What Causes Facial Nerve Palsy?
Discussion Facial nerve palsy has been known for centuries, but in 1821 unilateral facial nerve paralysis was described by Sir Charles Bell. Bell’s palsy (BP) is a unilateral, acute facial paralysis that is clinically diagnosed after other etiologies have been excluded by appropriate history, physical examination and/or laboratory testing or imaging. Symptoms include abnormal movement of facial nerve. It can be associated with changes in facial sensation, hearing, taste or excessive tearing. The right and left sides are equally affected but bilateral BP is rare (0.3%). Paralysis can be complete or incomplete at presentation. All ages can be affected but there are increased risks in the 15-45 year age group and those with diabetes, immunodeficiency or are pregnant. Etiology is specifically unknown but felt to be caused by facial nerve edema and nerve entrapment. Some theorize that reactivation of herpes simplex virus is a cause. Symptoms tend to peak about 72 hours after onset, and can be graded by the House-Brackmann facial nerve grading system which is: I. Normal II. Mild dysfunction – “Slight weakness noticeable only on close inspection…” No functional impairment III. Moderate dysfunction – “Obvious but not disfiguring difference between the two sides; no functional impairment…” IV. Moderately severe dysfunction – “Obvious weakness and/or disfiguring assymetry…” Has functional impairment V. ...
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