Monday, February 16, 2009

The way I treat my Bell's Palsy cases

Bells palsy is a LMN type of lesion of facial nerve. usually theere is a compressive pathology i.e. a oedema withing the outlet of facial nerve in the mastoid canal. the muscles of one side of the face are flaccid.

In many of my patients i found the following history:

Travel in bus or car for a long journey, with cold air hitting the affeted side face. i few cases patients repot of taking icecream & ear-ache.

some common suspected causes are:

- virus

- compression of nerve

- bacteria

- drugs

- cold temperature

- trauma of the facial nerve

- Pressure of facial nerve due to tumor

As a physical therapist i recommend a 21 day physical therapy course consising of following treatment modalities (i dont how many of these modalities are evidence based but i have been using them for at least 10 years now):

1. Facial Massage for 5-10 minutes twice a day in a chin - forehead direction to maintain the tone.

2. Infrared on the affected side to increase the blood supply and decrease skin resistance before ES application/ i many cases i chose monode SWD in subthermal doses.

3. Electrical Nerve Stimulation application to the nerve and muscle (i go for galvanic stimulation rather than faradic stimulation 5-10 mins with rectangular pulses).

4. Patient Education and advice. Patient should lie down at intervals to reduce the effects of gravity upon the paralyzed muscle. The eye should be blinked regularly because the blink reflex is lost.

5. The most important of all is Facial Exercise. following are some facial exercises i tell my patients:

- Closing eyelids

- Frowning

- Expression of surprise

- Wrinkling of the nose

- Pursing of the lips

- Compresses the cheek against the teeth

- Blowing

- Smiling

- uttering vowels in loud voice.

That’s it.. My patient was just treated for 3 weeks.


  1. Thank you for posting this. I just got Bell's Palsy this weekend right before my best friend's wedding. The doctor at the ER thinks I have gotten Bell's because I also have shingles around the nerves in my ear. That is also not fun.

  2. Please visit a neurologist as soon as possible


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