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1.12 Bell's Palsy (Idiopathic Facial Paralysis)


Presentation

This condition creates a very frightening facial disfigurement. An adult complains of sudden onset of "numbness," a feeling of fullness or swelling, pain or some other change in sensation on one side of the face; a crooked smile, mouth "drawing" or some other asymmetrical weakness of facial muscles; an irritated, dry or tearing eye; drooling out of the corner of the mouth; or changes in hearing or taste. Often there will have been a viral illness one to three weeks before. Upon initial observation of the patient, it is immediately apparent that he is alert and oriented, with a unilateral facial paralysis that includes one side of the forehead.

What to do:

What not to do:

Discussion

Idiopathic nerve paralysis is a common malady. It affects 20 per 100,000 people a year. Although Bell's palsy was described classically as a pure facial nerve lesion, and physicians have tried to identify the exact level at which the nerve is compressed, the most common presenting complaints are related to trigeminal nerve involvement. The mechanism is probably a spotty demyelination of several nerves at several sites, caused by a viral infection. Diabetics and pregnant women have increased incidence of Bell's palsy.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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