ICD-9-CM Diagnosis Code 351.0 : Bell's palsy.
What is right facial nerve disorder?
Right facial nerve disorder. Clinical Information. A disorder characterized by involvement of the facial nerve (seventh cranial nerve). A non-neoplastic or neoplastic disorder affecting the facial nerve (seventh cranial nerve). Diseases of the facial nerve or nuclei. Pontine disorders may affect the facial nuclei or nerve fascicle.
What causes facial nerves to be affected?
Diseases of the facial nerve or nuclei. Pontine disorders may affect the facial nuclei or nerve fascicle. The nerve may be involved intracranially, along its course through the petrous portion of the temporal bone, or along its extracranial course.
What is unilateral facial paralysis?
A syndrome characterized by the acute onset of unilateral facial paralysis which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis.
How long does it take for Bell's Palsy to show symptoms?
Symptoms are usually worst about 48 hours after they start. Scientists think that a viral infection makes the facial nerve swell or become inflamed. You are most likely to get bell's palsy if you are pregnant, diabetic or sick with a cold or flu.three in four patients improve without treatment.
Overview
- Bell's palsy causes sudden, temporary weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.Bell's palsy, also known as facial palsy, can occur at any age. The exact cause is unknown. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side …
Diagnosis
- Central nervous system lesions (e.g., multiple sclerosis, stroke, tumor) can also cause facial nerve palsy. However, some motor neurons to the forehead cross sides at the level of the brainstem, so the fibers in the facial nerve going to the forehead come from both cerebral hemispheres (Figure 2). Supranuclear (central) lesions affecting the facial nerve will not paralyze the forehead on the …
- All episodes of facial weakness or paralysis should be immediately examined by a doctor to rule out the possibility of a stroke. If you have had a previous episode of Bell's palsy and have another similar episode, you should again be examined to rule out other more serious causes of the facial weakness. Other causes of facial weakness can include these conditions: Often no tests are nee…
- There isn't a specific test for Bell's palsy. To make sure the paralysis is Bell's palsy and not another condition, your doctor will ask how long it took for the symptoms to develop and where the weakness or paralysis is.People who have strokes usually have weakness only in the lower half of their face and may have it in their arms and legs as well. The problems caused by tumor…
- Bell's palsy is diagnosed based on its symptoms and physical signs. There are a huge number of conditions, including head injury, that can cause facial paralysis, but few have the same pattern as Bell's palsy. Additional tests such as CAT scans or MRI scans are usually not necessary.Bell's palsy must be differentiated from Lyme disease, Guillain-Barré syndrome, sarcoidosis, parotid tu…
Causes
- Although the exact reason Bell's palsy occurs isn't clear, it's often related to exposure to a viral infection. Viruses that have been linked to Bell's palsy include the virus that causes: 1. Cold sores and genital herpes (herpes simplex) 2. Chickenpox and shingles (herpes zoster) 3. Infectious mononucleosis (Epstein-Barr) 4. Cytomegalovirus infections 5. Respiratory illnesses (adenovirus…
- Many conditions can produce isolated facial nerve palsy identical to Bell's palsy. Structural lesions in the ear or parotid gland (e.g., cholesteatoma, salivary tumors) can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome (an outbreak of herpes zoster in …
- There is a strong correlation with the herpes simplex virus, the same virus that causes cold sores or fever blisters on the lip. There has also been an association found with shingles and its associated blistering (from the herpes zoster virus). Bell's palsy has been associated with Lyme disease where it is common. The facial muscle is the most commonly paralyzed nerve of the bo…
- Babies drool because they dont yet have the fine motor control to prevent it. Sometimes even healthy adults can drool a little while they are sleeping. However, drooling in an adult who is awake and aware is not normal. In fact, its a sign of neurological damage.
Signs And Symptoms
- Signs and symptoms of Bell's palsy come on suddenly and may include: 1. Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days 2. Facial droop and difficulty making facial expressions, such as closing your eye or smiling 3. Drooling 4. Pain around the jaw or in or behind your ear on the affected side 5. Increased sensitivity to soun…
- Patients with Lyme disease often have a history of tick exposure, rash, or arthralgias. Facial nerve palsies from acute and chronic otitis media have a more gradual onset, with accompanying ear pain and fever. Patients with Ramsay Hunt syndrome have a pronounced prodrome of pain and often develop a vesicular eruption in the ear canal and pharynx, although cases without the vesic…
- If you have any difficulty with speech (slurred speech or change in speed of your conversation), arm or leg weakness, numbness, tingling, or difficulty with balance or walking, call 911 or go to a hospital's emergency department.
- 1. Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days 2. Facial droop and difficulty making facial expressions, such as closing your eye or smiling 3. Drooling 4. Pain around the jaw or in or behind your ear on the affected side 5. Increased sensitivity to sound on the affected side 6. Headache 7. A decrease in your ability to t…
Treatment
- In the past, surgical decompression within three weeks of onset has been recommended for patients who have persistent loss of function (greater than 90 percent loss on electroneurography) at two weeks. However, the most widely cited study supporting this approach only reported results for a total of 34 treated patients at three different sites, included a nonrand…
- Steroids, such as prednisone (Deltasone), can reduce the duration of symptoms by decreasing the inflammation of the nerve. Doctors will often add an antiviral agent, such as acyclovir (Zovirax) or valacyclovir (Valtrex), because of a strong correlation between herpes simplex virus and Bell's palsy. If Lyme disease is possible in certain areas of the country, an antibiotic may be added, su…
- Because persons with true Bell palsy generally have an excellent prognosis, and because spontaneous recovery is fairly common, treatment of Bell palsy is still controversial. The goals of treatment are to improve facial nerve (seventh cranial nerve) function and reduce neuronal damage. Many issues must be addressed in treating patients with Bell palsy. The most importan…
- Consult an optometrist or an ophthalmologist during an episode of Bell's palsy, as exposure keratitis can create significant problems that require treatment. If the episode lasts longer than 4-5 weeks, your doctor may suggest applying a weight to your eyelid. An eyelid weight works with gravity to assist your eyelid with blinking to prevent drying. Although doctors are not all in agree…
Risks
- Bell's palsy occurs more often in people who: 1. Are pregnant, especially during the third trimester, or who are in the first week after giving birth 2. Have an upper respiratory infection, such as the flu or a cold 3. Have diabetesRecurrent attacks of Bell's palsy are rare. But in some of these cases, there's a family history of recurrent attacks — suggesting a possible genetic predisposition to Be…
- The most common complication of surgery is postoperative hearing loss, which affects 3 to 15 percent of patients. Based on the significant potential for harms and the paucity of data supporting benefit, the American Academy of Neurology does not currently recommend surgical decompression for Bell's palsy.19...
Complications
- A mild case of Bell's palsy normally disappears within a month. Recovery from a more severe case involving total paralysis varies. Complications may include: 1. Irreversible damage to your facial nerve 2. Abnormal regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you're trying to move others (synkinesis) — for example, when you smile, the eye on the aff…
- Bell's palsy usually appears suddenly, often overnight. The primary symptom is weakness and paralysis on one side of the face. You may find that you can't make the same expressions as usual. Typically, you'll be unable to fully close one eye. Other possible symptoms include: 1. altered sense of taste 2. facial pain, pain in or behind the ear (in fewer than 50% of cases) 3. no t…
- There are risks associated with carpal tunnel surgery, like any other surgery. Aside from general surgery risks, such as anesthesia risks, there is a slight risk of nerve damage or infection. Nerve damage can cause paralysis of the hand. If the tendon is injured, it could result in weakness of the hand. Hand strength may not return to normal. Surgery may not be beneficial if another medical …
Prevention
- Influenza vaccines in the past have been associated with peripheral neuropathies. Although influenza vaccines currently available in the United States have not been associated with Bell's palsy,911 a recently developed Swiss intranasal vaccine was found to have a very high risk of postvaccine facial nerve palsy and has been withdrawn from use.12 Because influenza vaccine…
- If you think that you are experiencing symptoms of Bell's palsy, you should see a doctor as soon as possible. If you do experience a case of Bell's palsy, the following tips may help protect your eyes:
Clinical Presentation
- Loss of control of the muscles on one side of the face is the main physical presentation.Some patients also report general malaise in the first few days on onset, as well as some pain in the region of the ipsilateral mastoid (known as otalgia), but many of patients have no otalgia or malaise. At onset the paralysis may be complete, or partial (paresis) and although it frequently a…
- Most often, at symptom onset, patients believe that they have suffered a stroke or have an intracranial tumor.11 Individuals present with abrupt unilateral weakness or complete paralysis resulting in drooping of the eyebrow and the corner of the mouth.2,3 Patients commonly complain of facial numbness or eye irritation.2 A condition referred to as Bell’s phenomenon occurs when …
Prognosis
Bell's palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three w…
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