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__NOTOC__
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{{Bell's palsy}}
{{Bell's palsy}}
{{CMG}}
{{SI}}
{{CMG}}{{AE}}{{MMJ}}
 
==Overview==
==Overview==
The exact cause of Bell's palsy is unknown but there are some evidences which implies Bell's palsy may be caused by: [[herpes simplex virus]] reactivation, [[herpes Zoster]], [[cytomegalovirus]], [[epstein Barr virus]], [[rubella]] virus, [[mumps]], [[influenza B]], [[coxsackievirus]], [[Rickettsial|Rickettsia]]<nowiki/>l infection, [[borrelia burgdorferi]], acute [[HIV]] infection, ischemic [[mononeuropathy]], [[diabetes mellitus]], [[thyroid]] disorders and compression of the [[facial nerve]].


==Causes==
==Causes==
Many cases are likely due to [[Herpes Simplex Virus]] (HSV) reactivation
===Life-threatening Causes===
*[[Life-expectancy|Life-threatening]] causes include conditions which may result in death or [[Permanent makeup|permanent disability]] within 24 hours if left untreated. There are no life-threatening causes of [[Bell's palsy|Bells palsy]].
 
===Common Causes===
The exact cause of [[Bell's palsy (patient information)|Bell's palsy]] is unknown but there are some evidences which implies [[Bell's palsy (patient information)|Bell's palsy]] may be caused by:
* Viral infections:
**[[Herpes simplex virus]] reactivation<ref name="pmid9515763">{{cite journal| author=Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y et al.| title=Reactivation of herpes simplex virus type 1 in patients with Bell's palsy. | journal=J Med Virol | year= 1998 | volume= 54 | issue= 3 | pages= 162-6 | pmid=9515763 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9515763  }} </ref>
**[[Herpes Zoster]]<ref name="pmid11096766">{{cite journal| author=Morrow MJ| title=Bell's Palsy and Herpes Zoster Oticus. | journal=Curr Treat Options Neurol | year= 2000 | volume= 2 | issue= 5 | pages= 407-416 | pmid=11096766 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11096766  }} </ref>
**[[Cytomegalovirus]]<ref name="pmid6327983">{{cite journal| author=Walters BN, Redman CW| title=Bell's palsy and cytomegalovirus mononucleosis in pregnancy. | journal=J R Soc Med | year= 1984 | volume= 77 | issue= 5 | pages= 429-30 | pmid=6327983 | doi= | pmc=1439928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6327983  }} </ref>
**[[Epstein Barr virus]]<ref name="pmid10365586">{{cite journal| author=Maeda S, Tsuda H, Haruki S, Mitsuto I| title=Atypical Epstein-Barr virus infection associated with Gianotti-Crosti syndrome and Bell's palsy. | journal=Pediatr Int | year= 1999 | volume= 41 | issue= 3 | pages= 315-7 | pmid=10365586 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10365586  }} </ref>
**[[Rubella]] virus<ref name="pmid6886708">{{cite journal| author=Jamal GA, Al-Husaini A| title=Bell's palsy and infection with rubella virus. | journal=J Neurol Neurosurg Psychiatry | year= 1983 | volume= 46 | issue= 7 | pages= 678-80 | pmid=6886708 | doi= | pmc=1027493 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6886708  }} </ref>
**[[Mumps]]<ref name="pmid24653846">{{cite journal| author=Kondo K, Kanaya K, Baba S, Yamasoba T| title=Mumps, cervical zoster, and facial paralysis: coincidence or association? | journal=Case Rep Otolaryngol | year= 2014 | volume= 2014 | issue=  | pages= 289687 | pmid=24653846 | doi=10.1155/2014/289687 | pmc=3933221 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24653846  }} </ref>
**[[Influenza B]]<ref name="pmid28467420">{{cite journal| author=Wijnans L, Dodd CN, Weibel D, Sturkenboom M| title=Bell's palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series. | journal=PLoS One | year= 2017 | volume= 12 | issue= 5 | pages= e0175539 | pmid=28467420 | doi=10.1371/journal.pone.0175539 | pmc=5414992 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28467420  }} </ref>
**[[Coxsackievirus]]<ref name="pmid19561942">{{cite journal| author=McFarlin A, Peckler B| title=An unusual presentation of Bell's palsy: A case report and review of literature. | journal=J Emerg Trauma Shock | year= 2008 | volume= 1 | issue= 1 | pages= 50-2 | pmid=19561942 | doi=10.4103/0974-2700.40574 | pmc=2700557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19561942  }} </ref>
**[[Rickettsial Disease|Rickettsial infection]] <ref name="pmid11420202">{{cite journal| author=Bitsori M, Galanakis E, Papadakis CE, Sbyrakis S| title=Facial nerve palsy associated with Rickettsia conorii infection. | journal=Arch Dis Child | year= 2001 | volume= 85 | issue= 1 | pages= 54-5 | pmid=11420202 | doi= | pmc=1718833 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11420202  }} </ref>
**[[Borrelia burgdorferi]]<ref name="pmid3912092">{{cite journal| author=Schmutzhard E, Stanek G| title=Borrelia burgdorferi, a possible cause of Bell's palsy? | journal=Clin Neurol Neurosurg | year= 1985 | volume= 87 | issue= 4 | pages= 255-7 | pmid=3912092 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3912092  }} </ref>
**Acute [[HIV]] infection<ref name="pmid3361335">{{cite journal| author=Brown MM, Thompson A, Goh BT, Forster GE, Swash M| title=Bell's palsy and HIV infection. | journal=J Neurol Neurosurg Psychiatry | year= 1988 | volume= 51 | issue= 3 | pages= 425-6 | pmid=3361335 | doi= | pmc=1032872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3361335  }} </ref>
*Ischemic [[mononeuropathy]]<ref name="pmid23891413">{{cite journal| author=Fahimi J, Navi BB, Kamel H| title=Potential misdiagnoses of Bell's palsy in the emergency department. | journal=Ann Emerg Med | year= 2014 | volume= 63 | issue= 4 | pages= 428-34 | pmid=23891413 | doi=10.1016/j.annemergmed.2013.06.022 | pmc=3940662 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23891413  }} </ref>
*[[Diabetes mellitus]]<ref name="pmid7119834">{{cite journal| author=Pecket P, Schattner A| title=Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy? | journal=J Neurol Neurosurg Psychiatry | year= 1982 | volume= 45 | issue= 7 | pages= 652-5 | pmid=7119834 | doi= | pmc=491483 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7119834  }} </ref>
*[[Thyroid-medullary carcinoma|Thyroid]] disorders<ref name="pmid4015946">{{cite journal| author=Cox NH, Chew D, Williams JG, Morris AI| title=Bell's Palsy associated with hypothyroidism. | journal=Br J Clin Pract | year= 1985 | volume= 39 | issue= 4 | pages= 158-9 | pmid=4015946 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4015946  }} </ref>
*Compression of the [[facial nerve]]<ref name="pmid889228">{{cite journal| author=Gussen R| title=Pathogenesis of Bell's palsy. Retrograde epineurial edema and postedematous fibrous compression neuropathy of the facial nerve. | journal=Ann Otol Rhinol Laryngol | year= 1977 | volume= 86 | issue= 4 Pt 1 | pages= 549-58 | pmid=889228 | doi=10.1177/000348947708600416 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=889228  }} </ref>
 
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | Ischemic [[mononeuropathy]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
 
| '''Dental'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Dermatologic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Drug Side Effect'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"


'''Infectious causes '''
| '''Ear Nose Throat'''


:*Herpes simplex virus activation is the most likely cause of Bell's Palsy.
| bgcolor="Beige" | No underlying causes
:*Herpes Zoster may be the second most common viral infection. 
:*Cytomegalovirus
:*Epstein Barr virus
:*Adenovirus
:*Rubella virus
:*Mumps
:*Influenza B
:*Coxsackievirus 
:*Rickettsial infection
:*Ehrlichiosis
:*Borrelia burdopheri
:*HIV


'''Non-infectious causes'''
|-  


:*Several cases of Bell' Palsy were linked to an inactivated intranasal influenza vaccine in Switzerland
|- bgcolor="LightSteelBlue"
:*Genetic predisposition may be likely 
:*Ischemia of the facial nerve
:*Tumors and compression of the facial nerve
:*Temporal bone fracture
:*Systemic Lupus Erythematosus (SLE)
:*Sarcoidosis


===Lyme Disease===
| '''Endocrine'''


:*Facial nerve palsy is the most common cranial neuropathy associated with Lyme meningitis.
| bgcolor="Beige" | [[Diabetes mellitus]], [[Thyroid]] disorders
:*Screening for antibodies to B.burgdorferi not recommended among patients with seventh nerve palsy with no additional manifestations of Lyme disease.
:*Findings suggestive of possible Lyme disease include the development of facial palsy in a young patient, heart block, arthritis, vertigo, and hearing loss.


===HIV===
|-


:*HIV infection rarely causes facial palsy.
|- bgcolor="LightSteelBlue"
:*Onset at the time of sero-conversion when a CSF lymphocytosis is usually present.
:*In the later stages when cellular immunity wanes, the facial palsy is typically due to another infection such as Zoster, chronic demyelinating polyradiculopathy, or meningeal lymphomatosis.


===Melkersson-Rosenthal Syndrome===
| '''Environmental'''


:*Facial paralysis, episodic facial swelling, and a fissured tongue, typically beginning in adolescence, with recurrent episodes of facial palsy.
| bgcolor="Beige" | No underlying causes
:*Incomplete forms of this syndrome outnumber those with the classic triad.
:*The cause is unknown, and treatment unproven.


===Other Entities===
|-


:*Bacterial infection of the middle ear (otitis media)
|- bgcolor="LightSteelBlue"
:*Cholesteatoma, or tumors should be suspected if the onset of facial palsy is gradual.
 
:*Sarcoidosis, especially in patients with bilateral facial palsy.
| '''Gastroenterologic'''
:*Sjogren's syndrome is an unusual cause.
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Genetic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Hematologic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Iatrogenic'''
 
| bgcolor="Beige" | Inactivated intranasal [[influenza vaccine]]
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Infectious Disease'''
 
| bgcolor="Beige" | Acute [[HIV]] infection,  [[Adenovirus]],  [[Coxsackievirus]],  [[Cytomegalovirus]],  [[Epstein-Barr virus]],  [[Herpes simplex virus]],  [[Herpes zoster]],  Inactivated intranasal [[influenza vaccine]],  [[Influenza B]],  [[Mumps]],  [[Rickettsia|Rickettsial]] infection,  [[Rubella]],  [[Varicella-zoster virus]], [[Borrelia burgdorferi]]
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Musculoskeletal/Orthopedic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Neurologic'''
 
| bgcolor="Beige" | Compression of the [[facial nerve]],  [[Facial nerve]] [[inflammation]],  Ischemic [[mononeuropathy]], [[Tumors]] of the [[facial nerve]]
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Nutritional/Metabolic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Obstetric/Gynecologic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Oncologic'''
 
| bgcolor="Beige" | [[Tumor]]s of the [[facial nerve]]
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Ophthalmologic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Overdose/Toxicity'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Psychiatric'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Pulmonary'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Renal/Electrolyte'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Rheumatology/Immunology/Allergy'''
 
| bgcolor="Beige" | Inactivated intranasal [[influenza vaccine]]
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Sexual'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Trauma'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Urologic'''
 
| bgcolor="Beige" | No underlying causes
 
|-
 
|- bgcolor="LightSteelBlue"
 
| '''Miscellaneous'''
 
| bgcolor="Beige" | Compression of the [[facial nerve]],  [[Facial nerve]] [[inflammation]], [[Idiopathic]]
 
|-
 
|}
 
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Acute HIV infection]]
*[[Adenovirus]]
*[[Arteriosclerosis]]
*[[Borrelia burgdorferi]]
*[[Compression of the facial nerve]]
*[[Coxsackievirus]]
*[[Cytomegalovirus]]
*[[Diabetes mellitus]]
*[[Ehrlichiosis]]
{{col-break|width=33%}}
*[[Epstein-Barr virus]]
*[[Facial nerve]] [[inflammation]]
*[[Herpes simplex virus]]
*[[Herpes zoster]]
*[[Idiopathic]]
*Inactivated intranasal [[influenza vaccine]]
*[[Influenza B]]
{{col-break|width=33%}}
*[[Ischemic mononeuropathy]]
*[[Mumps]]
*[[Rickettsial infection]]
*[[Rubella]]
*[[Thyroid]] disorders
*[[Tumors]] of the [[facial nerve]]
*[[Varicella-zoster virus]]
{{col-end}}
 
===Causes by Etiology===
====Infectious Causes====
*[[Herpes simplex virus]] reactivation is the most likely cause of Bell's Palsy.
*[[Herpes Zoster]] may be the second most common viral infection.
*[[Cytomegalovirus]]
*[[Epstein Barr virus]]
*[[Adenovirus]]
*[[Rubella]] virus
*[[Mumps]]
*[[Influenza B]]
*[[Coxsackievirus]]
*[[Rickettsia|Rickettsial]] infection
*[[Ehrlichiosis]]
*[[Borrelia burgdorferi]]
*Acute [[HIV]] infection
 
====Non-Infectious Causes====
*[[Facial nerve]] inflammation
*[[Tumors]] and compression of the facial nerve
*[[Mononeuropathy|Ischemic mononeuropathy]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Neurological disorders]]
[[Category:Otolaryngology]]
[[Category:Neurology]]
[[Category:Disease]]
[[Category:Needs overview]]
[[Category:Needs causes]]

Latest revision as of 20:36, 29 July 2020

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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 exact cause of Bell's palsy is unknown but there are some evidences which implies Bell's palsy may be caused by: herpes simplex virus reactivation, herpes Zoster, cytomegalovirus, epstein Barr virus, rubella virus, mumps, influenza B, coxsackievirus, Rickettsial infection, borrelia burgdorferi, acute HIV infection, ischemic mononeuropathy, diabetes mellitus, thyroid disorders and compression of the facial nerve.

Causes

Life-threatening Causes

Common Causes

The exact cause of Bell's palsy is unknown but there are some evidences which implies Bell's palsy may be caused by:

Causes by Organ System

Cardiovascular Ischemic mononeuropathy
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine Diabetes mellitus, Thyroid disorders
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Inactivated intranasal influenza vaccine
Infectious Disease Acute HIV infection, Adenovirus, Coxsackievirus, Cytomegalovirus, Epstein-Barr virus, Herpes simplex virus, Herpes zoster, Inactivated intranasal influenza vaccine, Influenza B, Mumps, Rickettsial infection, Rubella, Varicella-zoster virus, Borrelia burgdorferi
Musculoskeletal/Orthopedic No underlying causes
Neurologic Compression of the facial nerve, Facial nerve inflammation, Ischemic mononeuropathy, Tumors of the facial nerve
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Tumors of the facial nerve
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Inactivated intranasal influenza vaccine
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Compression of the facial nerve, Facial nerve inflammation, Idiopathic

Causes in Alphabetical Order

Causes by Etiology

Infectious Causes

Non-Infectious Causes

References

  1. ↑ 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.
  2. ↑ Morrow MJ (2000). "Bell's Palsy and Herpes Zoster Oticus". Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Schmutzhard E, Stanek G (1985). "Borrelia burgdorferi, a possible cause of Bell's palsy?". Clin Neurol Neurosurg. 87 (4): 255–7. PMID 3912092.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Gussen R (1977). "Pathogenesis of Bell's palsy. Retrograde epineurial edema and postedematous fibrous compression neuropathy of the facial nerve". Ann Otol Rhinol Laryngol. 86 (4 Pt 1): 549–58. doi:10.1177/000348947708600416. PMID 889228.

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