with Bell's palsy recover full facial strength and expression.

What causes Bell's palsy?

A specific cause of Bell's palsy is unknown, however, it has been suggested that the disorder is due to inflammation that is directed by the body's immune system against the nerve controlling movement of the face. The weakness or symptoms seen in Bell's palsy is sometimes associated with the following:

• Diabetes

• High blood pressure

• Trauma

• Toxins

• Lyme disease

• Guillain-Barré syndrome

• Sarcoidosis

• Myasthenia gravis

• Infection, especially following a viral infection with Herpes simplex virus (a virus that is related to the cause of the common "cold sores" of the mouth)

These conditions cause weakness through a different mechanism than the usual inflammation of Bell's palsy.

What are the symptoms of Bell's palsy?

The following are the most common symptoms of Bell's palsy. However, each individual may experience symptoms differently. Symptoms may include:

• Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid

• Loss of feeling in the face

• Headache

• Tearing

• Drooling

• Loss of the sense of taste on the front two-thirds of the tongue

• Hypersensitivity to sound in the affected ear

• Inability to close the eye on the affected side of the face

  
  

Facial Reconstruction and Injuries

Facial reconstruction

Facial reconstruction, which is a subspecialty of craniofacial surgery, is surgery that rebuilds any part of the face, including bones and soft tissue. Injury, trauma and cancer are most often the cause for needing facial reconstruction surgery. Other patients come to plastic surgeons when a tumor, mole or other growth has been removed from the face; for growth or development problems; and for vascular or lymph malformations.

Using techniques employed in cosmetic and microvascular reconstructive surgery, like fat and skin grafting and bone and soft tissue transplantation, the surgeons can often replace missing or disfigured parts of the face with tissue and bone from nearby areas. For example, neck skin and fat can be moved up to the cheek to replace the skin and tissue there. Tissue can be removed from another part of the body (such as the abdomen or leg), moved to the face, and covered with skin from a nearby area.

Paralysis and pain

Facial paralysis and pain can be debilitating and cause those suffering from the conditions to retreat from the activities of daily living. Facial paralysis can be caused by a number of conditions, including:

• Traumatic injury
• tumor removal
• Surgery
• Stroke
• Infection
• Bells Palsy
• Moebius syndrome, a birth defect that results in the absence of the sixth and seventh facial cranial nerve
• Other congenital abnormalities

Facial pain generally stems from:

• Trigeminal Neuroma
• Trigeminal Neuragia
• Atypical Facial Pain

Pediatric Reconstruction

Depending on the condition, the child may be able to have surgery within his or her first year of life. In some cases, it may be better to wait longer. And in other cases, a series of surgeries may be needed. 

Craniofacial Conditions and Syndromes

Craniofacial microsomia, sometimes known as hemifacial microsomia or otomandibular dysostosis, among other names, is a condition that causes children to be born with underdeveloped or small parts of the face, most commonly the jaw and ear (which may be called microtia). After cleft lips and palates, this is the most common facial birth defect.
Some children are born with Pierre Robin Sequence, which may also be called Pierre Robin Syndrome or Pierre Robin Malformation. It is characterized by a jaw that is too small, a cleft palate, retraction of the tongue and upper airway obstruction. As with other types of facial conditions, the jaw and cleft palate can be repaired with surgery.

Obstetric brachial plexus injury

In infants, brachial plexus injury most often occurs during an abnormal or difficult birth, causing damage to the brachial plexus nerves (shoulder dystosia). Depending on the injury, a baby may be diagnosed with different kinds of palsy, including Erb’s palsy and Klumpke’s palsy. In about one in 10 cases, the child will need some kind of surgery to repair the nerves. Generally, surgeons recommend that the surgery be done when children are between the ages of four and nine months.
Jaw surgeries: For a child born with a small jaw or receding chin, a reconstructive surgeon can correct the condition through several different kinds of surgery. Most commonly, the reconstructive surgeon will cut the jawbone, a procedure known as an osteotomy, to reposition it using titanium screws and plates, which eliminates the need for wiring the teeth together.
Another technique, distraction osteogenesis, splits the jawbone and then moves the jawbone slowly by inserting a screw either inside the mouth or outside and turning it periodically over a few weeks. The advantage of the distraction technique is that it simultaneously increases bone length and the volume of the soft tissue around the bones.
The plastic surgeon may also create a new jawbone structure using bone grafts from the ribs, hips, or skull, or alloplastic grafts, which are created from synthetic materials.
Ear surgeries: Reconstructing the ear to make it a normal size will likely require three surgeries over a period of time. In some cases, a child may need an artificial or prosthetic ear, which also requires several surgeries.
Repairing the ear can take anywhere from two to four surgeries. The reconstructive surgeon may recommend using the child’s ribs to reconstruct the ear or may decide that an alloplast—synthetic material—would be best.

Jaw Synthesized Information

Problems with the jaw can result in difficulty speaking, eating, swallowing, breathing, and sleeping. Some people may have a facial disfigurement—a severely receding chin or protruding jaw or an unbalanced appearance from the front or side. In some cases, jaw problems can be the source of other health problems, such as debilitating headaches or sleep apnea. A severe overbite or underbite may make it impossible to close the teeth or lips together.

The most common jaw problem in children is cleft lip and palate.

Correcting jaw problems

A reconstructive surgeon can correct jaw conditions and injuries through surgery that repositions the jaw. This is sometimes called a maxillofacial procedure. Most commonly, the reconstructive surgeon will cut the jawbone, a procedure known as an osteotomy, to reposition it using titanium screws and plates. This eliminates the need for wiring the teeth together.

Another technique, distraction osteogenesis, splits the jawbone and then moves the jawbone slowly by inserting a screw either inside the mouth or outside and turning it periodically over a few weeks. The advantage of the distraction technique is that it simultaneously increases bone length and the volume of the soft tissue around the bones.

The plastic surgeon may also use bone grafts, taking bone from ribs, hips, or skull, or alloplastic grafts, created from synthetic materials, to create a new jawbone structure.

Reconstructive jaw surgery is major surgery that will require general anesthesia and a hospital stay of a few days as well as recovery time at home afterward.