Massage & Bodywork

July/August 2009

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pathology perspectives BY RUTH WERNER THE MANY FACES OF BELL'S PALSY Imagine one morning that you wake up and, as usual, shuffle into the bathroom. A quick glance in the mirror yields an unpleasant surprise: somehow in the night the right side of your face seems to have fallen. No matter how hard you try, you can't seem to make it move. Your right eyebrow sags, and you can't close that eye all the way. When you try, your right eye rolls up and inward. Your cheek droops, and an attempt at a smile reveals an unfamiliar grimace. Your face doesn't particularly hurt, but you're aware of a numb feeling. Furthermore, your taste sensation seems off: everything on the right side of your mouth has a vaguely soapy flavor. Noises are louder too—the running water in the bathroom is enough to make you wince, but only the left side of your face can move. You wonder, as panic begins to rise: Did you have a stroke? Do you have a tumor? Is there any way to fix this? Will you look like this forever? This is the textbook presentation of Bell's palsy, which is classified as damage to the facial nerve (cranial nerve VII) leading to a unilateral peripheral facial paresis or paralysis.1 What a diagnosis of Bell's palsy doesn't identify is the source of the nerve damage. Viral infection, bacterial infection, mechanical compression, and other factors can all impact the functioning of the facial nerve, but each cause requires a different treatment strategy for the best results. In this article, we will examine the many faces (pun intended) of Bell's palsy and discuss where and when massage might be included in a treatment strategy. WHAT IS BELL'S PALSY? Bell's palsy, named for British physician Dr. Charles Bell, was first described in 1821. It is a sudden onset (usually over the course of 1–3 days, often overnight) of one-sided flaccid paralysis of the face. Flaccid paralysis means the muscles become hypotonic: soft and weak. This is a typical sign of peripheral motor nerve damage. Because Bell's palsy comes on so dramatically—often without warning— people fear that they have had a stroke or brain tumor. In the United States, about one out of every 65 people will experience this condition at some point. Pregnant women and people with diabetes are more at risk than the rest of the population, and it is most common among people in their 40s.2 While many experts describe this condition as idiopathic, a source of facial nerve compression can often be found. It is important to identify exactly what is pressing on or irritating the facial nerve, because different problems require different solutions. visit massageandbodywork.com to access your digital magazine 99

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