Bell's palsy
Classification & external resources

ICD-10	G51.0
ICD-9	351.0
DiseasesDB	1303
MedlinePlus	000773
eMedicine	emerg/56
MeSH	D020330

Bell's palsy (or facial palsy) is characterised by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute mononeuropathy (disease involving only one nerve), and is the most common cause of acute facial nerve paralysis. The paralysis is of the infranuclear/lower motor neuron type. Bell’s palsy affects about 40,000 people in the United States every year. It affects approximately 1 person in 65 during a lifetime. Until recently, its cause was unknown in most cases, but it has now been related to both Lyme disease and Herpes Zoster. Image File history File links No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Palsy is a medical term derived from the word paralysis that is defined as paralysis of a body part often accompanied by loss of feeling and uncontrolled body movements such as shaking. ... The facial nerve is the seventh (VII) of twelve paired cranial nerves. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Sir Charles Bell Sir Charles Bell (November 1774, in Doun in Monteath, Edinburgh- April 28, 1842, in North Hallow, Worcestershire) was a Scottish anatomist, surgeon, and physiologist. ... Mononeuropathy (or mononeuritis) is a type of neuropathy that only affects a single peripheral or cranial nerve. ... Nerves (yellow) Nerves redirects here. ... Acute facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. ... Lyme disease, or borreliosis, is an emerging infectious disease caused by spirochete bacteria from the genus Borrelia. ... Herpes zoster, colloquially known as shingles, is the reactivation (from the general area of the spinal cord) of varicella zoster virus (VZV, primary infection of which leads to chickenpox), one of the Herpesviridae group, leading to a crop of painful blisters over the area of a dermatome. ...

Former Canadian Prime Minister Jean Chrétien.

Image File history File links JeanChrétien. ... Image File history File links JeanChrétien. ... Joseph Jacques Jean Chrétien, usually known as Jean Chrétien, PC, QC, BA, BCL, LLD (h. ...

Investigation

Clinicians should determine whether all branches of the facial nerve are involved, or whether the forehead muscles are spared. Since these receive innervation from both sides of the brain, the forehead can still be wrinkled by a patient whose facial palsy is caused by a problem in the brain rather than in the facial nerve itself. A nerve is an enclosed, cable-like bundle of nerve fibers or axons, which includes the glia that ensheath the axons in myelin. ...

Facial palsy results from inability to control movement in the facial muscles. The facial muscles become weak or paralyzed. There is no specific treatment for Bell's palsy, and it typically subsides on its own within 2-3 weeks.

Diagnosis

Bell's palsy is a diagnosis of exclusion; in many cases, no specific cause can be ascertained. The term diagnosis of exclusion (per exclusionem) refers to a medical condition whose presence cannot be established with complete confidence from examination or testing. ...

Pathology

It is supposed to be the result of inflammation of the facial nerve, which produces pressure on the nerve as it exits the skull within its bony canal. Patients with facial palsy for which an underlying cause can be readily found are not generally considered to have Bell's palsy per se. These underlying problems 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, and they exhibit many of the same symptoms as people with Bell's palsy; this is often due to a traumatic birth which causes irreparable damage to the facial nerve, i.e. acute facial nerve paralysis. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... For malignant tumors specifically, see cancer. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... For other uses, see Stroke (disambiguation). ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Acute facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. ...

The "Bell's smile" is characterized by an asymmetry caused by paralysis of one side of the face.

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, of the external ear and hearing disturbances, but these findings may occasionally be lacking. Image File history File links Bells. ... Image File history File links Bells. ... Herpes zoster, colloquially known as shingles, is the reactivation (from the general area of the spinal cord) of varicella zoster virus (VZV, primary infection of which leads to chickenpox), one of the Herpesviridae group, leading to a crop of painful blisters over the area of a dermatome. ...

In recent years, two new suspects have been added to the possible causes of Bell's palsy. Lyme disease may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific antibodies in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy. The subsequent observation of an increased incidence of antibodies to the Herpes simplex virus in patients with Bell's palsy has led many specialists to believe that this agent is the most likely underlying cause in areas where Lyme disease is uncommon. Lyme disease, or borreliosis, is an emerging infectious disease caused by spirochete bacteria from the genus Borrelia. ... Wikipedia does not yet have an article with this exact name. ... This article is about the disease. ...

In traditional Chinese medicine, considered an alternative medicine in the West, Bell's palsy is attributed to a "wind cold" attack brought about by exposure to wind.^[1] Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong. ... Alternative medicine is defined as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Complementary medicine is defined as any of the practices (as acupuncture) of alternative medicine accepted...

Epidemiology

Bell's Palsy is three times more likely to strike pregnant women than non-pregnant women.^[2] It is also considered to be four times more likely to occur in diabetics than the general population,^[3] and it is more common in young adults.^{[citation needed]}

Treatment

Treatment is a matter of controversy. In patients presenting with incomplete facial palsy, treatment may be unnecessary. However, patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated with anti-inflammatory corticosteroids. The efficacy of this treatment has not been reliably demonstrated. The likely association of Bell's palsy with the herpes virus has led most American neurologists to prescribe a course of anti-viral medication (such as acyclovir) to all patients with unexplained facial palsy. Surgical procedures to decompress the facial nerve have been attempted, but have not been proven beneficial. Acupuncture has also been studied, with inconclusive results.^[4] This article does not cite any references or sources. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Aciclovir (INN) or aciclovir (USAN), marketed as Zovirax®, is one of the main antiviral drugs. ... Surgery Surgery is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. ... Acupuncture chart from Hua Shou (fl. ...

People who think they may have Bell's Palsy should consult their doctor as soon as possible. Many times, the medications will not be effective if administered too late after the onset.

Although most patients (60–80%) recover completely from Bell's palsy within several weeks, some require several months, and others may be left with deficits of varying degrees.

Complications

Major complications of the condition are chronic loss of taste (ageusia), chronic facial spasm 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 reflex is also affected; great care should be taken to protect the eye from injury. Ageusia (pronounced ay-GOO-see-uh) is the loss of taste functions of the tongue, particularly the inability to detect sweetness, sourness, bitterness, and saltiness. ... A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. ... This article does not cite any references or sources. ...

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 which 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 will lift, or when smiling, the eye will close (synkinesis).

In addition, around 6% of patients exhibit crocodile tear syndrome on recovery, where they will shed 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. The tear system. ...

Famous persons with Bell's palsy

Well-known persons affected by Bell's palsy include:

• Jean Chretien, former prime minister of Canada.^[5]
• George Clooney, American actor, director, producer and screenwriter.^[6]
• Graeme Garden, British comedy writer and performer, who has written about his experiences with the condition.^[7]
• Danny Louis, musician and member of Gov't Mule.^[8]
• Jim Ross, professional wrestling announcer for the WWE.^[9]
• Rick Savage, British musician and bassist for Def Leppard.^[10]
• Pierce Brosnan, Irish-American actor and producer.^[10]
• Ralph Nader, American author, activist, politician.^[10]
• Jamey Sheridan, American actor.^[11]
• Tony Gonzalez, American NFL football player.^[12]
• Ralph Kiner, American baseball player in the 1940s and 1950s.^[13]
• Amy Goodman, American journalist.^[14]

The Right Honourable Joseph Jacques Jean Chrétien, PC (born January 11, 1934, Shawinigan, Quebec) was the twentieth Prime Minister of Canada, serving from November 4, 1993, to December 12, 2003. ... George Timothy Clooney (May 6, 1961) - is an American actor, director, producer and screenwriter, known for his role in the first five seasons of the long-running television drama ER (1994–99), and his rise as an A-List movie star in contemporary American cinema. ... Graeme Garden, as a Beefeater in The Goodies (TV series) episode The Tower of London David Graeme Garden (born February 18, 1943) is a British comedy writer and performer. ... Govt Mule is a southern rock/jam band formed in 1994 as an Allman Brothers Band side project, but has taken on a life of its own. ... Information in this article or section has not been verified against sources and may not be reliable. ... For the video game, see Pro Wrestling (video game). ... World Wrestling Entertainment, or WWE, is a professional wrestling promotion, currently the largest in North America. ... Rick Sav Savage (born Richard Savage, 2 December 1960, in Sheffield, South Yorkshire, England, where he attended Tapton School) is the bassist and founder of the English rock band, Def Leppard. ... Deon Rexroat of Anberlin. ... Def Leppard are an English hard rock band from Sheffield who formed in 1977 as part of the New Wave of British Heavy Metal. ... Pierce Brendan Brosnan, OBE [1] (born May 16, 1953) is an Irish actor and producer best known for portraying James Bond in four films from 1995 to 2002: GoldenEye, Tomorrow Never Dies, The World Is Not Enough and Die Another Day. ... Ralph Nader (born February 27, 1934) is an American attorney and political activist in the areas of consumer rights, humanitarianism, environmentalism and democratic government. ... Jamey Sheridan (born July 12 1951 Pasadena, California) is an American actor. ... Tony Gonzalez (born February 27, 1976 in Torrance, California) is an American football tight end who has played his entire NFL career for the Kansas City Chiefs. ... NFL redirects here. ... Ralph McPherran Kiner (born October 27, 1922) is an American former Major League Baseball player and current announcer. ... Amy Goodman on Democracy Now! Amy Goodman (b. ...

Notes

This article does not cite any references or sources. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... This article does not cite any references or sources. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 249th day of the year (250th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 249th day of the year (250th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 249th day of the year (250th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 249th day of the year (250th in leap years) in the Gregorian calendar. ... Year 2000 (MM) was a leap year starting on Saturday (link will display full 2000 Gregorian calendar). ... is the 332nd day of the year (333rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 47th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... is the 201st day of the year (202nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 289th day of the year (290th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 87th day of the year (88th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 140th day of the year (141st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Year 1998 (MCMXCVIII) was a common year starting on Thursday (link will display full 1998 Gregorian calendar). ... is the 91st day of the year (92nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 262nd day of the year (263rd in leap years) in the Gregorian calendar. ... Democracy Now! logo. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 275th day of the year (276th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 275th day of the year (276th in leap years) in the Gregorian calendar. ...

References

• "The Merck Manual"
• New England Journal of Medicine, Sept. 2004
• Lambert, Michael. (2007-03-05.) "Bell's Palsy." (Website.) Emedicine. Retrieved on 2007-09-27.

The Merck Manual of Diagnosis and Therapy (often referred to simply as The Merck Manual) is one of the worlds most widely used medical textbooks. ... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... This article is about the day. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the. ... is the 270th day of the year (271st in leap years) in the Gregorian calendar. ...

External links

• managment and treatment of facial paralysis
• Bell's Palsy Information Site, has a FAQ
• Bell's Palsy and Pregnancy
• Bell's Palsy Patient Info - Neurology Channel
• Living with Facial Palsy, a site for parents of children with Facial Palsy
• Links to pictures of Bells palsy (Hardin MD/Univ of Iowa)
• Bell's Palsy Association