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215: BELL’S PALSY

Eric Shamus, PhD, DPT, PT, CSCS; Jennie Q. Lou, MD, MSc

CONDITION/DISORDER SYNONYMS

  • Facial palsy

  • Peripheral facial paralysis

ICD-9-CM CODE

  • 351.0 Bell’s palsy

ICD-1-CM CODE

  • G51.0 Bell’s palsy, facial palsy

PREFERRED PRACTICE PATTERN

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-–acquired in adolescence or adulthood

PATIENT PRESENTATION

Patient is a 35-year-old female who woke up with facial nerve paralysis. Patient presents with facial droop (see image 1). On examination it was found that she had absent brow furrowing, weak eye closure and drooping of her mouth angle. She was provided eye lubricants and guidance on keeping her eye moist. Patient is unable to smile or control muscles on the left side of the face. Patient received direct current electric stimulation during exercises.1

KEY FEATURES

  • Paralysis or weakness of muscles on one side of face

  • Sudden onset, often overnight

  • Damage to the seventh cranial (facial) nerve that controls muscles on one side of the face, causing that side of face to droop2

  • Nerve damage may affect sense of taste, production of tears and saliva

  • Lower motor neuron (LMN) disease

  • Diagnosis usually made by history and clinical examination

  • Afflicts approximately 40,000 Americans each year

  • 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

FIGURE 215-1

Peripheral Seventh-Nerve Palsy. A peripheral nerve paralysis involving the entire ipsilateral face, including the forehead, is seen in this patient with Bell palsy. (From Knoop KJ et al: The Atlas of Emergency Medicine, 3rd edition. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved. Photo contributor: Lawrence B. Stack, MD.)

image
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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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

Functional Implications

  • Dry eyes

  • Eating

  • Hearing

  • Psychological impact

FIGURE 215-2

Pathways for the cortical control of facial motor neurons. (A) Pathway from the primary motor and premotor cortical areas, which are both located on the lateral surface of the cortex. (B) Pathway from the supplementary (top) and cingulate (bottom) motor areas, which are both located on the medial surface. The inset shows the locations of the ...

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