Persistent Muscle Stiffness After Bell's Palsy: Why Does It Happen, How to Prevent It?
Bell's palsy is a condition characterized by sudden and usually temporary paralysis of the nerve that controls the facial muscles (facial nerve). However, in some cases, even after recovery is complete, there may be persistent stiffness, contraction or involuntary movements of the facial muscles. This may be caused by nerve fibers making the wrong connections (impaired synergy) during nerve healing. Persistent muscle stiffness can make it difficult for the patient to mimic, cause aesthetic concerns and reduce the quality of daily life. At this point, in this article, we will discuss the causes, risk factors and effective methods to prevent permanent muscle stiffness after Bell's palsy. We wish you all good reading and healthy days.
Bell's Palsy and Muscle Problems
Bell's Palsy, which is a unilateral and sudden paralysis of the facial nerve, can lead to various muscle problems. Complete loss of muscle function, sudden muscle contractions and many other problems can cause drooling, drooping and other symptoms. For this reason, muscle problems that can be seen due to Bell's Palsy include.
- Muscle weakness
The muscles on one side of the face weaken and become weaker as they are not used or are suppressed. In some people, this pressure can cause the muscles to completely lose their function. This condition is called muscle weakness.
- Sinemesis
Damaged nerve fibers are likely to connect with other fibers during repair. Unwanted muscle movements, such as closing the eyelids when you want to laugh, may occur.
- Muscle stiffness
The pressed muscles may become tense over time and cause pain in the facial area. This is also common after bell's palsy.
- Muscle spasm
The tension caused by synkinesis and muscle overactivity is sometimes also experienced as muscle spasm. Unwanted and strong contractions can therefore lead to muscle stiffness.
- Muscle wasting (atrophy)
Muscle volume is maintained as long as regular signals are sent to the muscles. However, muscles that do not receive enough signals decrease in volume after a while. This is called muscle wasting.
- Muscle shortening (contracture)
Muscles maintain their flexibility and length as long as they move and are used. However, muscles that are not used for a long time lose their flexibility and start to shorten, and due to muscle shortening, mimic and expression problems and asymmetrical appearance may occur.
What Causes Persistent Muscle Stiffness After Bell's Palsy?
After Bell's Palsy, which causes permanent muscle stiffness, synkinesis and tension caused by muscle overactivity are frequently experienced. Conditions that cause permanent muscle stiffness after Bell's Palsy, which directly affects the quality of life of the person and sometimes causes pain, are as follows;
- Muscles cannot be used for a long time
Muscles that cannot be used for a while after facial paralysis may shorten, and hardening of the muscle connective tissue may be seen. This can cause permanent muscle stiffness after Bell's Palsy.
- Incorrect or incomplete nerve healing of the facial nerve
As the facial nerves heal in their natural process, some of the nerve fibers connect to other muscles. This is why involuntary muscle contraction or muscle spasm can occur when nerves and muscles combine incorrectly.
- Presence of Permanent Nerve Damage
Recovery from Bell's Palsy does not progress differently for every patient. In some people it can lead to permanent nerve damage. Sometimes nerve signals can be sent in a distorted, incorrect way. This leads to permanent muscle stiffness and impaired muscle tone.
- Problems in the Reconstruction of Facial Muscles
When facial nerves are damaged, signals are sent to the muscles irregularly or not at all. In such cases, irregular signaling can cause muscle spasm.
- Lack of Physical Therapy Support
If the facial muscles are not exercised regularly after Bell's Palsy, stiffness occurs in unused muscles. Lack of physical therapy applications and not applying other treatment methods cause the muscles to lose their elasticity. In this context, physical therapy and rehabilitation support within the first 72 hours after Bell's palsy prevents permanent muscle stiffness.
Who is more at risk of permanent muscle stiffness in Bell's Palsy?
Synkinesis and tension caused by muscle overactivity may be more common in some people. Being more careful in these people who are in the risk group also helps to reduce the symptoms of Bell's Palsy. But who is more at risk of permanent muscle stiffness in Bell's Palsy?
- Older people
- Diabetes patients
- Hypertension patients
- People who have had Bell's Palsy
- Pregnant women in the 3rd trimester of pregnancy
- People with Guillain-Barre syndrome
- People living with Lyme disease
- People with slow muscle recovery
- People with severe Bell's Palsy symptoms
These people are more likely to have permanent muscle stiffness and synkinesis. For this reason, starting physical therapy as soon as possible after Bell's Palsy for those in the risk group will affect their recovery process.
How Can Bell's Palsy Muscle Stiffness Be Prevented?
It is important to contact your doctor as soon as Bell's Palsy symptoms start to appear and evaluate possible treatment options. Treatments taken between the first 0 weeks and 3 weeks, called the early stage of Bell's Palsy, provide significant success in preventing muscle stiffness. If you are wondering how to prevent Bell's Palsy muscle stiffness, various treatment options can be evaluated according to different stages. Botulinum toxin applications, massage and physical therapy, myectomy or neurolysis are among the most commonly used treatments. As well as reducing the symptoms of Bell's Palsy seen in the person, it can greatly contribute to recovery and improve quality of life. In this context;
Botulinum toxin applications
Botulinum toxin applications may be preferred in muscle spasm, muscle hardening, involuntary muscle contractions and facial asymmetry problems that develop after Bell's Palsy. For this reason, botulinum toxin applications can offer a solution to ensure facial asymmetry and control excessive tear and saliva increase.
Different doses of botox materials are applied under the skin with the help of thin needles. The effect on the muscles can be seen within 3 to 7 days after the first dose is administered. It can be used to relax the surrounding muscles and reduce the pressure on the muscles. It can be applied in different doses and durations according to the condition of the person's facial muscles and nerves and involuntary muscle contractions. The effect of botulinum toxin applications can last for about 3 to 4 months.
Massage and physical therapies
Unlike other types of facial paralysis, Bell's Palsy shows faster recovery when physical therapy is started early. Within the first 72 hours, the function of the muscles can be restored with massage and physical therapies. Massage and physical therapies should be supported to relax the tissues and surrounding nerves that press on the muscles and to maintain muscle elasticity. In the early period, i.e. within the first 3 weeks, massage and physical therapies will significantly reduce symptoms. Regular massage to the area where the muscles are located provides relaxation of the area. In addition, the facial muscles can be restored with physical therapy devices and instruments.
For some people with Bell's Palsy, massage and physical therapies may not be sufficient. In line with this scope, other treatment options may come to the agenda when the intervention is made late. Depending on the muscle and nerve condition, your doctor will evaluate the effect of massage and physical therapy on the healing process and may use alternative treatment methods and surgical techniques.
Myectomy treatment
Myectomy treatment offers successful results in muscle stiffness and persistent facial muscle problems after Bell's Palsy. With myectomy treatment, a part of the facial muscle is removed. After this treatment, which is used to provide a permanent solution, facial symmetry is achieved and pain and tension in the muscles are reduced. Thus. Although botulinum toxin applications temporarily relieve that area, myectomy is functional for a permanent solution.
Myectomy treatment is frequently used for muscle spasms in the muscles around the eyes and involuntary contractions around the mouth. It is used in cases where Bell's palsy is followed by permanent synemesis and involuntary facial contractions affect the quality of life.
Neurolysis surgery
Permanent muscle stiffness in Bell's Palsy can be treated with neurolysis surgery. Neurolysis surgery can be preferred especially for the restoration and comfortable functioning of the facial nerves that are compressed and damaged.
This treatment can be used to correct nerves that do not heal or that show disturbances during healing. It will prevent the development of synemesis and muscle stiffness and help to restore nerve function in permanent paralysis. In this context, neurolysis surgery may be considered if no improvement is observed after 3 to 6 months of Bell's Palsy and the nerves have poor signaling. Permanent muscle stiffness can be treated with neurolysis surgery.
All of these methods can be applied according to individualized treatment options. If your doctor is an expert in the field of Bell's Palsy and muscle problems after Bell's Palsy, he/she will evaluate the appropriate treatment options for you. He/she will offer one or more of them as a personalized treatment. The stage of Bell's Palsy and the general health status of the person may cause treatment options to differ.
What happens if permanent muscle stiffness is not treated in Bell's Palsy?
Permanent muscle stiffness after Bell's Palsy greatly affects the quality of life of people. For this reason, this condition, which manifests itself with problems such as muscle spasm, muscle wasting, and sinemesis, can lead to various problems when left untreated. These are
- There may be an increase in unwanted muscle movements. People have difficulty in making simple movements such as smiling, blinking and frowning. The corners of the mouth may contract when they blink, and other muscles may be activated when they smile.
- Since the muscles are constantly contracting, you may experience chronic muscle pain.
- Permanent muscle spasms may develop.
- You may experience social and psychological difficulties.
- Muscle wasting and muscle shortening increase over time. As the process progresses, the deformation of connective tissues increases.
- Facial functions cannot be fully restored. There are symptoms of eye dysfunction and oral dysfunction.
- Corneal dryness, infection, risk of vision loss and eye diseases may occur.
- There may be an increase in unwanted muscle movements.
- Permanent asymmetry of the face may occur.
- Difficulty using gestures and facial expressions.
