Charles Bell - Bell’s Palsy
EDP column by Dr Ketan Dhatariya

“I cannot move the right side of my face. My GP tells me that I have a ‘Bell’s palsy’. What is this?”

Charles Bell (1774-1842) first described this condition in the early 1800’s. He was a renowned artist and surgeon, famed for his work during the battle of waterloo and for his excellence as a teacher. He qualified in Edinburgh, but was in part responsible for setting up the Middlesex Hospital Medical School in London.

A Bells Palsy is caused by damage to the nerve that controls the muscles of facial expression. This is also known as the facial nerve. It occurs to about 1 in 5000 people per year, and occurs more frequently in the elderly.

Bells Palsy is characterised by the fact that no one knows what causes it. It is usually of sudden onset and may be preceded by weakness of the entire half of the face, and is sometimes accompanied by pain and swelling behind the ears and neck stiffness. This is then followed by paralysis. You may notice that salivation and tear production can’t be controlled so that you drool and appear to be crying on that side of the face. At the more severe end of the spectrum cannot close the eye on the affected side and because this can lead to the eye becoming too dry, your GP may give you artificial tears that you will need to drop into your eye on a regular basis. The paralysis leads to facial expression being distorted.

Very occasionally the condition is associated with an infection within the ear. This is because as the nerve passes from the brain to the facial muscles, it passes through the ear, and it there is an infection, then this can affect the nerve giving rise to facial muscle weakness. This is known as Ramsey-Hunt syndrome.

Most people recover completely. Recovery may be swift in up to 50% of people, starting within a matter of weeks, and recovering within 3 to 6 months. However in others, it may take up to a year to recover. Unfortunately, a small number of people are left with permanent weakness.

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