Also known as facial nerve neuritis, Bell’s palsy is a rapidly progressive paralysis of the face. Several studies have implicated the herpes family of viruses as the cause of this disorder although the exact mechanism is not well understood. The fact that most Bell’s palsy is mediated by herpes simplex virus does not mean that you have a sexually transmitted disease. The virus remains dormant in nerve cells in many people and only manifests itself in certain conditions such as stress or poor immune system. When the chicken pox virus, which is also from the same virus family, is the cause, the disease is called Ramsey-Hunt Syndrome and much more severe in symptoms. These patients usually present with severe ear pain, hearing loss, balance issues and vesicles in the ear.
In general the prognosis of Bell’s palsy is excellent. It the paralysis is not complete a perfect resolution is expected. Per recent guidelines by the American Academy of Otolaryngology-Head and Neck Surgery, no further work up is needed in such cases.
People with other neurologic symptoms or slow progression of paralysis do not have Bell’s palsy and need different workup and treatment.
Even in cases that paralysis is dense, most patients would regain excellent or near excellent facial function. The main treatment for Bell’s palsy is oral corticosteroids. Antivirals (Valcycovir AKA Valtrex) have also shown to be helpful when administered within the first 72 hours of presentation.
Electroneurography and facial nerve decompression have been suggested for patients with complete dense paralysis but remain controversial topics.