Bell's palsy pathophysiology: Difference between revisions

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Latest revision as of 20:36, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The exact pathophysiology of Bell' palsy is not known. Bell's palsy occurs due to failure to function in a normal manner of the facial nerve (VII cranial nerve). The malfunction of the facial nerve caused involuntary spasm in the facial muscles which called facial palsy. Bell's palsy causes the lower motor neuron type paralysis. Although the exact etiology of Bell's palsy is unknown, there is some evidences that implies there may be some relation between vasospasm, from any cause, along any facial nerve branch, with Bell's palsy. There is no established association between genetic factors and Bell's palsy. Hereditary components may play a role in familial recurrent Bell's palsy. On microscopic histopathological analysis, thickened perineurium, infiltrates of inflammatory cells between nerve bundles and around blood vessels are characteristic findings of Bell’s palsy. It appears that the histology of the facial nerve in Bell's palsy is similar to Herpes Zoster infection, suggestive of an infectious cause.

Pathophysiology

Pathogenesis

The exact pathophysiology of Bell' palsy is not known.^[1]
- Bell's palsy occurs due to failure to function in a normal manner of the facial nerve (VII cranial nerve).^[2]
- The malfunction of the facial nerve caused involuntary spasm in the facial muscles which called facial palsy.^[2]
- Bell's palsy causes the lower motor neuron type paralysis.^[3]
Although the exact etiology of Bell's palsy is unknown, there is some evidences that implies there may be some relation between vasospasm, from any cause, along any facial nerve branch, with Bell's palsy.^[4]

Genetics

There is no established association between genetic factors and Bell's palsy.
Hereditary components may play a role in familial recurrent Bell's palsy.^[5]

Associated Conditions

1. Blepharospasm^[6]

Blepharospasm has been rarely seen in patients whit with Bell's palsy.
In most cases blepharospasm appeared within a month after the onset of Bell's palsy.

2. Herpes zoster infection^[7]

Microscopic Pathology

On microscopic histopathological analysis, thickened perineurium, infiltrates of inflammatory cells between nerve bundles and around blood vessels are characteristic findings of Bell’s palsy.^[8]

It appears that the histology of the facial nerve in Bell's palsy is similar to Herpes Zoster infection, suggestive of an infectious cause.^[7] ==References==

↑ 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.
↑ ^2.0 ^2.1 Holland J, Bernstein J (2011). "Bell's palsy". BMJ Clin Evid. 2011. PMC 3275144. PMID 21375786.
↑ Newadkar UR, Chaudhari L, Khalekar YK (2016). "Facial Palsy, a Disorder Belonging to Influential Neurological Dynasty: Review of Literature". N Am J Med Sci. 8 (7): 263–7. doi:10.4103/1947-2714.187130. PMC 4982354. PMID 27583233.
↑ 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.
↑ Qin D, Ouyang Z, Luo W (2009). "Familial recurrent Bell's palsy". Neurol India. 57 (6): 783–4. doi:10.4103/0028-3886.59478. PMID 20139511.
↑ Miwa H, Kondo T, Mizuno Y (2002). "Bell's palsy-induced blepharospasm". J Neurol. 249 (4): 452–4. doi:10.1007/s004150200038. PMID 11967652.
↑ ^7.0 ^7.1 Morrow MJ (2000). "Bell's Palsy and Herpes Zoster Oticus". Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.
↑ Liston SL, Kleid MS (1989). "Histopathology of Bell's palsy". Laryngoscope. 99 (1): 23–6. doi:10.1288/00005537-198901000-00006. PMID 2642582.

Template:WH Template:WS

[pmid28798513-1] 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.

[pmid21375786-2] 2.0 ^2.1 Holland J, Bernstein J (2011). "Bell's palsy". BMJ Clin Evid. 2011. PMC 3275144. PMID 21375786.

[pmid27583233-3] Newadkar UR, Chaudhari L, Khalekar YK (2016). "Facial Palsy, a Disorder Belonging to Influential Neurological Dynasty: Review of Literature". N Am J Med Sci. 8 (7): 263–7. doi:10.4103/1947-2714.187130. PMC 4982354. PMID 27583233.

[pmid889228-4] 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.

[pmid20139511-5] Qin D, Ouyang Z, Luo W (2009). "Familial recurrent Bell's palsy". Neurol India. 57 (6): 783–4. doi:10.4103/0028-3886.59478. PMID 20139511.

[pmid11967652-6] Miwa H, Kondo T, Mizuno Y (2002). "Bell's palsy-induced blepharospasm". J Neurol. 249 (4): 452–4. doi:10.1007/s004150200038. PMID 11967652.

[pmid11096766-7] 7.0 ^7.1 Morrow MJ (2000). "Bell's Palsy and Herpes Zoster Oticus". Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.

[pmid2642582-8] Liston SL, Kleid MS (1989). "Histopathology of Bell's palsy". Laryngoscope. 99 (1): 23–6. doi:10.1288/00005537-198901000-00006. PMID 2642582.

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@@ Line 6: / Line 6: @@
 ==Overview==
-The exact pathogenesis of [disease name] is not fully understood.
+The exact [[pathophysiology]] of Bell' palsy is not known[[Bell's palsy (patient information)|. Bell's palsy]] occurs due to failure to function in a normal manner of the [[Facial nerve|facial nerve (VII cranial nerve)]]. The [[Multivitamin|malfunction]] of the [[facial nerve]] caused involuntary [[spasm]] in the [[facial muscles]] which called [[facial palsy]]. [[Bell's palsy (patient information)|Bell's palsy]] causes the [[Lower motor neuron lesion|lower motor neuron type paralysis]]. Although the exact [[etiology]] of [[Bell's palsy (patient information)|Bell's palsy]] is unknown, there is some evidences that implies there may be some relation between [[Vasospasm|vasospasm,]] from any cause, along any [[Facial nerve|facial nerve branch]], with [[Bell's palsy (patient information)|Bell's palsy]]. There is no established association between [[Genetics|genetic]] factors and [[Bell's palsy (patient information)|Bell's palsy]]. [[Hereditary]] components may play a role in [[Family|familial recurrent Bell's palsy]]. On [[Microsatellite|microscopic histopathological]] analysis, thickened [[perineurium]], infiltrates of [[inflammatory cells]] between nerve bundles and around [[blood vessel]]s are [[Characteristic energy length scale|characteristic]] findings of [[Be bold in updating pages|Bell’s palsy]]. It appears that the [[histology]] of the [[facial nerve]] in [[Bell's palsy (patient information)|Bell's palsy]] is similar to [[Herpes Zoster infection]], suggestive of an infectious cause.
-OR
-It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
-OR
-[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
-OR
-Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
-OR
-[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
-OR
-The progression to [disease name] usually involves the [molecular pathway].
-OR
-The pathophysiology of [disease/malignancy] depends on the histological subtype.
 ==Pathophysiology==
 ===Pathogenesis===
-*The exact pathogenesis of [disease name] is not fully understood.
-OR
+*The exact [[pathophysiology]] of [[Belching|Bell' palsy]] is not known.<ref name="pmid28798513">{{cite journal| author=Somasundara D, Sullivan F| title=Management of Bell's palsy. | journal=Aust Prescr | year= 2017 | volume= 40 | issue= 3 | pages= 94-97 | pmid=28798513 | doi=10.18773/austprescr.2017.030 | pmc=5478391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28798513  }} </ref>
-*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
+**Bell's palsy occurs due to failure to function in a normal manner of the [[Facial nerve|facial nerve (VII cranial nerve)]].<ref name="pmid21375786">{{cite journal| author=Holland J, Bernstein J| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2011 | volume= 2011 | issue=  | pages=  | pmid=21375786 | doi= | pmc=3275144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21375786  }} </ref>
-*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
+**The [[Malformation|malfunction]] of the [[facial nerve]] caused involuntary [[spasm]] in the [[facial muscles]] which called [[facial palsy]].<ref name="pmid21375786">{{cite journal| author=Holland J, Bernstein J| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2011 | volume= 2011 | issue=  | pages=  | pmid=21375786 | doi= | pmc=3275144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21375786  }} </ref>
-*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
+**[[Bell's palsy (patient information)|Bell's palsy]] causes the [[Lower motor neuron lesion|lower motor neuron type paralysis]].<ref name="pmid27583233">{{cite journal| author=Newadkar UR, Chaudhari L, Khalekar YK| title=Facial Palsy, a Disorder Belonging to Influential Neurological Dynasty: Review of Literature. | journal=N Am J Med Sci | year= 2016 | volume= 8 | issue= 7 | pages= 263-7 | pmid=27583233 | doi=10.4103/1947-2714.187130 | pmc=4982354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27583233  }} </ref>
-*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
+*Although the exact [[etiology]] of Bell's palsy is unknown, there is some evidences that implies there may be some relation between [[Vasospasm|vasospasm,]] from any cause, along any [[Facial nerve|facial nerve branch]], with [[Bell's palsy (patient information)|Bell's palsy]].<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>
-*The progression to [disease name] usually involves the [molecular pathway].
-*The pathophysiology of [disease/malignancy] depends on the histological subtype.
 ==Genetics==
-*[Disease name] is transmitted in [mode of genetic transmission] pattern.
+*There is no established association between [[Genetics|genetic]] factors and Bell's palsy.
-*Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].
+*[[Hereditary Desmoid tumor|Hereditary]] components may play a role in [[Familial ATTR amyloidosis classification|familial recurrent Bell's palsy]].<ref name="pmid20139511">{{cite journal| author=Qin D, Ouyang Z, Luo W| title=Familial recurrent Bell's palsy. | journal=Neurol India | year= 2009 | volume= 57 | issue= 6 | pages= 783-4 | pmid=20139511 | doi=10.4103/0028-3886.59478 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20139511  }} </ref>
-*The development of [disease name] is the result of multiple genetic mutations.
 ==Associated Conditions==
+.  [[Blepharospasm]]<ref name="pmid11967652">{{cite journal| author=Miwa H, Kondo T, Mizuno Y| title=Bell's palsy-induced blepharospasm. | journal=J Neurol | year= 2002 | volume= 249 | issue= 4 | pages= 452-4 | pmid=11967652 | doi=10.1007/s004150200038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11967652  }} </ref>
-==Gross Pathology==
+* [[Blepharospasm]]  has been rarely seen in patients whit with Bell's palsy.
-*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
+* In most cases [[blepharospasm]] appeared within a month after the onset of Bell's palsy.
+. [[Herpes zoster]] infection<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>
 ==Microscopic Pathology==
-*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
+*On [[Micro-K|microscopic histopathological]] analysis, thickened [[perineurium]], infiltrates of [[inflammatory cells]] between nerve bundles and around [[blood vessel]]s are [[Characteristic energy length scale|characteristic]] findings of [[Bell's palsy CT|Bell’s palsy]].<ref name="pmid2642582">{{cite journal| author=Liston SL, Kleid MS| title=Histopathology of Bell's palsy. | journal=Laryngoscope | year= 1989 | volume= 99 | issue= 1 | pages= 23-6 | pmid=2642582 | doi=10.1288/00005537-198901000-00006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2642582  }} </ref>
-==References==
-{{Reflist|2}}
+* It appears that the [[histology]] of the [[facial nerve]] in Bell's palsy is similar to [[Herpes Zoster infection]], suggestive of an infectious cause.<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>         ==References==
+{{reflist|2}}
 {{WH}}
 {{WS}}
-[[Category: (name of the system)]]
-==Pathophysiology==
-=== Microscopic Pathology ===
-*The facial nerve has an edematous, thickened [[perineurium]] with infiltrates of inflammatory cells between nerve bundles and around [[blood vessel]]s.
-*It appears that the histology of the [[facial nerve]] in Bell's palsy is similar to [[Herpes Zoster infection]], suggestive of an infectious cause.
-=== Associated Conditions ===
-====Bell’s Palsy-induced Blepharospasm====
-Blepharospasm associated with Bell's palsy has been rarely reported. Instead of the classic presentation with the affected eye wide open, the affected eye is closed shut, with the patient unable to open it (Blepharospasm).
-*So far, seven patients previously reported: all women.
-*In five of the seven patients, blepharospasm appeared within a month after the onset of Bell’s palsy.
-=====Possible Mechanisms=====
-*The majority of patients with blepharospasm have a high incidence of local ocular symptoms prior to or at the onset of blepharospasm, such as blepharitis, conjunctivitis, dry eyes or photophobia.
-*Chronically disturbed sensory inputs to the central nervous system due to lagophthalmos and corneal irritation may contribute to the generation of blepharospasm.
-*In patients with Bell’s palsy, there is an enhanced blink reflex secondary to inputs from the paralyzed side compared which those of the non-paralyzed side.
-*Abnormal afferent input from the paralyzed side contributes to the abnormal sensitization of the blink reflex, thus facilitating the induction of abnormal facial motor outputs such as blepharospasm.
-*It is unclear why Bell’s palsy-induced blepharospasm is extremely rare.
-==References==
-{{reflist|2}}
+[[Category:(name of the system)]]
 [[Category:Neurological disorders]]
 [[Category:Otolaryngology]]
 [[Category:Neurology]]
 [[Category:Needs overview]]
-[[Category:Primary care]]
 [[Category:Disease]]
-{{WH}}
-{{WS}}