Facial Nerve Problems (cont.)

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What is and what causes Bell's palsy?

Bell's palsy (Bell palsy) is paralysis of the facial nerve of unknown cause. The diagnosis is made when no other cause can be identified. Although Bell's palsy is thought to be caused by a viral infection of the facial nerve, this hasn't been proven. Other names for this condition are "idiopathic facial palsy" or Antoni's palsy.

Bell's palsy is usually a self-limiting, non-life-threatening condition that resolves spontaneously, usually within six weeks. The incidence is 15 to 30 new cases per 100,000 people per year. There is no predominant age or racial predilection; however, it is 3.3 times more common during pregnancy and slightly more common in menstruating females. In general, the incidence increases with advancing age. Children under the age of 13 seem less at risk of developing Bell's palsy than older individuals.

What are the symptoms of Bell's palsy?

The typical symptoms of Bell's palsy include:

  • Acute unilateral paralysis of facial muscles is present; the paralysis involves all muscles, including the forehead.
  • About half the time, there is numbness or pain in the ear, face, neck or tongue.
  • There is a preceding viral illness in 60% of patients.
  • There is a family history of Bell's palsy in 4% to 10% of patients.
  • Less than 1% of patients have bilateral problems.
  • There may be a change in hearing sensitivity (often increased sensitivity).

What is the mechanism of injury in Bell's palsy?

While the actual mechanism of injury of the facial nerve in Bell's palsy is unknown, one proposed mechanism of injury includes:

  • Primary viral infection (herpes) sometime in the past.
  • The virus lives in the nerve (geniculate ganglion) from months to years.
  • The virus becomes reactivated at a later date.
  • The virus reproduces and travels along the nerve.
  • The virus infects the cells surrounding the nerve (Schwann cells) resulting in inflammation.
  • The immune system responds to the damaged Schwann cells, which causes inflammation of the nerve and subsequent weakness or paralysis of the face.
  • The course of the paralysis and the recovery will depend upon the degree and amount of damage to the nerve.
Medically Reviewed by a Doctor on 7/26/2012

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