Bell's palsy

Bell's palsy is a type of facial paralysis that results in an inability to control the facial muscles on the affected side.[1] Symptoms can vary from mild to severe.[1] They may include muscle twitching, weakness, or total loss of the ability to move one or rarely both sides of the face.[1] Other symptoms include drooping of the eyelid, a change in taste, pain around the ear, and increased sensitivity to sound.[1] Typically symptoms come on over 48 hours.[1]

The cause of Bell's palsy is unknown.[1] Risk factors include diabetes, a recent upper respiratory tract infection, and pregnancy.[1][4] It results from a dysfunction of cranial nerve VII (the facial nerve).[1] Many believe that this is due to a viral infection that results in swelling.[1] Diagnosis is based on a person's appearance and ruling out other possible causes.[1] Other conditions that can cause facial weakness include brain tumor, stroke, Ramsay Hunt syndrome, myasthenia gravis, and Lyme disease.[2]

The condition normally gets better by itself with most achieving normal or near-normal function.[1] Corticosteroids have been found to improve outcomes, while antiviral medications may be of a small additional benefit.[5] The eye should be protected from drying up with the use of eye drops or an eyepatch.[1] Surgery is generally not recommended.[1] Often signs of improvement begin within 14 days, with complete recovery within six months.[1] A few may not recover completely or have a recurrence of symptoms.[1]

Bell's palsy is the most common cause of one-sided facial nerve paralysis (70%).[2][6] It occurs in 1 to 4 per 10,000 people per year.[2] About 1.5% of people are affected at some point in their life.[7] It most commonly occurs in people between ages 15 and 60.[1] Males and females are affected equally.[1] It is named after Scottish surgeon Charles Bell (1774–1842), who first described the connection of the facial nerve to the condition.[1]

Bell's palsy
Bellspalsy
A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side (left side of the image; notice how the forehead is not spared).
SpecialtyNeurology, ENT
SymptomsInability to move the facial muscles on one side, change in taste, pain around the ear[1]
Usual onsetOver 48 hours[1]
Duration<6 months[1]
CausesUnknown[1]
Risk factorsDiabetes, recent upper respiratory tract infection[1]
Diagnostic methodBased on symptoms[1]
Differential diagnosisBrain tumor, stroke, Ramsay Hunt syndrome, Lyme disease[2]
TreatmentCorticosteroids, eye drops, eyepatch[1][3]
PrognosisMost recover completely[1]
Frequency1–4 per 10,000 per year[2]

Signs and symptoms

Bell's palsy is characterized by a one-sided facial droop that comes on within 72 hours.[8] In rare cases (<1%), it can occur on both sides resulting in total facial paralysis.[9][10]

The facial nerve controls a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, salivation, flaring nostrils and raising eyebrows. It also carries taste sensations from the anterior two-thirds of the tongue, via the chorda tympani nerve (a branch of the facial nerve). Because of this, people with Bell's palsy may present with loss of taste sensation in the anterior 2/3 of the tongue on the affected side.[11]

Although the facial nerve innervates the stapedius muscle of the middle ear (via the tympanic branch), sound sensitivity, causing normal sounds to be perceived as very loud, and dysacusis are possible but hardly ever clinically evident.[11][12]

Although defined as a mononeuritis (involving only one nerve), people diagnosed with Bell's palsy may have "myriad neurological symptoms" including "facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesias, ipsilateral limb weakness, and a sense of clumsiness" that are "unexplained by facial nerve dysfunction".[13]

Cause

Cranial nerve VII
Facial nerve: the facial nerve's nuclei are in the brainstem (they are represented in the diagram as a „θ“). Orange: nerves coming from the left hemisphere of the brain. Yellow: nerves coming from the right hemisphere of the brain. Note that the forehead muscles receive innervation from both hemispheres of the brain (represented in yellow and orange).

The cause of Bell's palsy is unknown.[1] Risk factors include diabetes, a recent upper respiratory tract infection, and pregnancy.[1][4]

Some viruses are thought to establish a persistent (or latent) infection without symptoms, e.g., the varicella-zoster virus[14] and Epstein–Barr viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested as a cause of acute Bell's palsy.[15] This new activation could be triggered by trauma, environmental factors, and metabolic or emotional disorders.[16]

Familial inheritance has been found in 4–14% of cases.[17] There may also be an association with migraines.[18]

Pathophysiology

Gray781
Anatomy of the face.

Bell's palsy occurs due to a malfunction of the facial nerve (cranial nerve VII), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the muscles of facial expression. The paralysis is of the infranuclear/lower motor neuron type.

It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal (the stylomastoid foramen), blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell's palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy.[19] In a few cases, bilateral facial palsy has been associated with acute HIV infection.

In some research, the herpes simplex virus type 1 (HSV-1) has been identified in a majority of cases diagnosed as Bell's palsy via endoneurial fluid sampling.[20] Other research, however, identified, out of a total of 176 cases diagnosed as Bell's palsy, HSV-1 in 31 cases (18 percent) and herpes zoster in 45 cases (26 percent).[15]

In addition, HSV-1 infection is associated with demyelination of nerves. This nerve damage mechanism is different from the above-mentioned - that edema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown immune response.

Diagnosis

Bell's palsy is a diagnosis of exclusion, meaning it is diagnosed by elimination of other reasonable possibilities. By definition, no specific cause can be determined. There are no routine lab or imaging tests required to make the diagnosis.[8] The degree of nerve damage can be assessed using the House-Brackmann score.

One study found that 45% of patients are not referred to a specialist, which suggests that Bell's palsy is considered by physicians to be a straightforward diagnosis that is easy to manage.[13]

Other conditions that can cause similar symptoms include: herpes zoster, Lyme disease, sarcoidosis, stroke, and brain tumors.[8]

Differential diagnosis

Once the facial paralysis sets in, many people may mistake it as a symptom of a stroke; however, there are a few subtle differences. A stroke will usually cause a few additional symptoms, such as numbness or weakness in the arms and legs. And unlike Bell's palsy, a stroke will usually let patients control the upper part of their faces. A person with a stroke will usually have some wrinkling of their forehead.[21]

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. The major differences in this condition are the presence of small blisters, or vesicles, on the external ear and hearing disturbances, but these findings may occasionally be lacking (zoster sine herpete). 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.

Lyme disease may produce facial palsy.[22] Sometimes the facial palsy occurs at the same time as the classic erythema migrans rash.[22] Other times, it occurs later.[22] In areas where Lyme disease is common, it may be the cause of facial palsy in half of cases.[22]

Treatment

Steroids have been shown to be effective at improving recovery in Bell's palsy while antivirals have not.[8] In those who are unable to close their eyes, eye protective measures are required.[8] Management in during pregnancy is similar to the non pregnant.[4]

Steroids

Corticosteroids such as prednisone improve recovery at 6 months and are thus recommended.[3] Early treatment (within 3 days after the onset) is necessary for benefit[23] with a 14% greater probability of recovery.[24]

Antivirals

One review found that antivirals (such as aciclovir) are ineffective in improving recovery from Bell's palsy beyond steroids alone in mild to moderate disease.[25] Another review found a benefit when combined with corticosteroids but stated the evidence was not very good to support this conclusion.[5]

In severe disease it is also unclear. One 2015 review found no effect regardless of severity.[26] Another review found a small benefit when added to steroids.[5]

They are commonly prescribed due to a theoretical link between Bell's palsy and the herpes simplex and varicella zoster virus.[27] There is still the possibility that they might result in a benefit less than 7% as this has not been ruled out.[28]

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.[29] 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.[29] To reduce pain, heat can be applied to the affected side of the face.[30] There is no high quality evidence to support the role of electrical stimulation for Bell's palsy.[31]

Surgery

Surgery may be able to improve outcomes in facial nerve palsy that has not recovered.[32] A number of different techniques exist.[32] Smile surgery or smile reconstruction is a surgical procedure that may restore the smile for people with facial nerve paralysis. It is unknown if early surgery is beneficial or harmful.[33] Adverse effects include hearing loss which occurs in 3–15% of people.[34] As of 2007 the American Academy of Neurology did not recommend surgical decompression.[34]

Alternative medicine

The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).[35] There is very tentative evidence for hyperbaric oxygen therapy in severe disease.[36]

Prognosis

Most people with Bell's palsy start to regain normal facial function within 3 weeks—even those who do not receive treatment.[37] In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later.

After a follow-up of at least one year or until restoration, complete recovery had occurred in more than two-thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients.[38] Another study found that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop sequelae.[39] A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.[16]

Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm, facial pain and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete paralysis. Where the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eye from injury.

Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination—but some nerves may sidetrack leading to a condition known as synkinesis. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.

Around 9%[40] of patients have some sort of sequelae after Bell's palsy, typically the synkinesis already discussed, or spasm, contracture, tinnitus and/or hearing loss during facial movement or |crocodile tear syndrome. This is also called gustatolacrimal reflex or Bogorad's syndrome and involves the sufferer shedding tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands. Gustatorial sweating can also occur.

Epidemiology

The number of new cases of Bell's palsy ranges from about one to four cases per 10,000 population per year.[41] The rate increases with age.[2][41] Bell's palsy affects about 40,000 people in the United States every year. It affects approximately 1 person in 65 during a lifetime.

A range of annual incidence rates have been reported in the literature: 15,[17] 24,[42] and 25–53[13] (all rates per 100,000 population per year). Bell's palsy is not a reportable disease, and there are no established registries for people with this diagnosis, which complicates precise estimation.

History

CharlesBell001
Sir Charles Bell

The Persian physician Muhammad ibn Zakariya al-Razi (865–925) detailed the first known description of peripheral and central facial palsy.[43][44]

Cornelis Stalpart van der Wiel (1620–1702) in 1683 gave an account of Bell's palsy and credited the Persian physician Ibn Sina (980–1037) for describing this condition before him. James Douglas (1675–1742) and Nicolaus Anton Friedreich (1761–1836) also described it.

Sir Charles Bell, for whom the condition is named, presented three cases at the Royal Society of London in 1829. Two cases were idiopathic and the third was due to a tumour of the parotid gland.

A notable person with Bell's palsy is former Prime Minister of Canada Jean Chrétien. During the 1993 Canadian federal election, Chrétien's first as leader of the Liberal Party of Canada, the opposition Progressive Conservative Party of Canada ran an attack ad in which voice actors criticized him over images that seemed to highlight his abnormal facial expressions. The ad was interpreted as an attack on Chrétien's physical appearance and garnered widespread anger among the public, while Chrétien used the ad to make himself more sympathetic to voters. The ad had the adverse effect of increasing Chrétien's lead in the polls and the subsequent backlash clinched the election for the Liberals, which the party won in a landslide.

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab "Bell's Palsy Fact Sheet". NINDS. February 5, 2016. Archived from the original on 8 April 2011. Retrieved 8 August 2016.
  2. ^ a b c d e f Fuller, G; Morgan, C (31 March 2016). "Bell's palsy syndrome: mimics and chameleons". Practical Neurology. 16 (6): 439–444. doi:10.1136/practneurol-2016-001383. PMID 27034243.
  3. ^ a b Madhok, VB; Gagyor, I; Daly, F; Somasundara, D; Sullivan, M; Gammie, F; Sullivan, F (18 July 2016). "Corticosteroids for Bell's palsy (idiopathic facial paralysis)". Cochrane Database of Systematic Reviews. 7: CD001942. doi:10.1002/14651858.CD001942.pub5. PMID 27428352.
  4. ^ a b c Hussain, A; Nduka, C; Moth, P; Malhotra, R (May 2017). "Bell's facial nerve palsy in pregnancy: a clinical review". Journal of Obstetrics and Gynaecology : The Journal of the Institute of Obstetrics and Gynaecology. 37 (4): 409–415. doi:10.1080/01443615.2016.1256973. PMID 28141956.
  5. ^ a b c Gagyor, Ildiko; Madhok, Vishnu B.; Daly, Fergus; Somasundara, Dhruvashree; Sullivan, Michael; Gammie, Fiona; Sullivan, Frank (2015-11-09). "Antiviral treatment for Bell's palsy (idiopathic facial paralysis)" (PDF). The Cochrane Database of Systematic Reviews (11): CD001869. doi:10.1002/14651858.CD001869.pub8. ISSN 1469-493X. PMID 26559436.
  6. ^ Dickson, Gretchen (2014). Primary Care ENT, An Issue of Primary Care: Clinics in Office Practice. Elsevier Health Sciences. p. 138. ISBN 9780323287173. Archived from the original on 2016-08-20.
  7. ^ Grewal, D. S. (2014). Atlas of Surgery of the Facial Nerve: An Otolaryngologist's Perspective. Jaypee Brothers Publishers. p. 46. ISBN 9789350905807. Archived from the original on 2016-08-20.
  8. ^ a b c d e Baugh, RF; Basura, GJ; Ishii, LE; Schwartz, SR; Drumheller, CM; Burkholder, R; Deckard, NA; Dawson, C; Driscoll, C; Gillespie, MB; Gurgel, RK; Halperin, J; Khalid, AN; Kumar, KA; Micco, A; Munsell, D; Rosenbaum, S; Vaughan, W (November 2013). "Clinical Practice Guideline: Bell's Palsy Executive Summary". Otolaryngology–Head and Neck Surgery. 149 (5): 656–63. doi:10.1177/0194599813506835. PMID 24190889.
  9. ^ Price, Fife, T; Fife, DG (January 2002). "Bilateral simultaneous facial nerve palsy". The Journal of Laryngology & Otology. 116 (1): 46–8. doi:10.1258/0022215021910113. PMID 11860653.
  10. ^ Jain V, Deshmukh A, Gollomp S (July 2006). "Bilateral facial paralysis: case presentation and discussion of differential diagnosis". Journal of General Internal Medicine. 21 (7): C7–10. doi:10.1111/j.1525-1497.2006.00466.x. PMC 1924702. PMID 16808763.
  11. ^ a b Mumenthaler, Mark; Mattle, Heinrich (2006). Fundamentals of Neurology. Germany: Thieme. p. 197. ISBN 978-3131364517.
  12. ^ Moore, Keith L.; Dalley, Arthur F.; Agur, A. M. R. (2013-02-13). Clinically Oriented Anatomy. Lippincott Williams & Wilkins. ISBN 9781451119459.
  13. ^ a b c Morris AM; Deeks SL; Hill MD; et al. (2002). "Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy". Neuroepidemiology. 21 (5): 255–61. doi:10.1159/000065645. PMID 12207155. Archived from the original on 2009-07-13.
  14. ^ Facial Nerve Problems and Bell's Palsy Information on MedicineNet.com Archived 2008-04-23 at the Wayback Machine
  15. ^ a b Furuta Y, Ohtani F, Chida E, Mesuda Y, Fukuda S, Inuyama Y (2001). "Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy". Auris Nasus Larynx. 28 (Suppl): S13–7. doi:10.1016/S0385-8146(00)00105-X. PMID 11683332.
  16. ^ a b Kasse C.A; Ferri R.G; Vietler E.Y.C; Leonhardt F.D; Testa J.R.G; Cruz O.L.M (October 2003). "Clinical data and prognosis in 1521 cases of Bell's palsy". International Congress Series. 1240: 641–7. doi:10.1016/S0531-5131(03)00757-X.
  17. ^ a b Döner F, Kutluhan S (2000). "Familial idiopathic facial palsy". European Archives of Oto-Rhino-Laryngology. 257 (3): 117–9. doi:10.1007/s004050050205. PMID 10839481. Archived from the original on 2013-01-06.
  18. ^ Silberstein, SD; Silvestrini, M (13 January 2015). "Does migraine produce facial palsy? For whom the Bell tolls". Neurology. 84 (2): 108–9. doi:10.1212/WNL.0000000000001136. PMID 25520314.
  19. ^ MedlinePlus Medical Encyclopedia: Facial nerve palsy due to birth trauma Archived 2008-10-01 at the Wayback Machine retrieved 10 September 2008
  20. ^ Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996). "Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle". Annals of Internal Medicine. 124 (1 Pt 1): 27–30. doi:10.7326/0003-4819-124-1_Part_1-199601010-00005. PMID 7503474.
  21. ^ S.C. TV Reporter Loses Her Smile after a Bell's Palsy Attack Archived 2016-03-05 at the Wayback Machine
  22. ^ a b c d Lorch, M; Teach, SJ (Oct 2010). "Facial nerve palsy: etiology and approach to diagnosis and treatment". Pediatric Emergency Care. 26 (10): 763–9, quiz 770–3. doi:10.1097/PEC.0b013e3181f3bd4a. PMID 20930602.
  23. ^ Hazin, R; Azizzadeh, B; Bhatti, MT (November 2009). "Medical and surgical management of facial nerve palsy". Current Opinion in Ophthalmology. 20 (6): 440–50. doi:10.1097/ICU.0b013e3283313cbf. PMID 19696671.
  24. ^ Gronseth, GS; Paduga, R (Nov 7, 2012). "Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 79 (22): 2209–13. doi:10.1212/WNL.0b013e318275978c. PMID 23136264.
  25. ^ Turgeon, RD; Wilby, KJ; Ensom, MH (June 2015). "Antiviral Treatment of Bell's Palsy Based on Baseline Severity: A Systematic Review and Meta-analysis". The American Journal of Medicine. 128 (6): 617–28. doi:10.1016/j.amjmed.2014.11.033. PMID 25554380.
  26. ^ Turgeon, Ricky D.; Wilby, Kyle J.; Ensom, Mary H.H. (June 2015). "Antiviral Treatment of Bell's Palsy Based on Baseline Severity: A Systematic Review and Meta-analysis". The American Journal of Medicine. 128 (6): 617–628. doi:10.1016/j.amjmed.2014.11.033. PMID 25554380.
  27. ^ Sullivan FM; Swan IR; Donnan PT; et al. (October 2007). "Early treatment with prednisolone or acyclovir in Bell's palsy". New England Journal of Medicine. 357 (16): 1598–607. doi:10.1056/NEJMoa072006. PMID 17942873.
  28. ^ Gronseth, GS; Paduga, R; American Academy of Neurology (Nov 27, 2012). "Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 79 (22): 2209–13. doi:10.1212/WNL.0b013e318275978c. PMID 23136264.
  29. ^ a b National Institute of Neurological Disorders and Stroke (NINDS) (April 2003). "Bell's Palsy Fact Sheet". Archived from the original on 8 April 2011. Retrieved 2011-05-12.
  30. ^ Shafshak, TS (March 2006). "The treatment of facial palsy from the point of view of physical and rehabilitation medicine". Europa Medicophysica. 42 (1): 41–7. PMID 16565685.
  31. ^ Teixeira, Lázaro J; Valbuza, J. S.; Prado, G. F. (Dec 2011). "Physical therapy for Bell's palsy (idiopathic facial paralysis)". Cochrane Database of Systematic Reviews (12): CD006283. doi:10.1002/14651858.CD006283.pub3. PMID 22161401.
  32. ^ a b Hazin R, Azizzadeh B, Bhatti MT (November 2009). "Medical and surgical management of facial nerve palsy". Current Opinion in Ophthalmology. 20 (6): 440–50. doi:10.1097/ICU.0b013e3283313cbf. PMID 19696671.
  33. ^ McAllister, Kerrie; Walker, David; Donnan, Peter T.; Swan, Iain (2013-10-16). "Surgical interventions for the early management of Bell's palsy" (PDF). Cochrane Database of Systematic Reviews (10): CD007468. doi:10.1002/14651858.CD007468.pub3. ISSN 1469-493X. PMID 24132718.
  34. ^ a b Tiemstra, JD; Khatkhate, N (Oct 1, 2007). "Bell's palsy: diagnosis and management". American Family Physician. 76 (7): 997–1002. PMID 17956069.
  35. ^ Chen, N; Zhou, M; He, L; Zhou, D; Li, N (4 August 2010). "Acupuncture for Bell's palsy". Cochrane Database of Systematic Reviews (8): CD002914. doi:10.1002/14651858.CD002914.pub5. PMID 20687071.
  36. ^ Holland, NJ; Bernstein, JM; Hamilton, JW (15 February 2012). "Hyperbaric oxygen therapy for Bell's palsy". Cochrane Database of Systematic Reviews. 2 (2): CD007288. doi:10.1002/14651858.CD007288.pub2. PMID 22336830.
  37. ^ Karnath, B. "Bell Palsy: Updated Guideline for Treatment". Consultant. HMP Communications. Archived from the original on February 25, 2013. Retrieved April 3, 2013.
  38. ^ Peitersen E (1982). "The natural history of Bell's palsy". The American Journal of Otology. 4 (2): 107–11. PMID 7148998. quoted in Roob G, Fazekas F, Hartung HP (1999). "Peripheral facial palsy: etiology, diagnosis and treatment". European Neurology. 41 (1): 3–9. doi:10.1159/000007990. PMID 9885321. Archived from the original on 2009-07-13.
  39. ^ Peitersen E, Andersen P (1966). "Spontaneous course of 220 peripheral non-traumatic facial palsies". Acta Oto-Laryngologica: Suppl 224:296+. PMID 6011525.
  40. ^ Yamamoto E, Nishimura H, Hirono Y (1988). "Occurrence of sequelae in Bell's palsy". Acta Oto-Laryngologica. Suppl 446: 93–6. PMID 3166596.
  41. ^ a b Ahmed A (2005). "When is facial paralysis Bell palsy? Current diagnosis and treatment". Cleveland Clinic Journal of Medicine. 72 (5): 398–401, 405. doi:10.3949/ccjm.72.5.398. PMID 15929453.
  42. ^ Wolf SR (1998). "[Idiopathic facial paralysis]". HNO (in German). 46 (9): 786–98. doi:10.1007/s001060050314. PMID 9816532. Archived from the original on 2000-06-23.
  43. ^ Sajadi MM, Sajadi MR, Tabatabaie SM (July 2011). "The history of facial palsy and spasm: Hippocrates to Razi". Neurology. 77 (2): 174–8. doi:10.1212/WNL.0b013e3182242d23. PMC 3140075. PMID 21747074.
  44. ^ van de Graaf RC, Nicolai JP (November 2005). "Bell's palsy before Bell: Cornelis Stalpart van der Wiel's observation of Bell's palsy in 1683". Otology & Neurotology. 26 (6): 1235–8. doi:10.1097/01.mao.0000194892.33721.f0. PMID 16272948.

External links

External resources
Carnie Wilson

Carnie Wilson (born April 29, 1968) is an American singer and television host, perhaps best known as a member of the pop music group Wilson Phillips.

Charles Bell

Sir Charles Bell (12 November 1774 – 28 April 1842) was a Scottish surgeon, anatomist, physiologist, neurologist, artist, and philosophical theologian. He is noted for discovering the difference between sensory nerves and motor nerves in the spinal cord. He is also noted for describing Bell's palsy.

His three older brothers included Robert Bell (1757–1816) a Writer to the Signet, John Bell (1763–1820), also a noted surgeon and writer; and the advocate George Joseph Bell (1770–1843) who became a professor of law at the University of Edinburgh and a principal clerk at the Court of Session.

Cranial nerve disease

Cranial nerve disease is an impaired functioning of one of the twelve cranial nerves. Although it could theoretically be considered a mononeuropathy, it is not considered as such under MeSH.

It is possible for a disorder of more than one cranial nerve to occur at the same time, if a trauma occurs at a location where many cranial nerves run together, such as the jugular fossa. A brainstem lesion could also cause impaired functioning of multiple cranial nerves, but this condition would likely also be accompanied by distal motor impairment.

A neurological examination can test the functioning of individual cranial nerves, and detect specific impairments.

Cranial nerves

Cranial nerves are the nerves that emerge directly from the brain (including the brainstem), in contrast to spinal nerves (which emerge from segments of the spinal cord). 10 of the cranial nerves originate in the brainstem. Cranial nerves relay information between the brain and parts of the body, primarily to and from regions of the head and neck.Spinal nerves emerge sequentially from the spinal cord with the spinal nerve closest to the head (C1) emerging in the space above the first cervical vertebra. The cranial nerves, however, emerge from the central nervous system above this level. Each cranial nerve is paired and is present on both sides. Depending on definition in humans there are twelve or thirteen cranial nerves pairs, which are assigned Roman numerals I–XII, sometimes also including cranial nerve zero. The numbering of the cranial nerves is based on the order in which they emerge from the brain, front to back (brainstem).The terminal nerves (0), olfactory nerves (I) and optic nerves (II) emerge from the cerebrum or forebrain, and the remaining ten pairs arise from the brainstem, which is the lower part of the brain.The cranial nerves are considered components of the peripheral nervous system (PNS), although on a structural level the olfactory (I), optic (II), and trigeminal (V) nerves are more accurately considered part of the central nervous system (CNS).

Cyclosporiasis

Cyclosporiasis is a disease caused by infection with Cyclospora cayetanensis, a pathogenic protozoan transmitted by feces or feces-contaminated food and water. Outbreaks have been reported due to contaminated fruits and vegetables. It is not spread from person to person, but can be a hazard for travelers as a cause of diarrhea.

Electroneuronography

Electroneuronography or electroneurography (ENoG) is a neurological non-invasive test used to study the facial nerve in cases of muscle weakness in one side of the face (Bell's palsy). The technique of electroneuronography was first used by Esslen and Fisch in 1979 to describe a technique that examines the integrity and conductivity of peripheral nerves. In modern use, ENoG is used to describe study of the facial nerve, while the term nerve conduction study is employed for other nerves.

It consists of a brief electrical stimulation of the nerve in one point underneath the skin, and at the same time recording the electrical activity (compound action potentials) at another point of the nerve's trajectory in the body. The response is displayed in a cathode ray tube (CRT) or through the video monitor of a computer. The stimulation as well as the recording are carried out by disc electrodes taped to the skin, and the technician may use electrically conducting gel or paste to bolster the signals being input and output. Alternatively, the recording electrodes may also be used to pick up the electrical activity of a muscle innervated by that nerve. In such instances electroneuronography is closely related to electromyography.

It is performed by an audiologist, who carries out tests to compare the two sides of the face.

The stimulation electrode is located at the stylomastoid foramen and the recording electrode is located near the nasolabial fold. The ENoG test is the only objective measure of facial nerve integrity.

Facial nerve decompression

Facial nerve decompression is a type of nerve decompression surgery where abnormal compression on the facial nerve is relieved.

Facial nerve paralysis

Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. The pathway of the facial nerve is long and relatively convoluted, so there are a number of causes that may result in facial nerve paralysis. The most common is Bell's palsy, a disease of unknown cause that may only be diagnosed by exclusion.

Facial toning

Facial toning, or facial exercise is a type of cosmetic procedure or physical therapy tool which promises to alter facial contours by means of increasing muscle tone, and facial volume by promoting muscular hypertrophy, and preventing muscle loss due to aging or facial paralysis. Facial toning and exercise is therefore in part a technique to achieve facial rejuvenation by reducing wrinkles, sagging and expression marks on the face and skin. As a physical therapy, facial toning is used for victims of stroke and forms of facial paralysis such as Bell’s palsy. Facial toning achieves this by performing facial muscle exercising. There are two types of facial toning exercises: active and passive face exercises.

Facial weakness

Facial weakness is a medical sign associated with a variety of medical conditions.

Some specific conditions associated with facial weakness include:

Stroke

Neurofibromatosis

Bell's palsy

Ramsay Hunt syndrome

Spontaneous cerebrospinal fluid leak

Myasthenia gravis

House–Brackmann score

The House–Brackmann score is a score to grade the degree of nerve damage in a facial nerve palsy. The measurement is determined by measuring the upwards (superior) movement of the mid-portion of the top of the eyebrow, and the outwards (lateral) movement of the angle of the mouth. Each reference point scores 1 point for each 0.25 cm movement, up to a maximum of 1 cm. The scores are then added together, to give a number out of 8. The score predicts recovery in those with Bell's palsy.The score carries the name of the Dr John W. House and Dr Derald E. Brackmann, otolaryngologists in Los Angeles, California, who first described the system in 1985. It is one of a number of facial nerve scoring systems, such as Burres-Fisch, Nottingham, Sunnybrook, and Yanagihara. Of these, the Nottingham scale has been identified as possibly being easier and more reproducible. A modification of the original House–Brackmann score, called the "Facial Nerve Grading Scale 2.0" (FNGS2.0) was proposed in 2009.

List of people with Bell's palsy

Well-known people who have been diagnosed with Bell's palsy include:

Roseanne Barr, American comedian and actress whose condition occurred as a child

Stevie Benton, bassist for Texas rock band Drowning Pool

Hafþór Júlíus Björnsson, Icelandic professional strongman, actor, and professional basketball player

Amy Brenneman, American actress and producer

Pierce Brosnan, Irish actor, film producer and environmentalist

Freddie Burns, England and Leicester Tigers rugby player

Scott Cairns, American poet and theological writer whose condition occurred as a child

Jean Chrétien, prime minister of Canada

George Clooney, American actor, director, producer, and screenwriter

Norm Coleman, United States Senator

Alexis Denisof, American actor

Glen Durrant, BDO World Darts Champion

Thomas C. Foley, American politician and businessman; U.S. Ambassador to Ireland

David Frum, Canadian-American pundit

Graeme Garden, British comedy writer and performer, who has written about his experiences with the condition

Allen Ginsberg, American beat poet

Tony Gonzalez, American NFL football player

Amy Goodman, American journalist and author

Jane Greer, American actress

Trenton Hassell, American basketball player for the New Jersey Nets of the NBA

Terrence Howard, American actor

Armando Iannucci, Scottish writer

Angelina Jolie, American actress and filmmaker

Anupam Kher, Indian actor

Ralph Kiner, American baseball player in the 1940s and 1950s

Ella Koon, Tahitian-born Hong Kong singer-actress

Curtis LeMay, United States Air Force general and 1968 independent vice presidential candidate

Gordon Lightfoot, Canadian singer

Martin Love, Australian cricketer

Joe Mantegna, American actor

Pete Maravich, American basketball player

Florence Mars, American civil rights activist and author

Tom McCarthy, Canadian National Hockey League player who played for the Minnesota North Stars and Boston Bruins.

Glenda McKay, British actor

Danny Meyer, American restaurateur in New York City; chief executive officer of Union Square Hospitality Group

Scarlett Moffatt, British television personality

Kim Mulkey, American basketball player and coach (Baylor University women)

Ralph Nader, American politician

Cliff Pennington, shortstop for the Oakland Athletics

Jim Ross, professional wrestling commentator for WWE and WCW

Rick Savage, bass guitarist for the British rock band Def Leppard

Tom Seaver, Hall of Fame Major League pitcher

Bernadette Sembrano, Filipino newscaster, host of the medical program Salamat Dok! and anchor of TV Patrol Weekend

Ayrton Senna, Brazilian Formula One racecar driver

Rahul Sharma, Indian cricketer

Jamey Sheridan, American actor whose condition was written into the show Law and Order: Criminal Intent

Sarah Smart, English actress

Mike South, American pornographic director

Bruce Sutter, American Major League Baseball pitcher

Bart Tommelein, Belgian politician

Kevin Tsai, Taiwanese writer and TV host

Colin Turkington, British touring car racing driver

Evan Turner, American basketball player

Chris Walker, British superbike racer

Wesley Walker, American football player was unable to blink his left eye due to Bell's palsy in 1982, but played football anyway

Andrew Lloyd Webber, British composer

Joseph C. Wilson, American diplomat

Nancy Zieman, American television host of the show Sewing with Nancy

Matt Weibring

Matthew Kirk Weibring (born December 4, 1979) is an American professional golfer. He is the son of D. A. Weibring.Weibring turned professional in 2002, and played on the second-tier Nationwide Tour in 2003 and 2005–08. He played on the PGA Tour in 2009–10 after graduating in 24th place from the 2008 Nationwide Tour. In 2011 he returned to the Nationwide Tour. Weibring's best result on the PGA Tour is T8 at the 2009 Verizon Heritage. He also played on the Canadian Tour in 2003.

Weibring has a history of injuries, include hip and knee surgery. He has Bell's palsy, a condition his father overcame during his career, and cannot blink his right eye.

Nancy Zieman

Nancy L. Zieman (née Luedtke; June 21, 1953 – November 14, 2017) was an American author and designer widely known as the host of the television show Sewing with Nancy.

Palsy

Palsy is a medical term which refers to various types of paralysis, often accompanied by weakness and the loss of feeling and uncontrolled body movements such as shaking. The word originates from the Anglo-Norman paralisie, parleisie et al., from the accusative form of Latin paralysis, from Ancient Greek παράλυσις (parálusis), from παραλύειν (paralúein, “to disable on one side”), from παρά (pará, “beside”) + λύειν (lúein, “loosen”). The word is longstanding in the English language, having appeared in the play Grim the Collier of Croydon, reported to have been written as early as 1599:

Rob. I'll have thee come, I say. Why tremblest thou?Grim. No sir, not I; 'tis a palsy I have still.

In some editions, the Bible passage of Luke 5:18 is translated to refer to "a man which was taken with a palsy". More modern editions simply refer to a man who is paralysed. Although the term has historically been associated with paralysis generally, "is now almost always used in connection to the word “cerebral”—meaning the brain".Specific kinds of palsy include:

Bell's palsy, partial facial paralysis

Bulbar palsy, impairment of cranial nerves

Cerebral palsy, a neural disorder caused by intracranial lesions

Conjugate gaze palsy, a disorder affecting the ability to move the eyes

Erb's palsy, also known as brachial palsy, involving paralysis of an arm

Spinal muscular atrophy, also known as wasting palsy

Progressive supranuclear palsy, a degenerative disease

Squatter's palsy, a common name for bilateral peroneal nerve palsy that may be triggered by sustained squatting

Third nerve palsy, involving cranial nerve III

Rahul Sharma (Indian cricketer)

Rahul Sharma (born 20 July 1987 in New Delhi, Punjab) is an Indian cricketer. He is primarily a right-handed legbreak and googly bowler. He has been a member of the Punjab cricket team since 2006. He came into the limelight due to his impressive bowling performances in IPL 2011 for Pune Warriors.

Roberto Pérez

Roberto Pérez (born December 23, 1988) is a Puerto Rican professional baseball catcher for the Cleveland Indians of Major League Baseball (MLB).

Sewing with Nancy

Sewing with Nancy was an American television show about sewing, hosted by Nancy Zieman. It made its debut on the now-defunct Satellite Program Network (SPN, later Tempo Television) in September 1982. On September 1, 1982, PBS began airing the series, which was distributed by NETA. As of 2011, the show aired on 89% of Public Television stations in the United States. It was the longest-running sewing series in the history of North American television.Sewing with Nancy was co-produced by Wisconsin Public Television at Vilas Hall on the University of Wisconsin campus in Madison. Zieman had Bell's palsy, a one-sided facial nerve paralysis, and talked about the condition on an episode in 2011. On September 5, 2017, Zieman announced her retirement due to cancer; she died just over two months later, the day after the final episode was broadcast. Older episodes continue to be broadcast on PBS under the name The Best of Sewing with Nancy.

Stylomastoid foramen

Between the styloid and mastoid processes of the temporal bone is the stylomastoid foramen

It is the termination of the facial canal, and transmits the facial nerve and stylomastoid artery.

Nervous system pathology, PNS, somatic (G50–G64, 350–357)

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