Bell's palsy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The onset of Bell's palsy is sudden and symptoms typically peak fast, within a few days. The main symptom is acute peripheral facial weakness. The hallmark of Bell's palsy is unilateral, acute paresis or paralysis of facial movement. A positive history of viral infections, Ischemic mononeuropathy,Diabetes mellitus and Thyroid disorders is suggestive of Bell's palsy. Patients with Bell's palsy may also have a positive history of: Herpes simplex virus reactivation, Herpes Zoster, Cytomegalovirus, Epstein Barr virus, rubella virus, Mumps, influenza B, coxsackie virus, rickettsial infection, Borrelia burgdorferi, acute HIV infection, ischemic mononeuropathy, Diabetes mellitus and Thyroid disorders. Complications of Bell’s palsy include: incomplete eyelid closure with resultant dry eye, permanent facial weakness with muscle contractures, motor synkinesis , crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating), contracture of facial muscles, reduction or loss of taste sensation and problems with dysarthria due to facial muscle weakness. Prognosis of Bell's palsy is generally good. If left untreated approximately 71% of patients with Bell's palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction. The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell's palsy. The Bell's palsy recurs in 7% of patients. The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.
Natural History, Complications, and Prognosis
Natural History
- The onset of Bell's palsy is sudden and symptoms typically peak fast, within a few days.[1][2]
- the main symptom is acute peripheral facial weakness.
- The hallmark of Bell's palsy is unilateral, acute paresis or paralysis of facial movement. A positive history of viral infections, Ischemic mononeuropathy,Diabetes mellitus and Thyroid disorders is suggestive of Bell's palsy.
Patients with Bell's palsy may have a positive history of:
- Viral infections:
- Herpes simplex virus reactivation[3]
- Herpes Zoster[4]
- Cytomegalovirus[5]
- Epstein Barr virus[6]
- Rubella virus[7]
- Mumps[8]
- Influenza B[9]
- Coxsackievirus[10]
- Rickettsial infection [11]
- Borrelia burgdorferi[12]
- Acute HIV infection[13]
- Ischemic mononeuropathy[14]
- Diabetes mellitus[15]
- Thyroid disorders[16]
Complications
- Complications of Bell’s palsy include:[17][18]
- Incomplete eyelid closure with resultant dry eye
- Permanent facial weakness with muscle contractures
- Motor synkinesis (involuntary movement of muscles occurring at the same time as deliberate movement, e.g. involuntary mouth movement during voluntary eye closure)
- Crocodile tears (tears when eating due to misdirection of regenerating gustatory fibres destined for the salivary glands, so that they become secretory fibres to the lacrimal gland and cause ipsilateral tearing while the patient is eating)
- Incomplete recovery
- Contracture of facial muscles
- Reduction or loss of taste sensation
- Problems with dysarthria due to facial muscle weakness
Prognosis
- Prognosis of Bell's palsy is generally good.[19]
- If left untreated approximately 71% of patients with Bell's palsy recover normal function and around 13% are left with slight weakness and around 4% with severe weakness resulting in major facial dysfunction.[18]
- The presence of complete palsy, advanced age and Herpes zoster infection is associated with a particularly poor prognosis among patients with Bell's palsy.[19]
- The Bell's palsy recurs in 7% of patients.[19]
- The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress.[20]
References
- ↑ Murthy JM, Saxena AB (2011). "Bell's palsy: Treatment guidelines". Ann Indian Acad Neurol. 14 (Suppl 1): S70–2. doi:10.4103/0972-2327.83092. PMC 3152161. PMID 21847333.
- ↑ Hauser WA, Karnes WE, Annis J, Kurland LT (1971). "Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota". Mayo Clin Proc. 46 (4): 258–64. PMID 5573820.
- ↑ Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y; et al. (1998). "Reactivation of herpes simplex virus type 1 in patients with Bell's palsy". J Med Virol. 54 (3): 162–6. PMID 9515763.
- ↑ Morrow MJ (2000). "Bell's Palsy and Herpes Zoster Oticus". Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.
- ↑ Walters BN, Redman CW (1984). "Bell's palsy and cytomegalovirus mononucleosis in pregnancy". J R Soc Med. 77 (5): 429–30. PMC 1439928. PMID 6327983.
- ↑ Maeda S, Tsuda H, Haruki S, Mitsuto I (1999). "Atypical Epstein-Barr virus infection associated with Gianotti-Crosti syndrome and Bell's palsy". Pediatr Int. 41 (3): 315–7. PMID 10365586.
- ↑ Jamal GA, Al-Husaini A (1983). "Bell's palsy and infection with rubella virus". J Neurol Neurosurg Psychiatry. 46 (7): 678–80. PMC 1027493. PMID 6886708.
- ↑ Kondo K, Kanaya K, Baba S, Yamasoba T (2014). "Mumps, cervical zoster, and facial paralysis: coincidence or association?". Case Rep Otolaryngol. 2014: 289687. doi:10.1155/2014/289687. PMC 3933221. PMID 24653846.
- ↑ Wijnans L, Dodd CN, Weibel D, Sturkenboom M (2017). "Bell's palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series". PLoS One. 12 (5): e0175539. doi:10.1371/journal.pone.0175539. PMC 5414992. PMID 28467420.
- ↑ McFarlin A, Peckler B (2008). "An unusual presentation of Bell's palsy: A case report and review of literature". J Emerg Trauma Shock. 1 (1): 50–2. doi:10.4103/0974-2700.40574. PMC 2700557. PMID 19561942.
- ↑ Bitsori M, Galanakis E, Papadakis CE, Sbyrakis S (2001). "Facial nerve palsy associated with Rickettsia conorii infection". Arch Dis Child. 85 (1): 54–5. PMC 1718833. PMID 11420202.
- ↑ Schmutzhard E, Stanek G (1985). "Borrelia burgdorferi, a possible cause of Bell's palsy?". Clin Neurol Neurosurg. 87 (4): 255–7. PMID 3912092.
- ↑ Brown MM, Thompson A, Goh BT, Forster GE, Swash M (1988). "Bell's palsy and HIV infection". J Neurol Neurosurg Psychiatry. 51 (3): 425–6. PMC 1032872. PMID 3361335.
- ↑ Fahimi J, Navi BB, Kamel H (2014). "Potential misdiagnoses of Bell's palsy in the emergency department". Ann Emerg Med. 63 (4): 428–34. doi:10.1016/j.annemergmed.2013.06.022. PMC 3940662. PMID 23891413.
- ↑ Pecket P, Schattner A (1982). "Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy?". J Neurol Neurosurg Psychiatry. 45 (7): 652–5. PMC 491483. PMID 7119834.
- ↑ Cox NH, Chew D, Williams JG, Morris AI (1985). "Bell's Palsy associated with hypothyroidism". Br J Clin Pract. 39 (4): 158–9. PMID 4015946.
- ↑ Tiemstra JD, Khatkhate N (2007). "Bell's palsy: diagnosis and management". Am Fam Physician. 76 (7): 997–1002. PMID 17956069.
- ↑ 18.0 18.1 Somasundara D, Sullivan F (2017). "Management of Bell's palsy". Aust Prescr. 40 (3): 94–97. doi:10.18773/austprescr.2017.030. PMC 5478391. PMID 28798513.
- ↑ 19.0 19.1 19.2 MATTHEWS WB (1961). "Prognosis in Bell's palsy". Br Med J. 2 (5246): 215–7. PMC 1969111. PMID 13768298.
- ↑ Reitzen SD, Babb JS, Lalwani AK (2009). "Significance and reliability of the House-Brackmann grading system for regional facial nerve function". Otolaryngol Head Neck Surg. 140 (2): 154–8. doi:10.1016/j.otohns.2008.11.021. PMID 19201280.