The recent 20th anniversary episode of the show brought back the same guests Jimmy Kimmel had on his first show in 2003: Snoop Dogg, George Clooney, and Coldplay. At one point, Kimmel showed throwback pictures of Snoop Dogg and then Clooney. The second picture shown of Clooney was taken when he was in high school, and it showed him with a slanted smile. Before Kimmel could say anything, Clooney said: "Now wait, I want to point out something, because you're going to laugh, gonna make a joke. I have Bell's palsy there and half of my face is paralyzed."
Clooney covered half his face in the photograph: "Look at this, watch this. If you go like this, on the other side, it's a completely different face. So now make your joke. Come on, funny man. Come on, let me give you my sad face."
Kimmel's response? "You know what? I didn't have a joke, George, and you really brought everybody down." Kimmel suggested they "have another toast to bring things back up," and all three took a shot together.
Bell's Palsy
Bell's palsy, also known as idiopathic facial palsy, is a form of temporary facial paralysis or weakness on one side of the face. It results from dysfunction of cranial nerve VII (facial nerve) and is the most common cause of facial paralysis. Although the condition typically affects only one side of the face, bilateral involvement can also occur rarely.
The annual incidence is 15-20 cases per 100,000 people. There are approximately 40,000 new cases a year. The lifetime risk is 1 in 60. Bell's palsy can affect anyone of any gender and age, but most commonly occurs in those between ages 15 and 45.
The exact cause of Bell's palsy is unknown, although the main theory is that reactivation of a dormant viral infection may cause the disorder. Impaired immunity from stress, sleep deprivation, physical trauma, minor illness, or autoimmune syndromes are believed to be the most likely triggers.
Inflammation of the facial nerve VII at the geniculate nucleus causes swelling of the nerve. As it passes through the narrowest portion of the facial canal, the labyrinthine segment, the nerve can become compressed and ischemic, leading to the associated symptoms.
Symptoms
The symptoms of Bell's palsy can vary greatly from person to person and affect any area innervated by the facial nerve. The condition can also vary in severity from mild weakness to total paralysis of the affected side.
The onset is often sudden -- from 1 day up to a week -- and the severity typically peaks at about 72 hours.
Symptoms, which often lead to significant facial distortion, include:
- Sudden weakness or paralysis on one side of the face, with the forehead almost always affected
- A drooping eyebrow and mouth
- Drooling from one side of the mouth
- Difficulty closing an eyelid, which can lead to eye dryness
Other less common symptoms of Bell's palsy include:
- Facial pain or abnormal sensations
- Excessive tearing in one eye
- Problems with taste
- Decreased tolerance for loud noises
- Pain around the jaw and behind the ear
- Problems eating or drinking
Diagnosis is based on clinical presentation -- i.e., acute unilateral facial weakness or paralysis of recent onset -- and by ruling out other potential causes of facial paralysis.
Prognosis and Treatment
The prognosis of someone with Bell's palsy is typically good. Even without treatment, 85% of cases resolve within 3 weeks, and in the remaining patients by 3-5 months. Recurrence occurs in 8-12% of patients.
For patients with new-onset Bell's palsy, corticosteroids can be highly effective and can increase the chances of full facial nerve recovery. Corticosteroids are most effective when begun within the first 72 hours of onset of symptoms. A common regimen consists of 60-80 mg/day for about 1 week. Although some have advised use of antivirals with steroids for the treatment of Bell's palsy, a meta-analysis showed that the addition of antivirals to steroids did not reach statistical significance for efficacy.
An important factor in the treatment of Bell's palsy is eye protection, since the condition can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Keeping the eye moist and protecting it from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.
Other therapies such as physical therapy, facial massage, or acupuncture may provide a potential small improvement in facial nerve function and pain.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children's Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.