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Drooping in Face – Bells’ Palsy

Postpartum Bell’s Palsy is when facial muscles become paralysed after birth and usually happens about 7-10 days after birth.  It is thought to occur as a result of ischaemic compression following inflammation of the nerve in the region of the geniculate ganglion as it passes along the narrow part of the facial canal (1).  If you notice symptoms please seek medical attention immediately.

Signs & Symptoms of Bell's Palsy

Usually the symptoms of a one sided facial droop happen suddenly and become worse within the next 48 hours.  There are other associated symptoms that can be experienced such as:

  • Loss of feeling in the face
  • Pain in the face
  • Ringing in the ear
  • Drooling
  • Headache
  • Excessive tear production
  • Speech issues
  • Sense of taste loss
  • Problems with closing the eye or blinking
  • Difficulty smiling
  • Sound hypersensitivity

Treatment Options

Treatment will always depend on the individual and the doctors preference but common treatments can include a course of Steroid medication which will help reduce the inflammation of the nerve (1).   Antivirals are sometimes offered but their efficacy is undetermined (1).

Traditional Chinese Acupuncture is believed to help by stimulating the muscles and promoting blood circulation to the face.  In addition helping reduce inflammation of the nerve (2).  The evidence though is limited (3).

An alternative non medication treatment is Physical Therapy where they can prescribe exercises to rebuild muscle and facial function and also try Electrotherapy and Acupuncture.  While there is limited research into the efficacy of facial exercises to help Bells Palsy (4) it is know than during the course of Bells Palsy that muscles can shorten and tighten.  And certain exercises can help maximise the return of muscle movement while the facial nerves recover. Some Exercises to try are below.

Exercises

eyebrows

EYEBROW EXERCISES

  1. Look in the mirror and raise your eyebrows up and try to hold them there until your corner of your mouth or cheek begins to move.  If within 15 seconds do not worry just relax and try again. Repeat 3 times
  2. Place your fingertips on affected eyebrow and massage firmly with your fingertips up to the hairline
  3. Try to draw your eyebrows down making a frowning face.
eyes

LIP EXERCISES 

  1. Lightly press your lips together and maintain this until your eyelids begin to move.
  2. Pucker both lips and keep the pucker for 10 seconds.  Try each time to do for longer ie. 20 seconds then 30 seconds.
  3. Try to Smile while keeping your neck muscles relaxed
  4. Try to Smile with mouth open and then with mouth closed
  5. Try puffing your cheeks keeping the air in so no air escapes holding for 10 seconds
lips

EYE EXERCISES 

  1. Try squinting your eyes making them narrower as if looking at the sun then closing your affected eye gently
  2. Keep your neck straight while trying to look down
  3. Close your affected eyelid and place your index finger over the eyes eyebrow to try and stretch eyebrow upwards
  4. Wink one eye gently and then the other eye
nose

NOSE EXERCISES 

  1. Try wrinkling your nose
  2. Take deep breath in through your nostrils and try to flare them

Recovery

If symptoms last longer than about 8 months and treatments above have no effect then there are other treatments available such as Botox, Neuromuscular Retraining (NMR) and Selective Neurolysis.  Your Doctor should be able to advise you on whether any of these treatments may be helpful.  More information about the treatments from The Facial Paralysis Institute. 

Botox – Non surgical injections are administered to the unaffected side of the face relaxing the overactive muscles and restoring symmetry and facial appearance – takes about 10-15 mins in a clinic and usually takes about 1-2 weeks for results to reach maximal levels and usually last about 4 months

NMR – for of Physical Therapy by an Occupational Therapist or Physical Therapist who are trained in neuromuscular therapy.  Can be offered concurrently with Botox injections

Selective Neurolysis – Surgery to provide reanimation of a lost smile and involves intricate mapping of the facial nerves to weak those nerves counterproductive to the smile mechanism.  Results usually within 1 day and are permenant.

REFERENCES

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