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

Bell's palsy (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 simplex. more...

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Symptoms

Additional symptoms that may accompany the condition are pain around the ear and loss of taste. In the great majority of patients, only one side of the face is affected. Detection of sensory loss, hearing loss, or ataxia during examination militates against the diagnosis of Bell's palsy and suggests the need for further evaluation.

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.

Diagnosis

Bell's palsy is a diagnosis of exclusion; in many cases, no specific cause can be ascertained.

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 irrepairable damage to the facial nerve, i.e.acute facial nerve paralysis.

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.

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.

Epidemiology

Bell's Palsy is three times more likely to strike pregnant women than non-pregnant women . It is also considered to be four times more likely to occur in diabetics than the general population, and it is more common in the elderly than children .

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The Official Patient's Sourcebook on Bell's Palsy $32.71 Outcome of treatment with valacyclovir and prednisone in patients with Bell's palsy : An article from: The Annals of Otology, Rhinology & Laryngology $10.00
Bell's Palsy: Electrodiagnostics are not indicative of cerebrospinal fluid abnormalities : An article from: The Annals of Otology, Rhinology & Laryngology $10.00 Bell's Palsy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References $20.00
Waveform changes in antidromic facial nerve responses in patients with Bell's palsy : An article from: The Annals of Otology, Rhinology & Laryngology $10.00 Gale Encyclopedia of Medicine : Bell's palsy $5.50
Surviving Bell's Palsy: A Patient's Guide to Facial Paralysis Management $9.95 Bell's palsy in children
Evidence of CNS impairment in Bell's palsy Selections from the writings of Sir Charles Bell: Bell's law, Bell's nerves, Bell's Palsy, Bell's phenomenon, with biography and bibliography (Medical classics)

New concepts in Bell's palsy improve treatment options
Bell's palsy affects about one in 60 persons and has an annual incidence of around 20 per 100,000 persons. Overall, the condition is most common in persons 15 to 45 years of age, but the incidence
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Parkinson's disease, Meniere's syndrome, Trigeminal neuralgia and Bell's palsy: One cause, one correction
Abstract I currently have 16 Meniere's syndrome, two Parkinson's disease, two Trigeminal neuralgia and two Bell's palsy patients under my care. They all ...
Report of Bell's palsy in upper motor syndrome
Re: Jane Doe To whom it may concern: The patient was seen in my San Juan Capistrano, Calif., office for an initial evaluation. She presented with moderate ...
Are drug therapies effective in treating Bell's palsy? - Clinical Inquiries
Photocopy for your patients "Bell's palsy" on page 160. * EVIDENCE-BASED ANSWER Early use of corticosteroid therapy results in less autonomic synkinesis and possibly improved rates of recover

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