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{{Bell's palsy}}
{{Bell's palsy}}


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==Overview==
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.


=== Microscopic Pathology ===  
==Pathophysiology==


:*The facial nerve has an edematous, thickened perineurium with infiltrates of inflammatory cells between nerve bundles and around blood vessels.
===Pathogenesis===
:*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 ===
*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>
**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>
**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>
**[[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>
*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>


====Bell’s Palsy-induced Blepharospasm====
==Genetics==
*There is no established association between [[Genetics|genetic]] factors and Bell's palsy.
*[[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>


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).
==Associated Conditions==
1.  [[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>
* [[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<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>


:*So far, seven patients previously reported: all women.  
==Microscopic Pathology==
:*In five of the seven patients, blepharospasm appeared within a month after the onset of Bell’s palsy.
*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>


'''Possible mechanisms'''
* 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==
 
:*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==
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{{reflist|2}}
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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 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

Genetics

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

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