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A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side. ICD-10 G51.0 ICD-9 351.0 DiseasesDB 1303 MedlinePlus 000773 eMedicine emerg/56 MeSH D020330 Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) that results in the inability to control facial muscles on the affected side. Several conditions can cause facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no specific cause can be identified, the condition is known as Bell's palsy. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute mononeuropathy (disease involving only one nerve) and is the most common cause of acute facial nerve paralysis. Bell's palsy is defined as an idiopathic unilateral facial nerve paralysis, usually self-limiting. The hallmark of this condition is a rapid onset of partial or complete palsy that often occurs overnight. In rare cases (1%), it can occur bilaterally resulting in total facial paralysis. It is thought that an inflammatory condition leads to swelling of the facial nerve. The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell's palsy has been found. Corticosteroids have been found to improve outcomes while anti-viral drugs have not. Early treatment is necessary for steroids to be effective. Most people recover spontaneously and achieve near-normal to normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment. Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision. In some cases denture wearers experience some discomfort.
Yellow: nerves coming from the right hemisphere of the brain. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior twothirds of the tongue. smiling.5 Physiotherapy • • • • • • 6 Prognosis 7 Epidemiology 8 History 9 See also 10 References 11 External links  Signs and symptoms Facial nerve: the facial nerve's nuclei are in the brainstem (they are represented in the diagram as a „θ“).Contents [hide] • • • • • 1 Signs and symptoms 2 Cause 3 Pathology 4 Diagnosis 5 Treatment ○ ○ ○ ○ ○ 5. The facial nerves control a number of functions. The paralysis is of the infranuclear/lower motor neuron type. such as blinking and closing the eyes. .4 Complementary therapy 5.3 Surgery 5. Note that the forehead muscles receive innervation from both hemispheres of the brain (represented in yellow and orange). Orange: nerves coming from the left hemisphere of the brain. frowning. lacrimation. Facial palsy is typified by inability to control movement in the facial muscles. which controls the muscles of the face. salivation. Bell's palsy is characterized by facial drooping on the affected half. due to malfunction of the facial nerve (VII cranial nerve). flaring nostrils and raising eyebrows.1 Steroids 5.2 Antivirals 5.
in short. One disease that may be difficult to exclude in the differential diagnosis is involvement of the facial nerve in infections with the herpes zoster virus. . environmental factors. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy).. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell's palsy per se. ipsilateral limb weakness. e. In these conditions. thus suggesting that stress . Although defined as a mononeuritis (involving only one nerve). Lyme disease may produce the typical palsy.g. Due to an anatomical peculiarity. memory problems. ipsilateral limb paresthesias.. on the external ear and hearing disturbances. balance problems. or vesicles. and metabolic or emotional disorders. bilateral facial palsy has been associated with acute HIV infection.emotional stress. physical stress (e. trauma) . It is thought that as a result of inflammation of the facial nerve.g. Because both the nerve to Stapedius and the chorda tympani nerve (taste) are branches of the facial nerve. patients with Bell's palsy may present with hyperacusis or loss of taste sensation in the anterior 2/3 of the tongue. including to the forehead (contralateral forehead still wrinkles). In endemic areas Lyme disease may be the most common cause of facial palsy. the neurologic findings are rarely restricted to the facial nerve. This is yet an enigmatic facet of this condition. Reactivation of existing herpes zoster infection leading to facial paralysis in a Bell's palsy type pattern is known as Ramsay Hunt syndrome type 2.Clinicians should determine whether the forehead muscles are spared. patients diagnosed with Bell’s palsy may have "myriad neurological symptoms" including "facial tingling. pressure is produced on the nerve where it exits the skull within its bony canal. Babies can be born with facial palsy. may trigger reactivation. environmental stress (e. The degree of nerve damage can be assessed using the House-Brackmann score. diabetes mellitus. but these findings may occasionally be lacking (zoster sine herpete). both of the herpes family. moderate or severe headache/neck pain. If the problem resides in the facial nerve itself (peripheral palsy) all nerve signals are lost on the ipsilateral (same side of the lesion) half side of the face. Studies suggest that this new activation could be preceded by trauma. brucellosis. stroke. In a few cases. head trauma and inflammatory diseases of the cranial nerves (sarcoidosis. The major differences in this condition are the presence of small blisters. Possible causes include tumor.  Pathology Anatomy of the face. and may be easily diagnosed by looking for Lymespecific antibodies in the blood or erythema migrans.. meningitis. Reactivation of an existing (dormant) viral infection has been suggested as cause behind the acute Bell's palsy. forehead muscles receive innervation from both sides of the brain. and a sense of clumsiness" that are "unexplained by facial nerve dysfunction". the varicella-zoster virus and Epstein-Barr viruses.g. cold).). blocking the transmission of neural signals or damaging the nerve.  Cause Some viruses are thought to establish a persistent (or latent) infection without symptoms. a host of different conditions. etc.
However. is implicated in the pathogenesis of HSV-1-induced facial palsy. identifies HSV-1 in only 31 cases (18 percent). are usually treated. by definition. by elimination of other reasonable possibilities. Early treatment (within 3 days after the onset) is necessary for therapy to be effective. treatment options. Demyelination may not even be directly caused by the virus. a new strategy of treatment to inhibit such an immune reaction may be also effective. marked by an inability to close the eyes and mouth on the involved side. They were however commonly prescribed due to a theoretical link between Bell's palsy and the herpes simplex and varicella zoster virus.  Steroids Corticosteroid such as prednisone significantly improves recovery at 6 months and are thus recommended. The quote below captures this hypothesis and the implication for other types of treatment: It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. where the prognosis for recovery is very good. In patients presenting with incomplete facial palsy. Patients presenting with complete paralysis.  Antivirals Antivirals (such as acyclovir) are ineffective in improving recovery from Bell's palsy beyond steroids alone.  Diagnosis Bell's palsy is a diagnosis of exclusion. This nerve damage mechanism is different from the above mentioned . This may inject fundamental uncertainty into the discussion below of etiology.  Surgery Surgery may be able to improve outcomes in facial nerve palsy that has not recovered. recovery patterns. A number of different techniques exist. some of them with smile surgery. That infection with herpes simplex virus should play a major role in cases diagnosed as Bell's palsy therefore remains a hypothesis that requires further research. no specific cause can be ascertained. herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell's Palsy. but by an unknown immune system response.  Treatment Bell's palsy affects each individual differently. Smile surgery or smile reconstruction is a surgical procedure that restores the smile for people with facial nerve paralysis. Steroids have been shown to be effective at improving recovery while antivirals have not. Studies show that a large number of patients (45%) are not referred to a specialist. the herpes simplex virus type 1 (HSV-1) infection is associated with demyelination of nerves. Because the demyelination of facial nerves caused by HSV-1 reactivation. Therefore. Other research however. treatment may be unnecessary. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir).that oedema. In addition. which depends on a thorough investigation. which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. See also the section below on Other symptoms. .In some research the herpes simplex virus type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell's palsy. via an unknown immune response.). Bell's palsy is commonly referred to as idiopathic or cryptogenic. swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage.  Complementary therapy The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices). Being a residual diagnostic category. the more severe cases may require treatment. This is unsurprising from a diagnosis of exclusion. meaning that it is due to unknown causes. the Bell's Palsy diagnosis likely spans different conditions that our current level of medical knowledge cannot distinguish. etc. A significant number of cases are misdiagnosed (Ibid.
contracture. chronic facial spasm. After a follow-up of at least 1 year or until restoration. tinnitus and/or hearing loss during facial movement or crocodile tear syndrome. Recovery was judged moderate in 12% and poor in only 4% of patients. To prevent the latter. facial pain and corneal infections. the blink reflex is also affected. or taped shut during sleep and for rest periods. When remission does not occur until the third week or later. A third study found a better prognosis for young patients. Physiotherapy Physiotherapy can be beneficial to some individuals with Bell’s palsy as it helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve. Around 9% of patients have some sort of sequelae after Bell's palsy. heat can be applied to the affected side of the face. nearly always in the course of one month. the eyes may be protected by covers. Bell’s palsy affects about 40. complete recovery had occurred in more than two-thirds (71%) of all patients.  History . It is important that muscle re-education exercises and soft tissue techniques be implemented prior to recovery in order to help prevent permanent contractures of the paralyzed facial muscles. A range of annual incidence rates have been reported in the literature: 15. 85% showed first signs of recovery within 3 weeks after onset.  Prognosis Even without any treatment. when the person closes the eye. of 1. movement of one also affects the other. In individuals with unresolved facial nerve paralysis. the corner of the mouth lifts involuntarily. recovery occurred 3–6 months later. Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. This is thought to be due to faulty regeneration of the facial nerve. which complicates precise estimation. and 25-53 (all rates per 100. Gustatorial sweating can also occur. Another study found that incomplete palsies disappear entirely. For instance. 24. and tear-like eye drops or eye ointments may be recommended.000 population. regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. especially for cases with complete paralysis. For the other 15%. while the patients over 61 years old presented a worse prognosis. Familial inheritance has been found in 4–14% of cases. and the incidence increases with age.000 population per year). In a 1982 study. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. and care must be taken to protect the eye from injury. a branch of which controls the lacrimal and salivary glands. To reduce pain. typically the synkinesis already discussed. when no treatment was available. During regrowth. and there are no established registries for patients with this diagnosis. nerves are generally able to track the original path to the right destination . It affects approximately 1 person in 65 during a lifetime. Bell’s palsy is not a reportable disease. aged below 10 years old. It is also considered to be four times more likely to occur in diabetics than the general population.  Epidemiology The annual incidence of Bell's palsy is about 20 per 100. Muscle reeducation exercises are also useful in restoring normal movement. transcutaneous electrical stimulation can be an effective treatment strategy. In this way. or spasm. Bell's palsy tends to carry a good prognosis. a significantly greater part of the patients develop sequelae. Where the eye does not close completely. This is also called gustatolacrimal reflex or Bogorad’s Syndrome and involves the sufferer shedding tears while eating.000 people in the United States every year.011 patients. Bell's Palsy is three times more likely to strike pregnant women than non-pregnant women. Major complications of the condition are chronic loss of taste (ageusia). For example.but some nerves may sidetrack leading to a condition known as synkinesis. The patients who regain movement within the first two weeks nearly always remit entirely.
a Scottish surgeon. In 1829 he presented three cases at the Royal Society of London. . Two cases were idiopathic and the third was due to a tumour of the parotid gland.This lesion was described by Sir Charles Bell.
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