Bell’s palsy

• Facial palsy
• Peripheral facial paralysis

• 351.0 Bell’s palsy

• G51.0 Bell’s palsy, facial palsy

Description

• 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

Essentials

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

General Considerations

• Afflicts approximately 40,000 Americans each year

Demographics

• 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

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

Possible Contributing Causes

• 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

Differential Diagnosis

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

Laboratory Tests

• Blood tests

Imaging

• MRI of the head to rule out brain tumor
• CT scan of the head to rule out brain tumor

Diagnostic Procedures

• 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

• 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 due to muscle weakness or paralysis

• Ophthalmologists
• Ear, Nose & Throat surgeons
• Plastic surgeons
• Psychologists

• Impaired facial expression due to paralysis
• Problems eating (food stuck in month or falling ...