Recently in an Instagram video, Justin Bieber broke the news that one side of his face has been fully paralyzed. “As you can see, this eye is not blinking. I can’t smile on this side of my face…So there’s full paralysis on this side of my face,” he said. The condition that he suffers from is rare and is typically known as Ramsay Hunt syndrome.
It is caused when a particular nerve out of the 12 cranial nerves in the body is affected. Ramsay Hunt Syndrome is a viral infection that impacts 7th cranial nerve that is involved in facial movements.
Is it different from Bell’s Palsy
Incidence rate of Ramsay Hunt is 50 per million as against which Bell’s Palsy is much higher. But externally the condition of the face of the patient closely resembles either of the two. The patients with Ramsay Hunt syndrome often have severe paralysis at the onset and are less likely to recover completely. The condition appears as half droopy face or stiff facial muscles. In Bell’s palsy what happens is a temporary weakness or paralysis of the muscles on one side of the face. It can occur at any age but notably it happens between 16 and 60.
Although the exact cause of nerve damage in the face is unknown till date, researchers believe that it’s triggered by a viral infection.
The thought is that the facial nerve reacts to the infection by swelling that in turn pressures the bony canal, thereby reducing the blood flow and oxygen to the nerve. The symptoms usually appear abruptly, that are noticed when a person wakes up in the morning or when trying to eat or drink.
Published reports note that in some cases people might even have an inherited predisposition for Bell’s palsy.
How are they diagnosed?
While there’s no specific lab tests to diagnose Ramsay Hunt syndrome, doctors generally use a variety of techniques to draw a conclusion. Which means, blood tests to check for bacterial or viral infection, diabetes and other conditions. Imaging is done to check the facial nerves to rule out brain tumor or the possibility of a stroke. Electromyography (EMG) test, where a thin wire electrode is inserted into a muscle to confirm whether there’s any damage to the nerves related to facial muscles, or lumbar puncture to see condition is not that of Lyme disease.
How is it treated?
In some cases, it improves without treatment, however in others it may take weeks or months for the facial muscles to regain their normal strength.
Medications such as corticosteroid are prescribed that reduce inflammation, while the eye drops are important to keep the affected eye well lubricated. Home treatment such as eye patch, a warm moist towel over the face to relieve pain, slow facial massage of the affected side or physical therapy exercises to stimulate facial muscles are tried by patients to good use.
What are the potential complications?
Generally none, however complications may occur in severe cases, such as excessive dryness in the eye, eye infection, ulcer, or even a vision loss.
Seldom does synkinesis happen though chances are there; it’s a condition in which one moving part of the face causes another to move involuntarily. For example, an eye may close when one smiles.
The bottom Line
Getting a sudden facial flaw diagnosed is frustrating. No one really knows for sure what causes it, and there isn’t any medication or treatment that may sort it quickly. Besides, what works for one person may not work for another.
Usually it’s a temporary condition, but one thing is sure that it needs patience as one has to wait for some time for the nerves and muscles to regain strength and start functioning again.
Sunil Kumar Kalra
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Sunil Kumar Kalra, LLB from Delhi University practiced as an Advocate in the Supreme Court of India, New Delhi and NCDRC Delhi. He was formerly a Vice President at Dr Reddy’s Labs and Genpact Inc.