By Jose Pujalte Jr.
“The serial number of a human specimen is the face, that accidental and unrepeatable combination of features.”— Milan Kundera (b. 1929), Czech author, critic. Immortality, pt. 1, ch. 3 (1991).
No one wants her face to sag. The idea scares vain women (and vain men). Surely, sagging means loss of elasticity, and youth, and beauty. But it could also mean, particularly if only one side of the face is affected, a malady called Bell’s palsy.
It was in 1882, in Edinburgh, when Charles Bell first reported a condition where the muscles that controlled facial expression were weakened or paralyzed. Interestingly, only half of the face was involved and this gave the unusual appearance of that side drooping while the rest of the face did not.
Who gets it and why. Men and women are affected equally. They are often between the ages of 30 and 60. For some reason, pregnant women, people with diabetes and influenza are at risk. The exact cause of Bell’s palsy is unknown but it is often related to a viral infection from herpes zoster. Japanese researchers have also implicated herpes simplex I or the cold sore virus. What is known is that Bell’s palsy results from the inflammation of the facial nerve (cranial nerve VII). Since the canal through which it passes through in the face is narrow, as the nerve swells it is compressed and the muscles it supplies suffer.
Signs and symptoms. The trouble with the facial nerve is that it is long and has many branches (5 major ones superficially alone!). Restriction along its course will have a corresponding sign or symptom. The onset may be sudden or over a few days. These include:
* Weakness or paralysis of one side of the face.
* Drooping of one side of the face.
* Difficulty in closing one eye.
* Sound appearing louder in one ear.
* Facial stiffness or numbness and the sensation it is being pulled to one side.
* Loss of taste one side of the tongue.
* Pain in front or behind the ear.
Diagnosis. A neurologist, ENT specialist, family medicine doctor may all help. They will certainly work to find out that it is not stroke (cerebrovascular accident), a tumor, or an infection. A test that measures nerve function and conduction (electromyography or EMG) may be requested. X-rays and MRI (magnetic resonance imaging) are in order.
Treatment. Medications include pain-killers, steroids (for inflammation) and antivirals like acyclovir to reduce nerve damage. The good news is that 80% of patients recover within 3 months. The rest recover partially but some don’t at all. While many factors determine recovery, early recognition of facial weakness should alert the patient to seek treatment promptly.
While Milan Kundera writes that the face is “that accidental and unrepeatable combination of features,” let us hope that one-sided drooping isn’t one of those.
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