Bell's Palsy Symptoms 

The onset of paralysis is sudden with Bells palsy and Ramsey Hunt syndrome, although symptoms can worsen during the early days. Bell's palsy symptoms typically peak within a few days, although it can take as long as 2 weeks. Ramsey Hunt syndrome symptoms will peak within 3 weeks. If paralysis develops slowly, tests for other causes of the palsy must be done. Patients with recurrences, particularly if within close time frames, should also be re-evaluated as a precautionary measure. 

Psychologically, facial paralysis can be devastating, particularly in cases that extend for a long period, or where residuals  are significant. Friends, family and doctors often have no true concept of how deeply  the patient's sense of self and self-esteem is affected. You will also find that they have little or no understanding of your physical discomfort, difficulty and frustration as you struggle to do seemingly simple things that they take for granted. 

There are many physical symptoms associated with facial paralysis, but the effects will differ between individuals. They can vary in accordance with the degree of nerve damage, and the location of the damage. 

GENERAL

• Muscle weakness or paralysis 
• Forehead wrinkles disappear 
• Overall droopy appearance 
• Impossible or difficult to blink 
• Nose runs 
• Nose  is constantly stuffed 
• Difficulty speaking 
• Difficulty eating and drinking 
• Sensitivity  to sound (hyperacusis) 
• Excess or reduced salivation 
• Facial swelling 
• Diminished or distorted taste 
• Pain in or near  the ear 
• Drooling 

EYE RELATED 

• Eye closure difficult  or impossible 
• Lack of tears 
• Excessive tearing 
• Brow droop 
• Tears fail to coat cornea 
• Lower eyelid droop 
• Sensitivity to light 

ADDITIONAL SYMPTOMS WITH RAMSEY HUNT SYNDROME 

• Hearing deficit 
• Severe pain 
• Long lasting pain 
• Vertigo 
• Blisters  in ear or other areas 
• Nausea 

RESIDUAL EFFECTS 

• Eye appears smaller 
• Blink remains incomplete or infrequent 
• Tearing abnormalities 
• Asymmetrical smile 
• Mouth pulls up and outward 
• Sinus problems 
• Nose runs during physical exertion 
• Post paralytic hemifacial spasm 
• Hypertonic muscles 
• Co-contracting muscles 
• Synkinesis (oral/ocular well known, but  can affect any muscle group) 
• Sweating while eating or during physical exertion 
• Muscles become more flaccid when tired, or during minor illness 
• Muscles stiffen when exposed  to cold, when tired, or during illness 
• Although the damage that causes the paralysis is specific  to the 7th nerve, other nerves may be temporarily irritated. For example, temporary facial numbness or pain can result when CN-V is irritated. 

Recovery is not consistent among patients. For some people the mouth may move before the ability to blink returns; in others it will be eyelids first  and mouth last. Twitching may precede movement, but it doesn't always. Pain  in areas starting  to "wake up" may occur,  or may not. The sense  of taste can be odd as  the sensation returns, or the sense  of taste may return without any awareness  of the change. Recovery can be gradual, rapid,  or hit occassional plateaus. Et cetera. 

RESIDUAL EFFECTS 

Residuals may be due to one, or a combination  of several factors. Initial trauma to the nerve can be minor  and temporary, or significant  and long lasting. When the damage is minor, recovery is likely  to be essentially complete, and rapid. With more extensive damage, other factors begin to effect recovery. 

In longer recoveries, other cranial nerves  may try to take over for the 7th nerve, growing into passageways formerly occupied by the 7th nerve. Also, the 7th nerve can regenerate incorrectly, taking some different paths than it had followed before Bells palsy. The result is "crossed wiring" and synkinesis, which is further described in the next section. 

After paralysis facial muscles have a tendancy to become hypertonic. This means they tend to be overactive, contracting when they should be at rest. Typical signs are a squinty eye, the mouth pulling up, a sore  or swollen cheek, and deepened creases. Unlike skeletal muscles, facial muscles lack spindles. Muscle spindles sense when a muscle is in a contracted state, and nerves can send  the appropriate signal to the muscle telling it to relax. Without these spindles, there is no awareness of the contraction,  and the muscles remain in a state  of tension. A muscle that can not fully relax also can not fully contract, so the range of motion becomes limited. 

Learned misuse and disuse of the muscles also can effect both appearance and mobility. While the muscles are paralysed, it's natural  to try to eat, drink and speak, etc., as well as you can. New habits may be learned while you're compensating for the nonworking muscles. You may inadvertantly call  on inappropriate muscles to join forces and work together to accomplish movements that aren't happening on their own (learned misuse). Or you may become accustomed to compensating without using  the lazy muscles (learned disuse). The effects of both may remain after nerve function returns. Both can also effect the "good"  side, which may have learned unnatural patterns while its muscles were assisting the nonworking muscles. 

Physical therapy can minimize asymmetrical appearance  and improve mobility, even when therapy is started years after the initial paralysis. 

Notes: DrJMinor

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EditText of this page (last edited December 17, 2009)