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Pathology of Bell's Palsy

Pathology of Bell's Palsy Abstract Segmental herniation of the facial nerve after epineural incision is regarded as proof that idiopathic Bell's palsy is due to elevated pressure caused by anoxia secondary to local vasospasm. However, epineural biopsies—taken at decompressions—have failed to reveal edema or other lesions. The nerve itself was observed to bulge through its entire intratympanic course. Idiopathic Bell's palsy often shows epidemiologic features and sometimes follows viral infections. Diabetes, especially latent diabetes, and arteriosclerosis are often associated with Bell's palsy—and could account for hemorrhages reported at the geniculate ganglion region. Bell's palsy is probably not one pathological entity—among its plausible causes are viral infections and vascular assaults both above the tympanic part of the facial nerve. The classical entrapment theory still awaits confirmation especially as myelin bulging is a normal phenomenon which becomes more pronounced in reaction to various injuries which are not necessarily local intratympanic ones. References 1. Jongkees LBW: On the histology of Bell's palsy . Acta Otolaryng 44:336-343, 1954.Crossref 2. Miller H: Facial paralysis . Brit Med J 3:815-819, 1967.Crossref 3. Guldberg-Moller JS, Olsen S, Kettel K: Histopathology of the facial nerve in herpes zoster oticus . Arch Otolaryng 69:266-275, 1959.Crossref 4. Denny-Brown D, Adams RD, Fitzgerald PJ: Pathologic features of herpes zoster . Arch Neurol Psychiat 51:216-231, 1944.Crossref 5. Leibowitz U: Epidemic incidence of Bell's palsy . Brain 92:109-114, 1969.Crossref 6. Denny-Brown D, Brenner C: Lesion in peripheral nerve resulting from compression by spring clip . Arch Neurol Psychiat 52:1-19, 1944.Crossref 7. Jain SN, Sharma AP: Role of compression in the aetiology of Bell's palsy . J Laryng 78:266-272, 1964.Crossref 8. Raff MC, Asbury AK: Ischemic mononeuropathy and mononeuropathy multiplex in diabetes melitus . New Eng J Med 279:17-22, 1968.Crossref 9. Currie S: Familial occulomotor palsy with Bell's palsy . Brain 93:193-198, 1970.Crossref 10. Sohar E, Ravid M, Benshaul Y, et al: Diabetic fibrillosis . Amer J Med 49:64-69, 1970.Crossref 11. Lovshin LL, Kernohan JW: Peripheral neuritis in periarteritis nodosa . Arch Intern Med 82:321-338, 1948.Crossref 12. Kettel K: Peripheral Facial Palsy, Pathology and Surgery . Copenhagen, Munksgaard, 1959. 13. Miehlke A: Die Chirurgie des Nervus Facialis . Munich, Urban & Schwarzenberg, 1960. 14. Cawthorne T: The pathology and surgical treatment of Bell's palsy . Proc Roy Soc Med 44:565-572, 1951. 15. Sadé J, Levy E, Chaco J: Surgery and pathology of Bell's palsy . Arch Otolaryng 82:594-602, 1965.Crossref 16. Sunderland S: The effect of rupture of the perinurium on the contained nerve fibers . Brain 69:149-152, 1946.Crossref 17. Collier J: Symposium on facial paralysis . Proc Roy Soc Med 44:564-572, 1951. 18. Johnson AC, McNabb AR, Rossiter BD: Chemistry of wallerian degeneration . Arch Neurol Psychiat 64:105-121, 1950.Crossref 19. Cawthorne T: Peripheral facial paralysis: Some aspects of its pathology . Laryngoscope 56:653-664, 1946.Crossref 20. Fowler EP: The pathologic findings in a case of facial paralysis . Trans Amer Acad Ophthal Otolaryng 67:187-197, 1963. 21. Monier-Vinard MM, Puech P: Néphrite chronique et paralysie faciale . Bull Mem Hop Paris 20:977-980, 1930. 22. Moxon A: Apoplexy into canal of fallopius in a case of Bright's disease, causing facial paralysis . Trans Path Soc Lond 20:420-421, 1869. 23. André-Thomas: Contribution a l'étude de l'anatomie pathologique de la paralysie faciale périphérique et de l'hemispasm facial . Rev Neurol 15:1273-1277, 1907. 24. Mirralie M: Paralysie faciale périphérique: Autopsie . Rev Neurol 14:702-703, 1906. 25. Alexander G: Zur Klinik und Pathologischen Anatomie der Sog "rheumatischen" Facialislahmung . Arch Psychiat 35:778-786, 1901-1902.Crossref 26. Dejerine J, Theohari A: Un cas de paralysie faciale périphérique die rhumatismale ou "a grigore," suivi d'autopsie . C R Soc Biol 4:1033-1035, 1897. 27. Minkowski: Zur Pathologischen Anatomie der Rheumatischen Facialislähmung . Arch Psychiat 23:586, 1891. 28. Mills CK: The sensory functions attributed to the seventh nerve . J Nerv Ment Dis 37:272-284, 1910.Crossref 29. Kumagami H, Sato I: Histopathology of Bell's palsy . Pract Otologica 61:20, 1968. 30. Sunderland S, Lossar DF: The structure of the facial nerve . Anat Rec 116:147-164, 1953.Crossref 31. Leibowitz U: Bell's palsy, two disease entities Neurology 16:197-1105, 1966.Crossref 32. Kurzin A: In "diabetic complications." Harefua 77:427-431, 1970. 33. Merwarth HR: The occurrence of peripheral facial paralysis in hypertensive vascular disease . Ann Intern Med 17:298-307, 1942.Crossref 34. Mallett BL, Zilkha KJ: Compression of the ulnar nerve at the wrist by a ganglion . Lancet 1:890-891, 1955.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

Pathology of Bell's Palsy

Archives of Otolaryngology , Volume 95 (5) – May 1, 1972

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American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1972.00770080642003
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Abstract

Abstract Segmental herniation of the facial nerve after epineural incision is regarded as proof that idiopathic Bell's palsy is due to elevated pressure caused by anoxia secondary to local vasospasm. However, epineural biopsies—taken at decompressions—have failed to reveal edema or other lesions. The nerve itself was observed to bulge through its entire intratympanic course. Idiopathic Bell's palsy often shows epidemiologic features and sometimes follows viral infections. Diabetes, especially latent diabetes, and arteriosclerosis are often associated with Bell's palsy—and could account for hemorrhages reported at the geniculate ganglion region. Bell's palsy is probably not one pathological entity—among its plausible causes are viral infections and vascular assaults both above the tympanic part of the facial nerve. The classical entrapment theory still awaits confirmation especially as myelin bulging is a normal phenomenon which becomes more pronounced in reaction to various injuries which are not necessarily local intratympanic ones. References 1. Jongkees LBW: On the histology of Bell's palsy . Acta Otolaryng 44:336-343, 1954.Crossref 2. Miller H: Facial paralysis . Brit Med J 3:815-819, 1967.Crossref 3. Guldberg-Moller JS, Olsen S, Kettel K: Histopathology of the facial nerve in herpes zoster oticus . Arch Otolaryng 69:266-275, 1959.Crossref 4. Denny-Brown D, Adams RD, Fitzgerald PJ: Pathologic features of herpes zoster . Arch Neurol Psychiat 51:216-231, 1944.Crossref 5. Leibowitz U: Epidemic incidence of Bell's palsy . Brain 92:109-114, 1969.Crossref 6. Denny-Brown D, Brenner C: Lesion in peripheral nerve resulting from compression by spring clip . Arch Neurol Psychiat 52:1-19, 1944.Crossref 7. Jain SN, Sharma AP: Role of compression in the aetiology of Bell's palsy . J Laryng 78:266-272, 1964.Crossref 8. Raff MC, Asbury AK: Ischemic mononeuropathy and mononeuropathy multiplex in diabetes melitus . New Eng J Med 279:17-22, 1968.Crossref 9. Currie S: Familial occulomotor palsy with Bell's palsy . Brain 93:193-198, 1970.Crossref 10. Sohar E, Ravid M, Benshaul Y, et al: Diabetic fibrillosis . Amer J Med 49:64-69, 1970.Crossref 11. Lovshin LL, Kernohan JW: Peripheral neuritis in periarteritis nodosa . Arch Intern Med 82:321-338, 1948.Crossref 12. Kettel K: Peripheral Facial Palsy, Pathology and Surgery . Copenhagen, Munksgaard, 1959. 13. Miehlke A: Die Chirurgie des Nervus Facialis . Munich, Urban & Schwarzenberg, 1960. 14. Cawthorne T: The pathology and surgical treatment of Bell's palsy . Proc Roy Soc Med 44:565-572, 1951. 15. Sadé J, Levy E, Chaco J: Surgery and pathology of Bell's palsy . Arch Otolaryng 82:594-602, 1965.Crossref 16. Sunderland S: The effect of rupture of the perinurium on the contained nerve fibers . Brain 69:149-152, 1946.Crossref 17. Collier J: Symposium on facial paralysis . Proc Roy Soc Med 44:564-572, 1951. 18. Johnson AC, McNabb AR, Rossiter BD: Chemistry of wallerian degeneration . Arch Neurol Psychiat 64:105-121, 1950.Crossref 19. Cawthorne T: Peripheral facial paralysis: Some aspects of its pathology . Laryngoscope 56:653-664, 1946.Crossref 20. Fowler EP: The pathologic findings in a case of facial paralysis . Trans Amer Acad Ophthal Otolaryng 67:187-197, 1963. 21. Monier-Vinard MM, Puech P: Néphrite chronique et paralysie faciale . Bull Mem Hop Paris 20:977-980, 1930. 22. Moxon A: Apoplexy into canal of fallopius in a case of Bright's disease, causing facial paralysis . Trans Path Soc Lond 20:420-421, 1869. 23. André-Thomas: Contribution a l'étude de l'anatomie pathologique de la paralysie faciale périphérique et de l'hemispasm facial . Rev Neurol 15:1273-1277, 1907. 24. Mirralie M: Paralysie faciale périphérique: Autopsie . Rev Neurol 14:702-703, 1906. 25. Alexander G: Zur Klinik und Pathologischen Anatomie der Sog "rheumatischen" Facialislahmung . Arch Psychiat 35:778-786, 1901-1902.Crossref 26. Dejerine J, Theohari A: Un cas de paralysie faciale périphérique die rhumatismale ou "a grigore," suivi d'autopsie . C R Soc Biol 4:1033-1035, 1897. 27. Minkowski: Zur Pathologischen Anatomie der Rheumatischen Facialislähmung . Arch Psychiat 23:586, 1891. 28. Mills CK: The sensory functions attributed to the seventh nerve . J Nerv Ment Dis 37:272-284, 1910.Crossref 29. Kumagami H, Sato I: Histopathology of Bell's palsy . Pract Otologica 61:20, 1968. 30. Sunderland S, Lossar DF: The structure of the facial nerve . Anat Rec 116:147-164, 1953.Crossref 31. Leibowitz U: Bell's palsy, two disease entities Neurology 16:197-1105, 1966.Crossref 32. Kurzin A: In "diabetic complications." Harefua 77:427-431, 1970. 33. Merwarth HR: The occurrence of peripheral facial paralysis in hypertensive vascular disease . Ann Intern Med 17:298-307, 1942.Crossref 34. Mallett BL, Zilkha KJ: Compression of the ulnar nerve at the wrist by a ganglion . Lancet 1:890-891, 1955.Crossref

Journal

Archives of OtolaryngologyAmerican Medical Association

Published: May 1, 1972

References