Seventy-five per cent of cases of facial paralysis in adults are caused by an inflammation of the facial nerve

called Bell's palsy. This disorder (probably derived from a virus) is common, affecting 25 out of 100,000 individuals
per year. It is more common in people with diabetes. It usually affects one side of the face (very rarely both sides
at one time), causing a drooping mouth, drooling, and excessive tearing from one eye. Paralysis occurs within a few
hours to a few days. There may also be a loss of taste on the front of the tongue on the affected side of the face.
Sound may also seem louder on the affected side (hyperacusis).
While the facial distortion usually improves over time, there may be some permanent deformity in 20% of
individuals. Full recovery is less likely in older people, as well as those with hyperacusis, loss of taste, and severe
paralysis. Recurrence of paralysis on the same side or the opposite side occurs in 1 in 10 people.
In facial paralysis due to stroke, the eye on the affected side can be closed and the forehead can be wrinkled. This
is not possible with Bell's palsy. Other muscles on one side of the body may also be involved with a stroke.
Facial paralysis due to a brain tumor generally develops gradually with accompanying headaches,seizures, or
hearing loss.
In newborns, facial paralysis may result from birth trauma.

Common Causes:

 Bell's palsy
 Stroke
 Brain tumor
 Sarcoidosis
 Lyme disease
 Infection
 Birth trauma (newborns)

Facial Palsy can have several causes, varying from congenital, idiopathic, traumatic or due to an after-effect of
an oncologic surgery and otitis media.

The most frequent one is the idiopathic palsy or else called Bell Palsy. It occurs due to the edema of the facial
nerve inside the Facial canal in the Temporal bone.

Bell palsy assaults one in every thirty people during their life-time. There are studies showing that complete
recovery happens in most cases. In the remaining ones there is a partial recovery with significant after-effects
and the older the patient, the worse improvement can be.

The techniques most used nowadays to refresh the paralyzed face are the cross-face nerve graft and the
transposition of the temporalis muscle, the neurorrahphy between the hypoglossal nerve and the damaged
facial nerve and the microsurgical transplant of the gracilis muscle.

For recent paralysis, we prefer the cross-face nerve graft with the end-to-side neurorrhaphy. That means to
put one or two grafts of the sural nerve connecting the normal facial nerve to the paralyzed one without
splitting any of the face nerves up.

In older cases, we use the orthodromic transposition of the temporalis muscle.

Therefore, in order to smile the patient makes a small movement as of biting, contracting the temporalis
muscle and so pulling the corner of the mouth up in a smile-like movement. In the same way, in congenital
paralysis this orthodromic transposition of the temporalis muscle can also be used.
One of the most serious situations is the Moebius Syndrome, a kind of congenital paralysis that is bilateral. In
these cases we have been also using the orthodromic transposition of the temporalis muscle.
 What Is Bell's Palsy?
Bell's palsy is a temporary weakness or paralysis of the muscles on one side of the face. These muscles are
controlled by the facial nerve. Because there's a facial nerve on each side of a person's face, and Bell's palsy usually
affects just one nerve, people with Bell's palsy will most likely notice stiffness or weakness on one side of the face.
When the facial nerve is working properly, it carries a host of messages from the brain to the face. These messages
may tell an eyelid to close, one side of the mouth to smile or frown, or salivary glands to make spit. Facial nerves
also help our bodies make tears and taste favorite foods. But if the nerve swells and is compressed, as happens
with Bell's palsy, these messages don't get sent correctly. The result is weakness or temporary paralysis of the
muscles on one side of the face.

What Causes It?

Bell's palsy is most often connected with a viral infection such as herpes (the virus that causes cold sores), Epstein-
Barr (the virus that causes mono), or influenza (the flu). It's also associated with the infectious agent that
causes Lyme disease. Of course, this doesn't mean that everyone who has a viral infection or Lyme disease will
develop Bell's palsy — most people don't. But in a few people, the immune system's response to a viral infection
leads to inflammation of the nerve. Because it's swollen, the nerve gets compressed as it passes through a small
hole at the base of the skull, which causes the symptoms of Bell's palsy.

Bell's palsy can affect people of all ages, but it is most common in adults. People with diabetes and pregnant
women are more likely to develop Bell's palsy.

What Are the Signs and Symptoms?

The symptoms of Bell's palsy usually show up about 1 to 2 weeks after a viral infection. The symptoms tend to
come on quickly — usually Bell's palsy reaches its worst point within 48 hours. A few hours or days before Bell's
palsy develops fully, some people may have a headache or feel pain behind or in front of their ears. A person may
notice one side of his or her face droops or feels stiff. Some people may only notice a slight weakness, whereas
others may not be able to move that side of their face at all.

Other symptoms of Bell's palsy include:

 difficulty closing one eye all the way
 dryness in one eye
 trouble tasting at the front of the tongue on the affected side
 changes in the amount of saliva or drooling
 hearing sounds that seem louder than usual in one ear

Bell's palsy affects only the face, so if a person has weakness or symptoms in other parts of the body, the problem
has another cause.
How Is It Diagnosed?
If you have any of the symptoms of Bell's palsy, you should see a doctor as soon as possible.
The doctor will take a detailed medical history and perform a thorough exam to eliminate other possible causes of
your symptoms. The doctor will want to know over what period of time your symptoms developed, if you had any
preceding illness or trauma, and if you are noticing any other problems such as weakness or paralysis in other parts
of your body.
Tell the doctor if you are having problems like double vision or trouble swallowing or if you recently injured your
face or head. Because more serious conditions than Bell's palsy, such as an injury, can cause facial paralysis, it's
important to report any other problems you may be noticing.
There isn't a specific test for Bell's palsy, although a doctor may test for Lyme disease, herpes virus (HSV), or other
infection. Some infections, like Lyme, can be treated, but in most cases the virus that may have caused Bell's palsy
in the first place has usually passed.
If the doctor suspects some other cause for a person's symptoms, he or she may use imaging tests, such as X-rays,
computed tomography (CT) scans, and magnetic resonance imaging (MRI), to look inside the body and check for
other problems. Some doctors may recommend an electromyography (EMG), which tests how well the muscles
respond to nerve signals.

How Is It Treated?
For the symptoms of Bell's palsy to improve, the nerve needs to renew itself, and that can only happen with time.
However, some doctors may prescribe medicine to reduce inflammation. If a person with Bell's palsy is unable to
close one eye completely, the doctor may prescribe eyedrops, an eye patch, and protective glasses to make a
person feel more comfortable and to prevent damage to the cornea.
Although it can seem frightening at first, most people with Bell's palsy recover fully within 1 to 3 months. A few
people are left with some permanent facial weakness after recovering from Bell's palsy, though.

Taking Care of Yourself

It's important to eat well and get lots of sleep when you have Bell's palsy. Good nutrition and rest will help your
body as it heals itself.
One of the hardest things about having Bell's palsy can be dealing with the emotions that go with it. To begin with,
Bell's palsy can be just plain scary. And because Bell's palsy affects how your face looks for a while, you may feel
self-conscious or embarrassed in public. Even your close friends may tease you in what they think is a good-
natured way, but if it feels hurtful to you, tell them. Let people know why your face looks the way it does. Bell's
palsy isn't contagious, so no one can catch it from you, and nothing you or anyone else did caused it to happen.

Dealing with a condition like Bell's palsy often helps you find out who your friends really are. Rely on the people
you know can offer you the best support — your closest friends, family, or a school counselor, for example. Within
a couple of months, you should be back to your old self.