Bell’s Palsy is an acute, idiopathic facial nerve(cranial nerve VII) paralysis that results in weakness or complete loss of muscle function on one side of the face.

In Ayurveda, Bell’s Palsy is correlated with Arditha Vata, a disorder caused by an imbalance of Vata dosha affecting facial nerves and muscles. It is classified under Vata Vyadhi(neurological disorders) and primarily affects one side of the face due to nerve inflammation and muscular weakness.

CAUSES:

1.Viral infections(Most common cause):

• Herpes simplex virus: The most prevalent cause of cold sores is the herpes simplex virus (HSV-1).
• VZV(Varicella Zoster Virus): The virus that causes shingles and chickenpox.
• EBV(Epstein-Barr Virus): The Epstein-Barr virus is the cause of mononucleosis.
• Cytomegalovirus (CMV): May become dormant and reawaken in cases where immunity is compromised.
• Influenza virus: can cause immunological reactions that damage nerves.
• Adenoviruses: Linked to illnesses of the respiratory system.

2. Autoimmune Reactions:

• The immune system of the body unintentionally targets the facial nerve’s myelin sheath, causing inflammation and temporary paralysis.

3. Ischaemic or Vascular Factors:

• Nerve injury and dysfunction can result from ischemia, or a decreased blood flow, to the facial nerve caused by microvascular disease (such as diabetes or hypertension).

4. Cold exposure and climate factors:

• Sudden exposure to cold wind or air conditioning has been linked to Bell’s Palsy, in some cases, possibly due to nerve irritation or vasospasm reducing blood flow.

5. Stress and weakened Immune system:

• Chronic illness, sleep deprivation, and emotional or physical stress can all impair immunity and raise the risk of viral reactivation.

6. Diabetes and metabolic disorders:

• Long-term high blood sugar levels put those with diabetes mellitus at greater risk for nerve injury.

7. Pregnancy:

• The risk is raised during the third trimester due to hormonal changes and increased fluid retention that might strain the facial nerve.

8. Ear and Upper Respiratory Tract infections:

• The facial nerve may be impacted by local inflammation brought on by sinus infections or middle ear infections (otitis media).

9. Trauma and surgery:

• The facial nerve may be harmed or compressed by head trauma, dental procedures, or facial surgery, particularly in the area of the parotid gland.

10. Post Vaccine or Post Infectious Reaction:

• After healing from diseases like Lyme disease or tuberculosis, some people get Bell’s Palsy.
• Although the risk is low, rare incidences of Bell’s Palsy have been documented following specific Immunisations (such as the COVID-19 and Influenza vaccines).

SYMPTOMS:

1.Facial Weakness or Paralysis(Hallmark Symptom):

• One side of the face may suddenly become weak or paralyzed.
• Not being able to close the afflicted eye.
• Mouth drooping, which makes it challenging to frown or smile.
• Inability to hold air in the mouth or blow out the cheeks.

2. Eye problems:

• Incapacity to blink, which causes dryness or excessive crying (epiphora).
• Elevated light sensitivity (photophobia) in the afflicted eye.
• Lagophthalmos, or difficulty closing the eye entirely, raises the risk of corneal ulcers or eye infections.

3. Changes in Taste or Salivation:

• Loss or diminished taste perception, notably on the affected side of the tongue’s front two-thirds.
• A change in saliva production that causes dry mouth or drooling.

4. Hearing issues:

• Pain or discomfort behind or around the ear, frequently before the onset of facial paralysis.
• Hyperacusis, or increased sensitivity to sound, in the afflicted ear.
• Some people have mild hearing loss.

5. Speech and eating difficulties:

• Slurred speech as a result of improper lip movement.
• Difficulty chewing, which causes food to become lodged between teeth and cheek.
• Improper drinking habits, result in liquid dripping from the mouth.

6. Headache and general Discomfort:

• Headache on the afflicted side that is mild to moderate.
• A sensation of numbness or heaviness in the face.

7. Psychological and Social Effects:

• Depression or anxiety brought on by changes in facial features.
• Social embarrassment brought on by facial symmetry.

CLASSIFICATION OF BELL’S PALSY:

The classification is based on severity, etiology, and electrophysiological findings.

1.Classification based on Severity(House-Brackmann Grading System):

• The House-Brackmann Grading System is the most widely used method for assessing the severity of Facial Nerve Dysfunction.

 

GRADE	CLINICAL FEATURES
I(Normal)	Normal facial function in every part.
II(Mild Dysfunction)	Mild weakness; Normal symmetry at rest. Slight asymmetry with movement.
III(Moderate Dysfunction)	Asymmetry at rest; incomplete eye closure; Weakness with moderate synkinesis(involuntary movement).
IV(Moderately severe Dysfunction)	Obvious facial asymmetry. Eye closure inability completely. Severe synkinesis or hemifacial spasm.
V(Severe Dysfunction)	Minimal facial movement. Incomplete closure of the eye. Severe facial asymmetry.
VI(Total Paralysis)	No movement; complete facial paralysis.

2. Classification based Electrophysiological Findings:

Electromyography(EMG)and nerve conduction studies help further classification:

• Mild neuropraxia: Characterized by a transient conduction block without any deterioration.
• Axonotmesis (Moderate): Slow healing; partial axon injury.
• Severe neurotmesis: total degeneration of the nerves; poor rehabilitation.

3. Classification based on Etiology:

Despite being idiopathic, Bell’s Palsy can be categorized according to possible underlying causes:

I. Idiopathic Bell’s Palsy, which makes up around 70% of cases.

II.Infectious cases:

• Bacterial (Mycobacterium leprae, Lyme disease) and viral (Herpes simplex virus, varicella-zoster, and cytomegalovirus).

III.Autoimmune or inflammatory causes: 

• Guillain-Barre syndrome.
• Multiple sclerosis.
• Sarcoidosis.

IV.Neoplastic Causes: 

• Schwannoma and parotid tumors compress the facial nerve.

V.Temporal bone fractures:

Bell’s Palsy can occur as a traumatic condition ( Iatrogenic injury) when surgery is done.

VI.Vascular Causes:

• Stroke (although the forehead is spared).
• Ischaemic neuropathy.

4. Classification based on Recovery:

• Complete Recovery (70–80%): All facial functions are fully restored.
• Incomplete Recovery (10–15%): Synkinesis or residual weakness.
• Poor Recovery (5–10%): Paralysis or permanent facial deformities.

DIAGNOSIS:

1. Clinical Diagnosis:

A)Analyzing clinical symptoms:

• Sudden onset(within 48-72 hours) of facial weakness or paralysis.
• Inability to close the eye on the affected side.
• Drooping of the mouth and difficulty smiling.
• Loss of nasolabial fold(flattened facial expression).
• Increased sensitivity to sounds(hyperacusis) in the affected ear.
• Altered taste sensation on the front two-thirds of the tongue.
• Dryness of the eye or excessive tearing.
• Pain behind the ear or around the jaw.

B)Physical Examination:

Examination of both upper and lower facial muscles:

Upper face(forehead,eyebrows,eyelids):

• In Bell’s Palsy: Complete Paralysis(Patient cannot wrinkle the forehead or close the eye).
• In Stroke: Forehead is spread(patient can still wrinkle the forehead).

Lower face(mouth, cheeks):

• In Bell’s Palsy: Mouth drooping on the affected side.
• In stroke: Mouth weakness but preserved forehead movement.

This helps differentiate Bell’s Palsy from stroke, which is a major step in diagnosis.

2. Investigations and Tests:

A)Electromyography(EMG) and Nerve Conduction Studies:

• Determines the extent of nerve damage.
• Helps assess prognosis(severe nerve degeneration indicates a longer recovery).

B)MRI or CT Scan:

• To rule out brain tumors, stroke, or multiple sclerosis if symptoms are unusual or prolonged.
• MRI may show facial nerve inflammation.

C)Blood Tests:

• Test for Lyme disease: Suspected, particularly in endemic regions.
• Herpes Simplex Virus (HSV) or Varicella Zoster Virus (VZV) serology.
• Elevated blood sugar levels.

DIFFERENTIAL DIAGNOSIS:

Several conditions can mimic Bell’s Palsy, so it’s crucial to rule them out.

• Stroke (additional neurological symptoms, such as arm weakness, and sparing of the forehead).
• Ramsay Hunt Syndrome (ear pain, vesicles in the ear, caused by Varicella-Zoster virus).
• Lyme disease (rash, history of tick bites, bilateral facial palsy).
• Brain tumors (symptoms that appear persistently and gradually).
• Guillain Barre syndrome (absence of reflexes, bilateral weakness).

TREATMENT OF BELL’S PALSY IN MAURYA AYURVEDA HOSPITAL:

Our hospital provides integrated treatment for Bell’s palsy with Ayurveda, physiotherapy, and acupuncture.

INTERNAL MEDICATIONS GIVEN ARE:

• Dhanwantharam Kashayam.
• Dhanadanayanadi Kashayam.
• Ashtavargam Kashayam.
• Prasaranyadi Kashayam.
• Maharasnadi Kashayam.
• Guggulutikthakam Kashayam.
• Punarnavadi Kashayam.
• Patyashadangam Kashayam.
• Gandharva Hasthadi Kashayam.

AYURVEDA TREATMENT GIVEN IN OUR HOSPITAL:

ABHYANGA:

In Ayurveda, Abhyanga is a therapeutic oil massage that aids dosha balance, circulation, and neuromuscular function. Abhyanga is essential in Bell’s palsy (Ardita Vata) because it lessens facial muscle paralysis, enhances nerve function, and speeds up recovery. Bala Ashwagandha Lakshadi Thailam, Ksheerabala Thailam, Mahamasha Thailam, and others are the most often utilized.

Benefits of Abhyanga:

• It improves blood circulation.
• It strengthens facial muscles.
• It enhances nerve regeneration.
• It reduces facial numbness and tingling sensation.
• It relieves pain and discomfort.

KSHEERA DHOOMA:

In Ksheera Dhoomam, medicinal milk (Ksheera) and a herbal decoction are heated, and steam (Dhooma) is applied to the afflicted area. Bell’s palsy (Ardita Vata) is among the neurological and facial conditions for which it is frequently used. Using Mahamasha Thailam, Ksheerabala Thailam, and Bala Ashwagandha Lakshadi Taila, an abhyanga (face massage) is performed beforehand.

Benefits of Ksheera Dhoomam:

• It reduces facial muscle stiffness.
• It improves nerve function.
• It enhances blood circulation.
• It relieves pain and tingling sensations.
• It reduces dryness and prevents atrophy.
• It supports fast recovery.

NASYAM:

Because the nose is considered the entryway to the head, Nasyam, a panchakarma treatment, involves administering herbal oils or powders through the nose.

First, the head, face, and neck are gently massaged. After that, a mild steaming (Swedana) is given to the face and neck to aid in opening the nasal pores. The patient is told to tilt their head slightly while lying on their back. Then, each nostril is filled with the medicinal oil or powder. The patient rests down for a short period to adequately absorb the medication. Any mucus or phlegm in the patient’s throat should be spat out.

Marsha Nasyam and Pratimarsha Nasyam are two types of Nasyam we normally perform here.

a)Pratimarsha Nasya:

• It is a milder, daily-use variant of Nasya therapy. It involves the administration of small quantities(1-2 drops) of medicated oil for preventive care, maintenance of health, and balancing of the doshas. Usually, Anu Taila is preferred.

b)Marsha Nasya:

• It is a therapeutic procedure involving the administration of a larger quantity(6-10 drops) of medicated oil, powder through the nostrils. Usually, we use Ksheerabala Taila here.

Benefits of Nasyam in Bell’s Palsy:

• It stimulates the facial nerves.
• It reduces facial paralysis and numbness.
• It enhances blood circulation to the face.
• It relieves pain, swelling, and tingling sensations.
• It clears sinuses and improves respiratory function.

NADI SWEDAM:

The process of Nadi Swedam, also known as sudation therapy, involves using a tube or pipe to deliver medicated steam to a particular area of the body. The steam produced by Dashamoola Kashayam is typically utilized for detoxification, pain relief, and musculoskeletal conditions.

Benefits of Nadi Swedam:

• It relieves pain and stiffness.
• It improves circulation.
• It reduces inflammation and swelling.
• It enhances joint and muscle mobility.
• It detoxifies the body.
• It soothes nerve-related disorders.

SHIRODHARA:

Shirodhara is a therapeutic ayurveda practice that involves gently pouring a continuous stream of warm, medicinal oil or other liquids across the forehead. It is useful for Bell’s palsy because it is normally done in 30-60 minutes.

Benefits of Shirodhara:

• It pacifies Vata Dosha.
• It increases blood circulation and nerve function.
• It relaxes the nervous system and reduces stress.
• It strengthens the facial muscles.
• It helps in reducing inflammation and pain.
• It stimulates brain function and cognitive health.

ROLE OF PHYSIOTHERAPY IN BELL’S PALSY:

The rehabilitation process for Bell’s palsy must include physiotherapy. Restoring normal facial expressions, preventing problems, and improving nerve recovery are all possible with a well-organized, individualized therapy plan. In addition to promoting neuromuscular control, they activate the face nerve (cranial nerve VII).

Acute stage(0-3 weeks): Eye protection, massage, and mild activities are recommended.

Subacute stage: Strength training, electrical stimulation, and neuromuscular reeducation are all part.

Chronic stage (>8 weeks): Prioritise coordination, and symmetry, and prevent long-term issues including synkinesis (involuntary facial movements).

Facial Exercises:

1) Warm-up Exercises.

• Gentle massage.
• Breathing exercises(pranayama).

2)Eyebrow and Forehead exercises.

• Eyebrow lift.
• Frowning.

3)Eye exercises:

• Slow eye closing.
• Blinking exercises.
• Assisted closure.
• Eye squeeze.
• Eyeball movement.

4)Cheek and Nose exercise:

• Puffing the cheeks.
• Nose wrinkling.

5)Lip and mouth exercises:

• Smiling exercises.
• Whistling.
• Lip stretching.
• Spoon exercise.
• Pronouncing ‘O’ and ‘E’.
• Drinking through a straw.

6)Jaw and Chin Exercises:

• Jaw movement.
• Chin Tucks.

Neuromuscular Re-education:

A specialized treatment neuromuscular re-education (NMR) is used to retrain facial muscles to restore normal movement patterns following injury to the facial nerves.

1. Proprioceptive training:

• Exercises done in front of a mirror are known as mirror therapy.
• Sensory stimulation: To enhance sensory feedback, apply cotton balls, warm or cold packs, or light tapping to the afflicted area.

2. Specific muscle Retraining Exercises:

Forehead and eyebrow muscle exercises:

• Eyebrow lifting.
• Frowning.

Assisted movements.

Eye Muscles:

• Gentle eye closing.
• Controlled blinking.

Cheek and Nose muscles:

• Cheek puffing.
• Nostril flaring.

Lip and mouth muscles:

• Smiling control.
• Lip pursing(Whistling exercise).
• Drinking through a straw.

3.Synkinesis Management(Reducing abnormal muscle movements):

• Slow controlled movements.
• Facial Relaxation Techniques.
• Differentiation exercises: Patients are trained to isolate movements.eg: Smiling without causing eye closure.

4.Electrical Stimulation(E-Stim)-Used with caution:

• Low-intensity Neuromuscular Electrical Stimulation(NMES) can be used to activate weak facial muscles.

Massage Therapy:

Techniques of facial massage in Bell’s Palsy:

• Effleurage(Gentle Stroking Movements).
• Kneading(Petrissage): Deep tissue massage.
• Tapotement(Tapping or percussion movements).
• Circular massage(Friction techniques).
• Myofascial Release(Gentle stretching of skin and muscles).

Benefits of Physiotherapy in Bell’s Palsy:

• It improves facial muscle function.
• It prevents muscle stiffness and contractures.
• It enhances blood circulation and nerve stimulation.
• It reduces synkinesis(involuntary movements).

ROLE OF ACUPUNCTURE IN BELL’S PALSY:

Techniques of Acupuncture in Bell’s Palsy:

I. Manual Acupuncture(Needling Techniques):

• Fine, sterile needles are inserted at certain acupuncture locations associated with the function of the facial nerve.

II. ElectroAcupuncture(EA):

• When needles are placed, low-frequency electrical pulses are applied.

III. Acupressure:

It is a non-invasive therapy that uses acupressure tools or fingers and thumbs to gently press on particular acupuncture points.

• Here, each point is gently yet firmly compressed for 30 to 60 seconds.
• Do this two or three times a day.
• Add a face massage to it: To activate the muscles in your face, use gentle strokes.
• Don’t put too much pressure on the afflicted areas.

Common Acupuncture/Acupressure points used:

• L14(Hegu): It stimulates circulation and reduces inflammation.
• ST4(Dicang) and ST6(Jiache): It strengthens facial muscles.
• GB14(Yangbai): It helps lift the eyebrow and improve facial tone.
• TW17(Yifeng): It targets the facial nerve directly.
• GB20(Fengchi): It boosts nerve recovery.

Benefits of Acupuncture:

• It enhances nerve stimulation.
• It improves muscle tone and movement.
• It reduces pain and discomfort.
• It boosts circulation.

ROLE OF YOGA AND ITS BENEFITS IN BELL’S PALSY:

Yoga Practices Suggested for Bell’s Palsy:

Yoga Asanas(Postures):

• Bhujangasana(Cobra pose): Improves nerve function and relaxes the mind.
• Simhasana(Lion’s pose): Engages facial muscles, preventing stiffness.
• Matsyasana(Fish pose): It enhances oxygen flow to the brain and promotes facial nerve recovery.
• Vrikshasana(Tree pose): It enhances body muscles and neuromuscular coordination.
• Marjariasana(Cat cow pose): Enhances neural coordination.
• Tadasana(Mountain pose): Improves overall blood circulation.
• Sarvangasana(Shoulder stand): It helps with facial muscle relaxation.
• Uttanasana(Standing forward bend): It helps improve circulation to the head and relaxes the nervous system.
• Shavasana(Corpse pose): It relieves stress and tension, supports nerve healing, and enhances relaxation and recovery.

 Facial Yoga and Exercises:

• Simha Mudra(Lion’s pose).
• Raising eyebrows, smiling, and gently massaging the face to stimulate facial muscles.
• Blinking exercises to keep the eye muscles active.

Pranayama(Breathing Techniques):

• Anuloma-Viloma(Alternate nostril breathing): It improves nerve function and relaxes the mind.
• Brahmari(Humming Bee breath): Vibrations stimulate the facial nerve.
• Sheetali Pranayama(Cooling breath): Helps in the reduction of nerve inflammation.

Meditation and Relaxation:

Practicing mindfulness and relaxation techniques to support the nervous system healing.

Benefits of Yoga and Pranayama:

• It enhances blood circulation.
• It reduces stress and anxiety.
• It improves neuromuscular coordination.
• It prevents muscle stiffness and atrophy.
• It supports overall nervous system health.
• It improves facial symmetry.

DIET RECOMMENDATIONS IN OUR HOSPITAL:

Our senior physicians suggest to avoid:

• Milk, milk products, cold food, pickles, fruits, dry fruits, nuts, fast food, fried and oily foods.
• Fermented foods like dosa, idli, and fermented appam.
• Tuber items like potato, tapioca, and sweet potato.
• Nonvegetarian items like Fish, egg, and meat(can be taken in curry form, if necessary).

A few recommended food items to be taken are:

• Hot kanji.
• Steamed food items like idiyappam, put, and chapati.
• Vegetable in boiled form.

General Suggestion:

• Avoid strenuous activities.
• Drink enough water(2.5L-3L).

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

Maurya Ayurveda Ortho & Neuro Rehabilitation Centre ( Ayurveda Hospital )