Audrey Hepburn in “Funny Face” was stunning in front of camera of her fashion photograph, Fred Astaire. She was most magnificent when she walked down the stairs in the Louve while holding a red scarf that floated up like a parachute. “Hello, Audrey!” Her face, charm, and style made her an international legend. Even in 2009, a Gap commercial used movie footage of the stylish Hepburn dancing like a bohemian.

What would have happened if the beautiful Audrey Hepburn ever got Bell’s Palsy?

Bell’s Palsy is an acute condition of facial paralysis, which was first described by Sir Charles Bell in the 1800s. The facial nerve degenerates to wreak havoc on either the right or left side of the face. The cause of the facial weakness is unknown, though it might be due to viral infection. Pregnant women and diabetics are at increased risk of Bell’s Palsy.

One side of the face is suddenly paralyzed to cause that side of the mouth to droop, just like seen in some patients with strokes. Because one side of the mouth is weak, the mouth is drawn to the unaffected side to look like the most extreme of crooked smiles. Puffing out the cheeks, such as when blowing out candles, doesn’t occur on the weakened side.

Raising the eyebrows occurs only on the unaffected side. The unmoving eyebrow and forehead on the affected side gives the appearance of a skeptical person who is thinking, “Hm, really?” Ironically though the eyebrow won’t go up, the eyelid of that same affected side won’t go down. Not being able to close the eye fully or at all can cause an ulcer of the cornea due to dryness. Also, not being able to blink could allow foreign things (i.e. dust, dirt) to enter the eye. “Holy I Dream of Jeannie, Batman!” Wearing an eye patch in bed can keep the eye shut. Artificial tears are used every hour while awake to keep the eye moist.

Dry eye and dry mouth occur with Bell’s Palsy as well. Loss of taste in the front part of the tongue just adds to the misery of this condition. Hyperacusis (pain in the ear due to sounds) can make a whirling sound of a fan seem more like a helicopter on top of the head. Louds sounds (e.g. screaming children or just the clank of plates being unloaded from a dishwasher) can become unbearable to the ear. Wearing noise-blocking headphones can be a lifesaver.

At least half of persons with this condition suffer from psychological stress. The appearance can be unsettling to some due to the facial droop and the asymmetry of facial movements. To make things worse, some folks get synkinesis, which means unintentional facial movements that occur with an intentional movement. For example, when a person blinks, the corner of the mouth on the same side will twitch. Smiling will cause the eye to wink. Salivating over a meal might cause the eye on the same side to tear (AKA “syndrome of crocodile tears”). Synkinesis occurs because during the recovery process, the regenerating nerves “short-circuit.”

Bell’s Palsy reaches it worst within three week, but almost everyone recovers to some degree within a month. The worse the paralysis, the worse the prognosis for full recovery. In general, two-thirds of people have complete recovery. Recurrence of this God-awful condition is 7-15%, usually occurring 10 years later. Rarely, a tumor is the cause of a recurrence.

Oral steroids are used to help treat this condition. If herpetic lesions are evident, anti-virals are used as well.

Audrey Hepburn showed the world that a unique face can be a gorgeous face. I hope the world can be kind to those whose face is not so typical.
(c) John Hong, MD, MS

This entry was posted on Sunday, January 15th, 2012 at 3:10 pm and is filed under Infections, Neurologic. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.