Facial paralysis and sensitivity are alarming symptoms of Bell's palsy, but full recovery is possible, especially when treated at the right time.
Every year, about 40,000 people in the United States are diagnosed with Bell’s palsy. Defined as a partial weakness or paralysis of the face, it can be an alarming occurrence in someone’s life. The good news is that 85% of people who are diagnosed with Bell’s palsy recover within a few months.
The Facial Plastic and Reconstructive Surgery Division of the Jefferson Health Department of Otolaryngology – Head and Neck Surgery has recently introduced its Facial Nerve Center. For those who have more severe cases of Bell’s palsy—as well as other facial nerve conditions—the Jefferson Facial Nerve Center uses a combination of surgical treatment, botulinum toxin (Botox) injections, and a specialized facial nerve rehabilitation program.
We spoke with Dr. Ryan Heffelfinger, otolaryngologist and director of facial plastic and reconstructive surgery, and Stacey Baer, occupational therapist and facial nerve rehabilitation specialist at the Jefferson Facial Nerve Center, to learn more about Bell’s palsy, its symptoms, and how it’s treated.
Bell’s Palsy Basics
The hallmark symptoms of Bell’s palsy include drooping or weakness of one side of the face, loss of feeling, disordered facial movements, drooling, tearing, loss of sense of taste, and hypersensitivity to sound on the affected side of the face.
“If you experience these symptoms, it’s important to see your doctor or visit the emergency room within the first 72 hours,” says Dr. Heffelfinger. “You’ll likely be treated with steroids and possibly an antiviral. Patients who are treated within the first 72 hours have better outcomes than those who aren’t.”
While the cause of Bell’s palsy is still unknown, researchers are continually working towards pinpointing its risk factors. “It’s also unknown why some people recover within a few months, and some don’t. But we’re here to help the 15% of people who are still suffering from facial weakness, even years after the onset of Bell’s palsy,” says Baer.
For those who don’t completely recover from Bell’s palsy, Jefferson Facial Nerve Center takes a team approach to treatment. “Once we determine if the patient is having an incomplete or abnormal recovery, we think about how to best approach treatments—starting with non-surgical options,” says Dr. Heffelfinger.
“Once facial nerves have been injured, the muscles are no longer active—the fascia (connective tissue) around them becomes tight and causes the muscles to feel sore and stiff. To treat this, we’ll use a combination of facial tissue massage, which helps break down the connective tissue, and neuromuscular training exercises, which re-train and coordinate facial muscles,” says Baer.
“In conjunction with rehabilitation and massage, we can use Botox injections to even out the facial appearance and improve muscle coordination,” says Dr. Heffelfinger.
Some patients with Bell’s palsy develop a symptom called synkinesis, which is an abnormal involuntary movement of facial muscles. Patients with synkinesis may find that their eye closes when they try to smile or drink from a cup. One muscle movement triggers another involuntary one. “We can treat synkinesis with Botox injections, which will selectively paralyze muscles,” says Dr. Heffelfinger.
Another non-surgical treatment option is to use fillers, which are injected under the skin and can help immensely with facial appearance. “Fillers can weigh down the upper eyelid to help it close, provide volume to the lips to treat drooling or even out the face, so one side appears less droopy,” he says.
If Bell’s palsy patients still have symptoms after rehabilitation, physical therapy, and injections, the Facial Nerve Center team will discuss surgical options. “Surgical interventions vary depending on the patient and their symptoms. For example, we can insert eyelid weights in people who can’t close their eyes,” says Dr. Heffelfinger
“More recently, we’ve started to perform synkinesis surgery in which we identify branches of the facial nerve through incisions around the ear—much like when we perform a facelift—then determine which nerves are the culprits for the patient’s symptoms and cut those nerves, so they’re no longer active.”
Bell’s Palsy and the COVID-19 Vaccine
If Bell’s palsy sounds familiar, you may have seen the disorder in the news alongside the COVID-19 vaccine, as a few participants in the vaccine trial were diagnosed with the disorder. But we’re here to do some medical myth-busting: The incidence level of Bell’s palsy among vaccine recipients is about the same as in the general population. Meaning, you have the same likelihood of developing Bell’s palsy after receiving the vaccine as you do before getting the vaccine.
Why Choose the Jefferson Facial Nerve Center
Dr. Heffelfinger and Baer work alongside their colleague Dr. Howard Krein, director of the Herbert Kean Center for Facial Aesthetics, to treat a myriad of patients with facial weakness. “It’s very rare to have a facial nerve rehabilitation expert work hand-in-hand with physicians and surgeons. But Stacey Baer, Dr. Krein and I take a team approach to every patient we treat. We see patients together, share information and come up with cohesive treatment plans,” says Dr. Heffelfinger.
Patients who visit the Jefferson Facial Nerve Center can feel confident about the care they will receive. “We plan our treatments always focusing on the patients’ top priorities, whether it’s being able to drink out of a cup again or simply feeling less self-conscious about their appearance in social settings,” says Baer.
The Jefferson Facial Nerve Center is the only treatment center in the area that specializes in facial nerve rehabilitation. “We’ve worked with patients who had untreated facial asymmetry and synkinesis for 30+ years and have successfully improved their facial function through our effective treatment combinations,” says Baer. “We are providing new hope to patients with chronic facial nerve disorders who otherwise have not had innovative treatment options.”