By Jang Su-hee

New patients always give me a sense of excitement. Their gait, facial expression and demeanor all tell stories.

They are very helpful non-verbal signs that are useful in understanding their chief complaints. Even with a poker face, one of the obvious conditions that cannot be mistaken is Bell’s palsy.

Bell’s palsy has a long history — it was first described by Nicolaus Friedreich in 1797. On June 7 this year, A. Greco and colleagues at the University of Rome published a massive study on Bell’s palsy, after reviewing publications from 1975 to 2012.

According to the study, the annual incidence of Bell’s palsy is 15 to 30 cases per 100,000 people.

It mentions that the median age at onset is 40 years, but the disease may occur at any age (Katusic 1986).

Interestingly, different studies have reported that either females are more prone to Bell’s palsy or that women and men are equally affected.

The study also revealed that the prevalence increases among pregnant women (43 cases per 100,000) (Holland 2004).

Bell’s palsy is defined as a paralysis of one side of the face. The lack of movement of muscles on the paralyzed side prevents full closure of the eyelid resulting in dry eye, and causes drooling while eating and drinking, and a slanted smile. It usually occurs overnight so patients don’t notice the change until they start eating or see their reflection in a mirror.

When patients are asked to raise their eyebrows, they can only make wrinkles. Because of the paralysis of the muscles, they cannot do simple movements like flare their nostrils or show their teeth.

Depending on the patients’ personality, it may affect their self-esteem — some may lose confidence and become introverted. One of my in-patients suffered some mood-changes due to the condition.

The first step in diagnosis is to determine whether the facial weakness is due to a problem in the central or peripheral nervous systems.

The facial nerve controls all facial expressions, and a small sensory branch that carries the sensation of taste.

It is important to diagnose whether the patient has watery or dry eyes, pain around the ear, or an altered sense of taste. These can give helpful information to estimate the location of the damaged nerve.

The etiology of Bell’s palsy is not yet known but viral infection or autoimmune disease could be possible causes.

Guillain-Barre syndrome, an acute demyelinating disease, or Ramsey-Hunt syndrome, acute facial paralysis with blisters in the ear, need to be excluded.

According to “Donguibogam,” a medical encyclopedia compiled during the Joseon Kingdom (1392-1910), when circulating blood is hit by the wind, lips and eyes take on a grimace.

The side of the face with intruded pernicious energy will drop down, while the other side with healthy energy will be more tightened pulling the face toward the healthy side making the face look twisted.

It is best to massage the philtrum, and moxibust right below the ear lobe at once.

According to “The Nei Jing,” the earliest book on Chinese medical theory compiled around 100 B.C., when the stomach meridian is attacked by pernicious influences, the lips will become crooked because this meridian circulates around them.

From the onset of the symptoms, it progresses to a maximal degree within a week or two. Some patients may complain of worsened symptoms during treatment sessions due to the lack of a full understanding of the prognosis so teaching the right information beforehand helps relieve patient’s excess concerns.

However,unfortunately, depending on the degree and the starting point of treatment after the onset, even after 4~6 weeks of treatment, some may have possible complications.

The writer practices traditional Korean medicine at Nasaret Oriental Medical Hospital in Incheon.