Bell's palsy is a kind of facial paralysis that results in an inability to control the facial muscles on the affected side. Symptoms may vary from mild to severe. They may include muscle twitching, weakness, or total loss of ability to move one or rarely either side of the face. Other symptoms include sagging eyelids, taste changes, pain around the ears, and increased sensitivity to sound. Usually symptoms come more than 48 hours.
The cause of Bell's palsy is unknown. Risk factors include diabetes and upper respiratory tract infections recently. This results from cervical nerve dysfunction VII (facial nerve). Many believe that this is caused by a viral infection that causes swelling. The diagnosis is based on a person's appearance and excludes other possible causes. Other conditions that can cause facial weakness include brain tumor, stroke, Ramsay Hunt syndrome, myasthenia gravis, and Lyme disease.
The condition usually improves by itself with most reaching normal or near normal function. Corticosteroids have been found to improve outcomes, while antiviral drugs may have little additional benefit. The eyes should be protected from dryness with the use of eye drops or eye patches. Surgery is generally not recommended. Often signs of improvement begin within 14 days, with complete recovery within six months. Some may not fully recover or have symptoms of relapse.
Bell's palsy is the most common cause of a facial nerve paralysis (70%). That happens in 1 to 4 per 10,000 people per year. Approximately 1.5% of people are affected at some point in their lives. This is most common in people between the ages of 15 and 60. Men and women are affected equally. It was named after Scottish surgeon Charles Bell (1774-1842), who first described the facial nerve relationship with the condition.
Video Bell's palsy
Signs and symptoms
Bell's palsy is characterized by a one-sided face droop that appears within 72 hours. In rare cases (& lt; 1%), this can occur on both sides causing total facial paralysis.
Facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, saliva, flaring the nostrils and raising eyebrows. It also carries a taste sensation of the anterior two thirds of the tongue, through the chorda tympani nerve (the branch of the facial nerve). Therefore, people with Bell's palsy may present with a loss of taste sensation in the anterior 2/3 of the tongue on the affected side.
Although the facial nerve innervates the middle ear stapedius muscle (via the tympanic branch), the sound sensitivity, causing normal sound is considered very loud, and dysacusis may be but almost never clinically proven.
Despite being defined as mononeuritis (involving only one nerve), people diagnosed with Bell's palsy may have "myriad neurological symptoms" including "facial, moderate or severe pain/neck pain, memory problems, balance problems, ipsilateral limb paresthesia, ipsilateral limb weakness , and a sense of awkwardness "that" can not be explained by facial nerve dysfunction ".
Maps Bell's palsy
Cause
Some viruses are thought to form asymptomatic persistent (or latent) infections, eg, varicella-zoster virus and Epstein-Barr virus, both of which are herpes families. Reactivation of an existing viral infection (dormant) has been suggested as the cause of Bob's acute paralysis. Studies show that this new activation can be preceded by trauma, environmental factors, and metabolic or emotional disorders, suggesting that a number of different conditions can trigger reactivation.
Family heritage has been found in 4-14% of cases. Bell's palsy is three times more likely in pregnant women than in non-pregnant women. It is also considered four times more likely to occur in diabetics than in the general population.
Pathophysiology
Bell's palsy occurs because of facial nerve damage (VII of the cranial nerve), which controls the facial muscles. Facial palsy is characterized by an inability to control movement in the muscles of facial expression. Paralysis is an infranuklear/lower motor neuron type.
It is thought that as a result of facial nerve inflammation, pressure is generated on the nerve where it exits the skull inside the bony canal (foramen stylomastoid), blocking the transmission of nerve signals or damaging the nerve. Patients with facial paralysis whose underlying cause can be found are not considered to have Bell's palsy per se . Possible causes include tumors, meningitis, stroke, diabetes mellitus, head trauma and cranial nerve inflammatory disease (sarcoidosis, brucellosis, etc.). In these conditions, neurologic findings are seldom confined to the facial nerve. Babies can be born with a paralyzed face. In some cases, bilateral facial palsy has been associated with acute HIV infection.
In some studies, the herpes simplex virus type 1 (HSV-1) has been identified in most cases diagnosed as Bell's palsy. It has given hope to anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other studies, however, identified HSV-1 as only 31 cases (18 percent), herpes zoster (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases that were clinically diagnosed as Bell's Palsy. Infection with herpes simplex virus should play a major role in cases diagnosed as Bell's palsy because it remains a hypothesis that requires further research.
In addition, herpes simplex virus infection type 1 (HSV-1) is associated with nerve demyelination. The mechanism of nerve damage is different from those mentioned above - that edema, swelling and nerve compression in narrow bone channels are responsible for nerve damage. Demielination may not be directly caused by a virus, but by an unknown immune system response.
Diagnosis
Bell's palsy is a diagnosis of exclusion, meaning that it is diagnosed with a possible other possible elimination. By definition, no specific cause can be determined. No regular laboratory or imaging tests are required to make the diagnosis. The degree of nerve damage can be assessed using the House-Brackmann score.
One study found that 45% of patients were not referred to a specialist, suggesting that Bell's palsy is considered by doctors as an easily manageable, direct diagnosis.
Other conditions that can cause similar symptoms include: herpes zoster, Lyme disease, sarcoidosis, stroke, and brain tumors.
Differential diagnosis
Once facial paralysis occurs, many people may misinterpret it as a symptom of a stroke; However, there are some subtle differences. Stroke will usually cause some additional symptoms, such as numbness or weakness in the arms and legs. And unlike Bell's palsy, a stroke will usually let the patient control the upper part of their face. A person with a stroke will usually have some wrinkles on their forehead.
One disease that may be difficult to exclude in the differential diagnosis is facial nerve involvement in herpes zoster virus infection. The main difference in this condition is the presence of small blisters, or vesicles , on the external ear and hearing loss, but these findings may sometimes be lacking (zoster sinus herpete). Reactivation of existing herpes zoster infections results in facial palsy in a Bell palsy type pattern known as Ramsay Hunt type 2 syndrome.
Lyme disease can cause facial palsy. Sometimes the false face occurs at the same time as classical erythema inflammation. At other times, it happens next. In areas where Lyme disease is common, it may be the cause of paralysis of the face in half the cases.
Treatment
Steroids have been shown to be effective in improving recovery at Bell's palsy while antivirus has not yet. For those who can not blind their eyes, eye protection is needed.
Steroids
Corticosteroids such as prednisone improve recovery at 6 months and are thus recommended. Early treatment (within 3 days of onset) is required to benefit with a 14% greater likelihood of healing.
One review found that antivirals (such as acyclovir) were ineffective in boosting recovery from Bell's palsy beyond steroids alone in mild to moderate disease. Other reviews found benefit when combined with corticosteroids but stated evidence was not too good to support this conclusion.
In severe disease is also not clear. One 2015 review found no effect regardless of its severity. Other reviews found little benefit when added to steroids.
They are commonly prescribed because of the theoretical relationship between Bell's palsy and herpes simplex virus and varicella zoster. There is still a possibility that they may yield a benefit of less than 7% because this has not been ruled out.
Physiotherapy
Physiotherapy can be beneficial for some individuals with Bell's palsy as it helps maintain muscle tone from affected facial muscles and stimulates facial nerves. It is important that muscle reuse training and soft tissue techniques are implemented prior to recovery to help prevent the permanent contracting of the paralyzed facial muscles. To reduce pain, heat can be applied to the affected side of the face. There is no evidence of high quality to support the role of electrical stimulation for Bell's palsy.
Surgery
Surgery may improve the outcome of facial nerve palsies that have not yet recovered. A number of different techniques exist. Smile surgery or smile reconstruction is a surgical procedure that can restore a smile for people with facial nerve paralysis. It is not known whether the initial operation is useful or harmful. Side effects include hearing loss that occurs in 3-15% of people. In 2007, the American Academy of Neurology did not recommend decompression surgery.
Alternative medicine
The efficacy of acupuncture is still unknown because of the available studies of low quality (poor basic study design or inadequate reporting practices). There is very tentative evidence for hyperbaric oxygen therapy in severe disease.
Prognosis
Most people with Bell's palsy start regaining normal facial function in 3 weeks - even those who do not receive treatment. In a 1982 study, when no treatment was available, of 1,011 patients, 85% showed the first signs of recovery within 3 weeks of onset. For the other 15%, recovery occurs 3-6 months later.
After a follow-up of at least one year or until recovery, total recovery has occurred in more than two-thirds (71%) of all patients. Recovery is rated as being in 12% and poor in only 4% of patients. Other studies have found that incomplete palpation is lost entirely, almost always within a month. Patients who regain movement within the first two weeks almost always send out the whole. When remission does not occur until the third week or so, most patients experience residual symptoms. The third study found a better prognosis for young patients, aged under 10 years, while patients over the age of 61 showed poor prognosis.
The main complications of this condition are loss of chronic (ageusia), chronic facial spasm, facial pain and corneal infection. To prevent the latter, the eyes may be covered by cover, or attached during sleep and for rest periods, and eye drops such as eye or eye ointment may be recommended, especially for cases with total paralysis. If the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eyes from injury.
Other complications can occur in cases of incomplete or wrong regeneration of damaged facial nerves. The nerves can be thought of as bundles of individual smaller nerve connections that branch off to the right destination. During regrowth, nerves can generally trace the original pathway to the right destination - but some nerves may divert toward a condition known as synkinesis. For example, nerve regrowth that controls the muscles attached to the eye can divert and also regenerate the connections that reach the muscles of the mouth. In this way, the movement of a person also affects the other. For example, when people close their eyes, the corners of the mouth are raised unconsciously.
Approximately 9% of patients have some sort of residual symptoms after Bell's palsy, usually synkinesis already discussed, or seizures, contractures, tinnitus and/or hearing loss during facial movement or teardrops syndrome. It is also called gustatolacrimal reflex or Bogorad's syndrome and involves the sufferer who cries during a meal. This is thought to be due to false facial nerve regeneration, the branch that controls the lacrimal glands and saliva. Gustatorial sweat can also occur.
Epidemiology
The number of new cases of Bell's palsy is about 20 per 100,000 population per year. Rate increases with age. Bell's palsy affects about 40,000 people in the United States each year. It affects about 1 person in 65 during a lifetime.
Various annual incidence rates have been reported in the literature: 15, 24, and 25-53 (all rates per 100,000 population per year). Bell's palsy is not a reported disease, and there are no established registries for people with this diagnosis, which complicates the right estimates.
History
The Persian physician Muhammad ibn Zakariya al-Razi (865-925) detailed the first known description of peripheral and central facial palpation.
Cornelis Stalpart van der Wiel (1620-1702) in 1683 gave a report on Bell's palsy and praised the Persian physician Ibn Sina (980-1037) to describe this condition in his presence. James Douglas (1675-1742) and Nicolaus Anton Friedreich (1761-1836) also described it.
Sir Charles Bell, whose name was named, presented three cases at the Royal Society of London in 1829. Two cases were idiopathic and the third was caused by a parotid gland tumor.
Someone famous for Bell's palsy is former Canadian Prime Minister Jean Chrà ©  © tien. During Canada's 1993 Canadian federal election, the first Chrà ©  © tien as the leader of the Canadian Liberal Party, the opposition Conservative Progressive Party of Canada ran an adver- tive advertisement in which the voice actor criticized him for an image that seemed to highlight his abnormal facial expression. The ad was interpreted as an attack on ChrÃÆ'  © tien's physical appearance and garnered widespread anger among the public, while ChrÃÆ' © tien used the ad to make himself more sympathetic to voters. The advertisement had a devastating effect on increasing ChrÃÆ' © tien's leadership in the polls and the subsequent backlash reached elections for the Liberals, which the party won in a landslide.
References
External links
- Bell's palsy in Curlie (based on DMOZ)
Source of the article : Wikipedia
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