The symptoms are usually acute appearing within 48 hours and they include lower facial paralysis on one side of the face, reduced secretion of tears, posterior auricular pain, increased sensitivity to sound (hyperacusis), disorders in taste, pain in the ear, inability to close the eye lids, facial muscle weakness, eye pain, blurred vision and epiphora [6].

• Dysgeusia

  At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. [ncbi.nlm.nih.gov]

  These findings are frequently accompanied by symptoms of neck, mastoid or ear pain, dysgeusia, hyperacusis or altered facial sensation. These associated symptoms are present in 50–60%23 and are reassuring for the diagnosis of Bell's palsy. [jnnp.bmj.com]

  Incomplete sensory regeneration Dysgeusia or ageusia (impairment or loss of taste, respectively) may occur with incomplete regeneration of the chorda tympani. [emedicine.com]

• Blister

  There is a strong correlation with the herpes simplex virus, the same virus that causes cold sores or fever blisters on the lip. There has also been an association found with shingles and its associated blistering (from the herpes zoster virus). [emedicinehealth.com]

  Researchers suspect the inflammation is most often triggered by a viral infection, such as herpes simplex, the same virus that causes cold sores (fever blisters). [drugs.com]

  The blisters may also appear inside the mouth. Recent studies show that antivirals do not improve the outcome for patients with Bell’s palsy. [facialpalsy.org.uk]

• Dermatitis

  Fisher's Contact Dermatitis, 6/e. Hamilton, Ont: BC Decker Inc. p. 256. ISBN 978-1-55009-378-0. ^ Coopman S, Degreef H, Dooms-Goossens A (July 1989). [en.wikipedia.org]

  (most are less than 2 cm in diameter) with central clearing Diffuse lesions with mucous membrane involvement Granuloma annulare Scaling erythematous lesions with central clearing Most commonly located on the feet and hands Hypersensitivity reaction/dermatitis [aafp.org]

• Skin Rash

  rash generalized prickle sensation localized injection site urticaria red and itchy eyes Cardiovascular reduced peripheral circulation as indicated by the combination of at least 2 of the following: o tachycardia and o a capillary refill time of >3s [sukl.sk]

• Muscle Weakness

  The school nurse may be the first person to assess facial palsy and muscle weakness in children. [ncbi.nlm.nih.gov]

  When the facial nerve is damaged — for example, it can be swollen, inflamed or compressed — it's unable to carry messages from the brain to the facial muscles as well as it normally can, which is what leads to the muscle weakness, paralysis or twitching [livescience.com]

  weakness on the affected side, including the muscles of the eyelids and forehead Reduced tear production on the affected side Increased sensitivity of hearing in the affected ear. [southerncross.co.nz]

  Bell’s palsy happens when the nerve ending that controls the muscles in your face becomes compressed. The main sign of Bell’s palsy is weakness on one side of the face which can range from mild muscle weakness to paralysis. [dailystar.co.uk]

• Muscular Atrophy

  تؤثر أساساً في الجهاز العصبي المركزي Huntington's disease - Spinocerebellar ataxia ( Friedreich's ataxia, Ataxia telangiectasia, Hereditary spastic paraplegia ) Spinal muscular atrophy : Werdnig-Hoffman disease - Kugelberg-Welander disease - Fazio Londe [marefa.org]

• Lacrimation

  They should be applied to make up for the lack of lacrimation. The use of external eyelid weights have also proven to be beneficial. [symptoma.com]

  The parasympathetic secretomotor fibers supply the submandibular and sublingual salivary glands, the lacrimal glands and the glands of the nose and palate. [flexikon.doccheck.com]

  In conjunction with a review of the literature, this case suggests that this phenotype carries with it a greater risk of serious complications affecting the eyelids and lacrimal gland. [ncbi.nlm.nih.gov]

• Excessive Tearing

  This means that symptoms can also include drooling, excessive tearing, dryness of the eye or mouth, and ringing in the ear. [livescience.com]

  They can range from mild to severe and include Twitching Weakness Paralysis Drooping eyelid or corner of mouth Drooling Dry eye or mouth Excessive tearing in the eye Impaired ability to taste Scientists think that a viral infection makes the facial nerve [medlineplus.gov]

  Upon observation, the left upper and lower eyelids were drooping and the left eye had excessive tearing. Motion palpation indicated multiple fixations in the cervical spine. Laboratory studies showed a microcytic anemia. [ncbi.nlm.nih.gov]

  Changes in the ability to taste food Distorted facial expression due to weakness or paralysis Drooling Drooping of the eyelid and corner of the mouth Dry eyes or excessive tearing in one eye Pain on the affected side of face behind ear Sensitivity to [foundationforpn.org]

• Lagophthalmos

  We speculate that corneal irritation caused by lagophthalmos contributes to the induction of blepharospasm. [ncbi.nlm.nih.gov]

  […] side of face Watering of eye (epiphora) Ocular exposure causes: redness, discomfort, pain, photophobia, reduced vision Signs Unilateral facial weakness including orbicularis oculi incomplete blink leads to corneal drying incomplete closure at night (lagophthalmos [college-optometrists.org]

  Also, a Bell’s palsy patient may need eye protection, as patients who are dealing with total facial paralysis sometimes struggle to close their eyes completely (lagophthalmos). [facialparalysisinstitute.com]

  Lagophthalmos (pronounced lag-op-thal-mus): This is an inability to close the affected eye, which if prolonged may result in eye dryness and/or corneal ulceration. [facialpalsy.org.uk]

• Eye Pain

  Eye drops for affected eye Medications such as steroids to reduce inflammation of nerve and decrease pain Surgery (in rare cases to improve appearance) Treatment of underlying viral infection [foundationforpn.org]

  […] ear, inability to close the eye lids, facial muscle weakness, eye pain, blurred vision and epiphora. [symptoma.com]

  Among the symptoms of Bell’s palsy are the following: paralysis or weakness on one side of the face, eye problems like drooping eyes, excessive tearing or dry eyes, pain inside or behind the ear, increased sensitivity to sound, drooling, and loss of taste [businessmirror.com.ph]

  Other symptoms may include: Inability to close the eye on the affected side Drooping of the affected side (within a few hours to overnight) Teariness or dryness of the affected eye Pain in or behind the ear on the affected side Sensitivity to sound Drooling [moveforwardpt.com]

• Hyperacusis

  Typically, presentation is with facial distortion, loss of taste, hyperacusis and a watery eye. [gpnotebook.co.uk]

  Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. [ncbi.nlm.nih.gov]

  The symptoms are usually acute appearing within 48 hours and they include lower facial paralysis on one side of the face, reduced secretion of tears, posterior auricular pain, increased sensitivity to sound (hyperacusis), disorders in taste, pain in the [symptoma.com]

  Initial presentation may be pain around the ear or surrounding areas May be associated with hyperacusis Prodrome of ear pain and dysacusis may be present Physical manifestations of Bell's Palsy. http://www.facialpalsy.org.uk/imagebank/2/4/7/247.jpg Differential [pedclerk.bsd.uchicago.edu]

  Additional Bell's palsy symptoms may include: Pain in or behind the ear Numbness of the affected side of the face Increased sensitivity to sounds (hyperacusis) Altered taste on half of the front part of the tongue Inability to fully close the eyelids [allaboutvision.com]

• Otalgia

  Some patients also report general malaise in the first few days on onset, as well as some pain in the region of the ipsilateral mastoid (known as otalgia), but many of patients have no otalgia or malaise. [physio-pedia.com]

  Chronic otitis media usually presents in an ear with chronic discharge ( otorrhea ), or hearing loss, with or without ear pain ( otalgia ). [marefa.org]

  Signs and symptoms Signs and symptoms of Bell palsy include the following: Acute onset of unilateral upper and lower facial paralysis (over a 48-hr period) Posterior auricular pain Decreased tearing Hyperacusis Taste disturbances Otalgia Weakness of the [emedicine.com]

• Hearing Problem

  Irish Times 1997 – Employers cannot afford to turn a deaf ear to staff hearing problems How We Can Help The medical negligence team at Coleman Legal Partners have significant experience of dealing with claims where hearing impairment or loss occurs as [colemanlegalpartners.ie]

  I also had hearing problems and all sounds were tinny and annoying. The hearing was one of the first things to recover. I had been told by my doctor to keep the affected side of my face warm and not to over-exercise it. [bbc.com]

  Adour et al. ( Adour 1978 ) advocated making a diagnosis based on the history and clinical symptoms including the presence of taste and the absence of hearing problems. [dx.doi.org]

• Postauricular Pain

  If patients suffer from postauricular pain, pharmacopuncture and cupping is utilized. [ncbi.nlm.nih.gov]

  At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. [hindawi.com]

  Prolonged pain is also a predictor of worse outcome. [jnnp.bmj.com]

• Facial Pain

  Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. [ncbi.nlm.nih.gov]

  We address synkinesis, contractures of facial muscles, related facial pains, excessive tearing and dynamic facial asymmetry. [crystal-touch.nl]

  Aside from feeling facial pain, I struggled to eat, drink and talk for several weeks. Ordinary activities like chewing food, sipping from a straw and attending short meetings at work would tire me out. [lifestyle.inquirer.net]

• Dizziness

  […] azt akarod, hogy elszálljon az adósságod en Hypoglycemia, a seizure, Bell's palsy. en Facial palsy ( Bell s palsy hu Szenátor úr...... már van is egy önkéntesünk en Not known: afebrile convulsions or seizures, Bell s palsy, cerebrovascular accident, dizziness [hu.glosbe.com]

  Dizziness. Difficulty eating or drinking. Impaired speech. Diagnosis There is no specific test to diagnose Bell’s palsy, however tests can be used to rule out other conditions that cause similar symptoms - such as stroke. [huffingtonpost.co.uk]

  […] needles, Facial paralysis, Nerve inflammations including Guillain-Barre Syndrome, Inflammation of the nerve of the eye that leads to impaired vision, Brain inflammation, Exacerbation of multiple sclerosis, Multiple sclerosis, Convulsions, Headache, Dizziness [mymemory.translated.net]

  […] for seven days Creatinine clearance : Less than 10 mL per minute: 500 mg daily 10 to 29 mL per minute (0.17 to 0.48 mL per second): 1 g daily 30 to 49 mL per minute (0.50 to 0.82 mL per second): 1 g twice daily None Gastrointestinal upset, headache, dizziness [aafp.org]

  Allergy symptoms may include: hives breathing difficulties swelling of the face lips tongue throat If the patient feels dizzy or drowsy they should refrain from driving or operating heavy machinery. [medicalnewstoday.com]

• Peripheral Neuropathy

  Facial weakness from Bell’s palsy can be associated with a more generalized peripheral neuropathy as well. People with diabetes are at a four times greater risk of developing Bell’s palsy. [foundationforpn.org]

  neuritis (including Guillain Barre Syndrome, myelitis hu A házasság munkával jár en Nervous system disorders Very rare (< #,#) Paresthesia, paralysis ( Bell 's palsy ), peripheral neuropathies (polyradiculoneuritis, facial paralysis), neuritis (including [hu.glosbe.com]

  Peripheral Neuropathy. p. 1219. CrossRef Google Scholar Kilic, Rahmi Ozdek, Ali Felek, Sevim Safak, M.Asim and Samim, Erdal 2003. A case presentation of bilateral simultaneous Bell’s palsy. [doi.org]

• Unilateral Facial Weakness

  Abstract Bell's palsy is a kind of peripheral neural disease that cause abrupt onset of unilateral facial weakness. [ncbi.nlm.nih.gov]

  Bell's palsy is the most common cause of unilateral facial weakness. Pathogenesis Idiopathic, congenital, traumatic, and neoplastic causes can all acount for facial nerve palsy. [pedclerk.bsd.uchicago.edu]

  Bells Palsy Symptoms Clinically, individuals who develop Bells palsy typically experience the rapid onset of unilateral facial weakness affecting all the branches of the facial nerve. [methodistfacialparalysis.com]

• Seizure

  […] hu Nem, ha azt akarod, hogy elszálljon az adósságod en Hypoglycemia, a seizure, Bell's palsy. en Facial palsy ( Bell s palsy hu Szenátor úr...... már van is egy önkéntesünk en Not known: afebrile convulsions or seizures, Bell s palsy, cerebrovascular [hu.glosbe.com]

  Organic personality syndrome, organic affective syndrome, psychotic manifestations and seizures are more common side effects of PEG-IFN-α whereas cranial neuropathy and movement disorders are less common. [ncbi.nlm.nih.gov]

  Facial paralysis due to a brain tumor generally develops slowly and causes headaches, seizures, or hearing loss. In newborns, facial paralysis may result from birth trauma. [jariboti.pk]

  Add a translation English Subacute sclerosing panencephalitis Maltese Panenċefalite sottoakuta bi sklerożi Last Update: 2017-04-26 Usage Frequency: 1 Quality: English Afebrile convulsions or seizures, Bell’s palsy, Cerebrovascular accident, Dizziness, [mymemory.translated.net]

  Seizure associated with loss of consciousness OR 3. Focal or multifocal findings referable to the central nervous system, including one or more of the following a. [sukl.sk]

• Trigeminal Neuralgia

  G51.0 ICD-10-CM Codes Adjacent To G51.0 G47.63 Sleep related bruxism G47.69 Other sleep related movement disorders G47.8 Other sleep disorders G47.9 Sleep disorder, unspecified G50 Disorders of trigeminal nerve G50.0 Trigeminal neuralgia G50.1 Atypical [icd10data.com]

  neuralgia - شلل بل - Thoracic outlet syndrome - Phantom limb - Mononeuropathy ( Carpal tunnel syndrome, Meralgia paraesthetica, Tarsal tunnel syndrome ) Polyneuropathies والاضطرابات الأخرى في الجهاز العصبي المحيطي Charcot-Marie-Tooth disease - Dejerine [marefa.org]

  Inheritance in such cases may be autosomal dominant with low penetration; however, which predisposing factors are inherited is unclear. [25] The family history may also be positive for other nerve, nerve root, or plexus disorders (eg, trigeminal neuralgia [emedicine.com]

The diagnosis of Bell’s palsy is usually made based on history and physical examination. However, investigations may be needed to exclude other conditions.

Laboratory tests

• Complete blood count
• Erythrocyte sedimentation rate
• VDRL test
• HIV screening
• Fasting blood glucose
• Thyroid function test
• CSF analysis

Imaging

• CT scan
• MRI

Other investigations that can be carried out include EMG, nerve conduction tests, blepharokymography and histology.

Most patients who suffer from this condition often recover spontaneously without treatment. However, treatment might be needed in some patients and also to accelerate recovery. Medical treatments include the use of corticosteroids, antiviral agents and a combination of the two.

The eye should also be protected with the use of artificial tears and ointments. They should be applied to make up for the lack of lacrimation. The use of external eyelid weights have also proven to be beneficial.

There is a place for physical therapy like facial exercises, neuromuscular retraining, and acupuncture in the treatment of Bell’s palsy [7]. Surgeries to manage this condition, though not commonly advocated, include facial nerve decompression and eyelid implants.

Close to 90% of patients recover in 3 months or less without any apparent disfigurement. There are three groups that the patients fall into based on their prognosis. The first group are those who recover completely from the lesion without any long-term complications and this is the group most patients fall into. The second group does not recover completely but they appear completely recovered to the inexperienced eye, most people in this group have had axonotmesis with interruption of the axons. The last group are those with permanent neurological damage, visible even to the inexperienced eye, and this group is made up mostly by the elderly [5].

Factors associated with poor prognosis include advanced age, complete paralysis and reduced taste or salivation on the affected side. Other factors are pain in the posterior auricular area and decreased lacrimation.

The cause of Bell’s palsy has not been fully understood, however, some factors have been associated with increased likelihood of developing the disease. The most implicated factor is exposure to cold like in chilly weathers and air-conditioned environments. Others include infection with herpes simplex virus, herpes zoster, Lyme disease, HIV, Epstein-Barr virus, cytomegalovirus, syphilis and mycoplasma. It could also result from microvascular disease like diabetes and hypertension and from other inflammatory causes, viral diseases and autoimmune diseases [2].

Bell’s palsy has an annual incidence of between 0.015% and 0.03%. It is most commonly seen during the winter months. It is the commonest cause of unilateral facial paralysis and it occurs more on the right side of the face. Bell’s palsy affecting both sides of the face is rare. It also has a higher incidence in people who have underlying medical conditions like diabetes, HIV and preeclampsia.

The incidence of Bell’s palsy increases with advancing age with the highest incidence seen in patients 65 years and over. It affects both male and female sexes equally, and there is no clear difference in the incidence for different races [3].

The exact way by which this condition occurs is still unclear. However, it is mostly agreed that due to ischemia and edema, there is compression of the facial nerve within the facial canal. Thee facial canal is a small hole in the temporal bone which the facial nerve goes through during its course. The exact way by which this edema or inflammation comes about is unclear.

The commonest site of compression of the facial nerve is at the meatal foramen which has a diameter that is less than 0.7mm. The labyrinthine segment, the first portion of the facial nerve goes through this foramen. Due to its constricted limits, it is rational that processes such as inflammation, compression, ischemia and demyelination will weaken nerve conduction at this site [4].

Facial nerve injury in Bell’s palsy usually occurs near or at the geniculate ganglion, peripheral to the nerve’s nucleus. There is associated autonomic and gustatory abnormalities accompanying the motor paralysis if the injury occurs proximal to the geniculate ganglion. The same effects are seen if they occur between the geniculate ganglion and the origin of the corda tympani, but the lacrimal glands are spared. If it occurs at the stylomastoid foramen, there is only facial paralysis.

There is no documented way to prevent Bell’s palsy. However, lifestyle changes that reduce the risk of acquiring risk factors like HIV, diabetes and hypertension could be beneficial.

Bell’s palsy is named after Sir Charles Bell, a Scottish anatomist who first described the disease. It results from an injury to the motor neuron of the facial nerve and is self-limiting in over 80% of cases. Symptoms usually subside over a period of three months [1].

Definition

Bell’s palsy is a condition that leads to weakness of one side of the face and it is caused by injury to the facial nerve.

Cause

The cause of Bell’s palsy is unclear but the following factors have been known to contribute to development of the condition. They are exposure to cold, herpes simplex virus, herpes zoster, HIV, cytomegalovirus, sarcoidosis, Lyme disease and Epstein–Barr virus.

Signs and symptoms

Symptoms of Bell’s palsy mainly affect one half of the face and they include drooping of the face, drooping of the eyelid, altered taste sensation, lack of tears in the eye, increased sensitivity to sound, drooling, inability to make facial expressions like smiling [8].

Diagnosis

Diagnosis of Bell’s palsy is mainly made one the bases of the presenting symptoms, although some tests might be needed to exclude other conditions. Such tests include blood tests for infection, glucose, HIV and syphilis. Imaging tests like CT scan and MRI may also be required. Some nerve conduction tests may also be carried out.

Treatment

Treatment involves the use of corticosteroids, antivirals, artificial tears and ointments. Physical therapies to train the muscles of the face are also beneficial. In some cases, surgery on the facial nerve or the eyelids would be beneficial [9] [10].

1. Anderson P. New AAN guideline on Bell's palsy. Medscape Medical News. November 7, 2012. Accessed November 12, 2012.
2. Holland NJ, Weiner GM. Recent developments in Bell's palsy. BMJ. Sep 4 2004;329(7465):553-7.
3. Mutsch M, Zhou W, Rhodes P, Bopp M, Chen RT, Linder T, et al. Use of the inactivated intranasal influenza vaccine and the risk of Bell's palsy in Switzerland. N Engl J Med. Feb 26 2004;350(9):896-903.
4. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. Jan 1 1996;124(1 Pt 1):27-30.
5. Unlu Z, Aslan A, Ozbakkaloglu B, Tunger O, Surucuoglu S. Serologic examinations of hepatitis, cytomegalovirus, and rubella in patients with Bell's palsy. Am J Phys Med Rehabil. Jan 2003;82(1):28-32.
6. Kim YH, Choi IJ, Kim HM, Ban JH, Cho CH, Ahn JH. Bilateral simultaneous facial nerve palsy: clinical analysis in seven cases. Otol Neurotol. Apr 2008;29(3):397-400.
7. Cardoso JR, Teixeira EC, Moreira MD, Fávero FM, Fontes SV, Bulle de Oliveira AS. Effects of exercises on Bell's palsy: systematic review of randomized controlled trials. Otol Neurotol. Jun 2008;29(4):557-60.
8. Baugh R, Basura G, Ishii L, Schwartz S, Drumheller C, Burkholder R, et al. Clinical Practice Guideline: Bell's Palsy. Otolaryngol Head Neck Surg November 2013 vol. 149 no. 3 suppl S1-S27. 
9. Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol. Apr 2007;28(3):408-13.
10. de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. Sep 2 2009;302(9):985-93.