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Condition/Disorder Synonyms

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  • Facial palsy
  • Peripheral facial paralysis

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ICD-9-CM Code

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  • 351.0 Bell’s palsy

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ICD-1-CM Code

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  • G51.0 Bell’s palsy, facial palsy

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Key Features

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Description

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  • Paralysis or weakness of muscles on one side of face
  • Sudden onset, often overnight
  • Damage to the 7th cranial (facial) nerve that controls muscles on one side of the face, causing that side of face to droop
  • Nerve damage may affect sense of taste, production of tears and saliva

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Essentials

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  • Lower motor neuron (LMN) disease
  • Diagnosis usually made by history and clinical examination

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General Considerations

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  • Afflicts approximately 40,000 Americans each year

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Demographics

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  • Equally likely in men and women
  • Can present at any age, but less common before age 15 years or after age 60
  • More prevalent in people with diabetes or upper respiratory ailments, such as flu or cold
  • More likely in pregnant women

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Clinical Findings

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Signs and Symptoms

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  • Sudden weakness or paralysis on one side of face that causes it to droop (main symptom)
  • Difficulty closing eye on affected side
  • Drooling
  • Dry mouth
  • Eye problems, such as excessive tearing or dry eye
  • Loss of ability to taste
  • Pain in or behind ear
  • Facial numbness on affected side
  • Increased sensitivity to sound
  • Headache
  • Facial twitch
  • Inability to smile or make facial expressions

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Functional Implications

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  • Dry eyes
  • Eating
  • Hearing
  • Psychological impact

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Possible Contributing Causes

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  • The nerve that controls muscles on one side of the face is damaged by inflammation in most cases
  • Root cause of Bell's palsy is not clear
  • Most cases thought to be caused by the herpes virus that causes chickenpox and shingles, or Epstein-Barr virus that causes mononucleosis

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Differential Diagnosis

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  • Stroke
  • HIV infection
  • Herpes simplex virus
  • Infections
  • Lyme disease
  • Middle ear infection
  • Meningitis
  • Diabetes mellitus
  • Sarcoidosis
  • Brucellosis
  • Tumors
  • Ramsay Hunt syndrome

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Blood tests

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Imaging

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Diagnostic Procedures

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  • History and physical and neurological exam to check facial nerve function
  • If cause of symptoms is not clear, other tests are needed, such as
    • Nerve conduction test for facial nerve
    • Electromyography (EMG) for facial nerve

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Findings and Interpretation

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  • Facial muscle weakness or total paralysis (e.g., unable to frown) due to swollen, inflamed, or compressed facial nerve
  • Drooping of eyelid and corner of mouth on the affected side ...

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