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Bell s palsy - Wikipedia


Patients with Bell's palsy usually progress from onset of symptoms to maximal weakness within three days and almost always within one week. A more insidious onset or progression over more than two weeks should prompt reconsideration of the diagnosis. Left untreated, 85 percent of patients will show at least partial recovery within three weeks of onset. 3

Many conditions can produce isolated facial nerve palsy identical to Bell's palsy. Structural lesions in the ear or parotid gland (e.g., cholesteatoma, salivary tumors) can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome (an outbreak of herpes zoster in the facial nerve distribution), sarcoidosis, and some influenza vaccines. Although these conditions can present as isolated facial nerve palsies, they usually have additional features that distinguish them from Bell's palsy.

Patients with Lyme disease often have a history of tick exposure, rash, or arthralgias. Facial nerve palsies from acute and chronic otitis media have a more gradual onset, with accompanying ear pain and fever. Patients with Ramsay Hunt syndrome have a pronounced prodrome of pain and often develop a vesicular eruption in the ear canal and pharynx, although cases without the vesicular eruption (i.e., zoster sine herpete) have been reported. Polyneuropathies (e.g., Guillain-Barré syndrome, sarcoidosis) will more often affect both facial nerves. Tumors will present with a more insidious onset of symptoms over weeks or months.

Central nervous system lesions (e.g., multiple sclerosis, stroke, tumor) can also cause facial nerve palsy. However, some motor neurons to the forehead cross sides at the level of the brainstem, so the fibers in the facial nerve going to the forehead come from both cerebral hemispheres ( Figure 2 ) . Supranuclear (central) lesions affecting the facial nerve will not paralyze the forehead on the affected side, resulting in a unilateral facial paralysis with forehead sparing. Often, there will be at least some weakness of extremities on the affected side as well. Table 1 1 , 6 – 8 summarizes the differential diagnosis of Bell's palsy.

Influenza vaccines in the past have been associated with peripheral neuropathies. Although influenza vaccines currently available in the United States have not been associated with Bell's palsy, 9 – 11 a recently developed Swiss intranasal vaccine was found to have a very high risk of postvaccine facial nerve palsy and has been withdrawn from use. 12 Because influenza vaccines change annually, public health officials should be notified of any cases of Bell's palsy occurring in the six weeks following vaccine administration.

Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy. Patients who present with complete facial nerve paralysis have a lower rate of spontaneous recovery and may be more likely to benefit from treatment. 1 – 3 , 19

Patients with Bell's palsy usually progress from onset of symptoms to maximal weakness within three days and almost always within one week. A more insidious onset or progression over more than two weeks should prompt reconsideration of the diagnosis. Left untreated, 85 percent of patients will show at least partial recovery within three weeks of onset. 3

Many conditions can produce isolated facial nerve palsy identical to Bell's palsy. Structural lesions in the ear or parotid gland (e.g., cholesteatoma, salivary tumors) can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome (an outbreak of herpes zoster in the facial nerve distribution), sarcoidosis, and some influenza vaccines. Although these conditions can present as isolated facial nerve palsies, they usually have additional features that distinguish them from Bell's palsy.

Patients with Lyme disease often have a history of tick exposure, rash, or arthralgias. Facial nerve palsies from acute and chronic otitis media have a more gradual onset, with accompanying ear pain and fever. Patients with Ramsay Hunt syndrome have a pronounced prodrome of pain and often develop a vesicular eruption in the ear canal and pharynx, although cases without the vesicular eruption (i.e., zoster sine herpete) have been reported. Polyneuropathies (e.g., Guillain-Barré syndrome, sarcoidosis) will more often affect both facial nerves. Tumors will present with a more insidious onset of symptoms over weeks or months.

Central nervous system lesions (e.g., multiple sclerosis, stroke, tumor) can also cause facial nerve palsy. However, some motor neurons to the forehead cross sides at the level of the brainstem, so the fibers in the facial nerve going to the forehead come from both cerebral hemispheres ( Figure 2 ) . Supranuclear (central) lesions affecting the facial nerve will not paralyze the forehead on the affected side, resulting in a unilateral facial paralysis with forehead sparing. Often, there will be at least some weakness of extremities on the affected side as well. Table 1 1 , 6 – 8 summarizes the differential diagnosis of Bell's palsy.

Influenza vaccines in the past have been associated with peripheral neuropathies. Although influenza vaccines currently available in the United States have not been associated with Bell's palsy, 9 – 11 a recently developed Swiss intranasal vaccine was found to have a very high risk of postvaccine facial nerve palsy and has been withdrawn from use. 12 Because influenza vaccines change annually, public health officials should be notified of any cases of Bell's palsy occurring in the six weeks following vaccine administration.

Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy. Patients who present with complete facial nerve paralysis have a lower rate of spontaneous recovery and may be more likely to benefit from treatment. 1 – 3 , 19

In the early days of Bells palsy, eye care is the most important concern. Maintenance of moisture and protection from debris are important functions that are frequently disrupted with 7th nerve damage. Permanent damage to the cornea is a risk if care is not taken to protect the eye. Acoustic neuroma patients may also encounter corneal dryness after surgery, even when the facial nerve remains intact.

The dry eye and the associated problems are caused by a combination of things. For some people the tear gland may not be producing moisture. Blinking is the mechanism that protects the eye from external debris and spreads tears over the cornea. Under normal circumstances we blink every 5-7 seconds. With every blink the eyelid spreads moisture over the cornea. With facial paralysis the ability to blink may be disrupted. Eyelid closure can be weak or the eye can be stuck wide open.

Take action if the eye feels uncomfortable. A stinging or burning sensation can mean the eye is too dry, even if tears are apparent. The 7th nerve does not control focus, so if you are experiencing blurred vision, don’t ignore it. It may be a warning of a dry cornea that needs to be protected.

For many, although the lacrimal gland produces tears, without a blink the tears cannot coat the eye. The eye may appear to be tearing excessively. It actually only seems that way because the tears are not being spread over eye, but instead are collecting in the limp lower lid or running out of the eye. Or, the eye may tear excessively, especially while chewing. We refer to this as “Crocodile Tears”. Crocodile tears can occur from the onset of Bell’s palsy, or can develop during recovery.

In some cases all that is needed for extra help maintaining moisture during the day is artificial tears. Look for a brand that is labeled “for sensitive eyes”, “non-allergic”, or “preservative free”, etc. Thimerosal is a preservative that can be particularly irritating. Eye-drops don’t last long, and are not the solution for everyone.

Tears Naturale has the same active ingredient as Gen-Teal. It’s available with a preservative similar to GenTeal, as well as preservative-free (Tears Naturale Free).

Patients with Bell's palsy usually progress from onset of symptoms to maximal weakness within three days and almost always within one week. A more insidious onset or progression over more than two weeks should prompt reconsideration of the diagnosis. Left untreated, 85 percent of patients will show at least partial recovery within three weeks of onset. 3

Many conditions can produce isolated facial nerve palsy identical to Bell's palsy. Structural lesions in the ear or parotid gland (e.g., cholesteatoma, salivary tumors) can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome (an outbreak of herpes zoster in the facial nerve distribution), sarcoidosis, and some influenza vaccines. Although these conditions can present as isolated facial nerve palsies, they usually have additional features that distinguish them from Bell's palsy.

Patients with Lyme disease often have a history of tick exposure, rash, or arthralgias. Facial nerve palsies from acute and chronic otitis media have a more gradual onset, with accompanying ear pain and fever. Patients with Ramsay Hunt syndrome have a pronounced prodrome of pain and often develop a vesicular eruption in the ear canal and pharynx, although cases without the vesicular eruption (i.e., zoster sine herpete) have been reported. Polyneuropathies (e.g., Guillain-Barré syndrome, sarcoidosis) will more often affect both facial nerves. Tumors will present with a more insidious onset of symptoms over weeks or months.

Central nervous system lesions (e.g., multiple sclerosis, stroke, tumor) can also cause facial nerve palsy. However, some motor neurons to the forehead cross sides at the level of the brainstem, so the fibers in the facial nerve going to the forehead come from both cerebral hemispheres ( Figure 2 ) . Supranuclear (central) lesions affecting the facial nerve will not paralyze the forehead on the affected side, resulting in a unilateral facial paralysis with forehead sparing. Often, there will be at least some weakness of extremities on the affected side as well. Table 1 1 , 6 – 8 summarizes the differential diagnosis of Bell's palsy.

Influenza vaccines in the past have been associated with peripheral neuropathies. Although influenza vaccines currently available in the United States have not been associated with Bell's palsy, 9 – 11 a recently developed Swiss intranasal vaccine was found to have a very high risk of postvaccine facial nerve palsy and has been withdrawn from use. 12 Because influenza vaccines change annually, public health officials should be notified of any cases of Bell's palsy occurring in the six weeks following vaccine administration.

Given the safety profile of acyclovir, valacyclovir, and short-course oral corticosteroids, patients who present within three days of the onset of symptoms and who do not have specific contraindications to these medications should be offered combination therapy. Patients who present with complete facial nerve paralysis have a lower rate of spontaneous recovery and may be more likely to benefit from treatment. 1 – 3 , 19

In the early days of Bells palsy, eye care is the most important concern. Maintenance of moisture and protection from debris are important functions that are frequently disrupted with 7th nerve damage. Permanent damage to the cornea is a risk if care is not taken to protect the eye. Acoustic neuroma patients may also encounter corneal dryness after surgery, even when the facial nerve remains intact.

The dry eye and the associated problems are caused by a combination of things. For some people the tear gland may not be producing moisture. Blinking is the mechanism that protects the eye from external debris and spreads tears over the cornea. Under normal circumstances we blink every 5-7 seconds. With every blink the eyelid spreads moisture over the cornea. With facial paralysis the ability to blink may be disrupted. Eyelid closure can be weak or the eye can be stuck wide open.

Take action if the eye feels uncomfortable. A stinging or burning sensation can mean the eye is too dry, even if tears are apparent. The 7th nerve does not control focus, so if you are experiencing blurred vision, don’t ignore it. It may be a warning of a dry cornea that needs to be protected.

For many, although the lacrimal gland produces tears, without a blink the tears cannot coat the eye. The eye may appear to be tearing excessively. It actually only seems that way because the tears are not being spread over eye, but instead are collecting in the limp lower lid or running out of the eye. Or, the eye may tear excessively, especially while chewing. We refer to this as “Crocodile Tears”. Crocodile tears can occur from the onset of Bell’s palsy, or can develop during recovery.

In some cases all that is needed for extra help maintaining moisture during the day is artificial tears. Look for a brand that is labeled “for sensitive eyes”, “non-allergic”, or “preservative free”, etc. Thimerosal is a preservative that can be particularly irritating. Eye-drops don’t last long, and are not the solution for everyone.

Tears Naturale has the same active ingredient as Gen-Teal. It’s available with a preservative similar to GenTeal, as well as preservative-free (Tears Naturale Free).

Angelina Jolie has already spoken publicly about her preventive double mastectomy, reconstructive surgery, and ovary removal . Now the actress is opening up about another health condition she’s facing: Bell's palsy .

In Vanity Fair ’s latest cover story , Jolie reveals she developed the form of facial paralysis last year. “Sometimes women in families put themselves last,” she says in the interview, “until it manifests itself in their own health.”

Bell’s palsy occurs when a nerve in the face becomes swollen or inflamed, triggering symptoms like muscle weakness, drooling, a drooping eyelid or corner of the mouth, twitching, or paralysis, which can come on quickly. These symptoms usually affect one side of the face, and typically worsen over 48 hours.

About 40,000 Americans are diagnosed with the condition each year. While it can affect anyone, Bell's palsy is most common among pregnant women, and people who have the flu , a cold, or diabetes .

It’s not entirely clear what causes the condition, says David Simpson, MD, director of the neuromuscular division at the Icahn School of Medicine at Mount Sinai in New York City. “In the majority of cases we don’t identify any specific cause of Bell’s palsy, although it’s presumed it may be associated with a viral infection,” he says. To fight the infection, the body produces inflammation, which may be misdirected to the nerve that controls movement of the face.

Jolie hasn't revealed whether or not she suffered any infection leading up to her diagnosis with Bell’s palsy. And it’s unlikely that the facial paralysis would be related to her preventive mastectomy or the removal of her ovaries, says Dr. Simpson (who has never treated the actress). However, people who have been diagnosed with cancer or other conditions that weaken the immune system may have a slightly higher risk of Bell’s palsy, he says.


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