Bell's palsy

Bell's palsy
A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side. Note how the forehead is not spared.
SpecialtyNeurology, Ophthalmology, ENT, oral and maxillofacial surgery
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 type 2, Lyme disease[2]
TreatmentCorticosteroids, eye drops, eyepatch[1][3]
PrognosisMost recover completely[1]
Frequency1–4 per 10,000 per year[2]

Bell's palsy is a type of facial paralysis that results in a temporary inability to control the facial muscles on the affected side of the face.[1] In most cases, the weakness is temporary and significantly improves over weeks.[4] Symptoms can vary from mild to severe.[1] They may include muscle twitching, weakness, or total loss of the ability to move one or, in rare cases, both sides of the face.[1] Other symptoms include drooping of the eyebrow,[5] a change in taste, and pain around the ear. Typically symptoms come on over 48 hours.[1] Bell's palsy can trigger an increased sensitivity to sound known as hyperacusis.[6]

The cause of Bell's palsy is unknown[1] and it can occur at any age.[4] Risk factors include diabetes, a recent upper respiratory tract infection, and pregnancy.[1][7] 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 type 2, 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.[8] 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][9] 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 lives.[10] 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]

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".[11]

  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 "Bell's Palsy Fact Sheet". National Institute of Neurological Disorders and Stroke. July 25, 2022. Archived from the original on 8 April 2011. Retrieved October 11, 2022.
  2. ^ a b c d e Fuller G, Morgan C (December 2016). "Bell's palsy syndrome: mimics and chameleons". Practical Neurology. 16 (6): 439–44. doi:10.1136/practneurol-2016-001383. PMID 27034243. S2CID 4480197.
  3. ^ Cite error: The named reference ReferenceA was invoked but never defined (see the help page).
  4. ^ a b "Bell's palsy - Symptoms and causes". Mayo Clinic. Retrieved 2022-03-22.
  5. ^ "Bell's Palsy".
  6. ^ Purves D (2012). Neuroscience (5th ed.). Sunderland, Massachusetts: Sinauer. p. 283. ISBN 9780878936953.
  7. ^ 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. 37 (4): 409–15. doi:10.1080/01443615.2016.1256973. PMID 28141956. S2CID 205479752.
  8. ^ Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F (November 2015). "Antiviral treatment for Bell's palsy (idiopathic facial paralysis)" (PDF). The Cochrane Database of Systematic Reviews (11): CD001869. doi:10.1002/14651858.CD001869.pub8. PMID 26559436.
  9. ^ Dickson G (2014). Primary Care ENT, An Issue of Primary Care: Clinics in Office Practice. Elsevier Health Sciences. p. 138. ISBN 978-0323287173. Archived from the original on 2016-08-20.
  10. ^ Grewal DS (2014). Atlas of Surgery of the Facial Nerve: An Otolaryngologist's Perspective. Jaypee Brothers Publishers. p. 46. ISBN 978-9350905807. Archived from the original on 2016-08-20.
  11. ^ Cite error: The named reference Morris was invoked but never defined (see the help page).
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