A male client with Bell’s Palsy asks the nurse what has caused this problem. The nurse’s response is based on an understanding that the cause is:
A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem.
B. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia.
C. Primary genetic in origin, triggered by exposure to meningitis.
D. Primarily genetic in origin, triggered by exposure to neurotoxins.
Correct Answer: A. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem
Bell’s palsy is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown but may include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of these factors. BP is thought to result from compression of the seventh cranial nerve at the geniculate ganglion. The first portion of the facial canal, the labyrinthine segment, is the narrowest and it is here that most cases of compression occur. Due to the narrow opening of the facial canal, inflammation causes compression and ischemia of the nerve.
Option B: BP is by definition idiopathic in nature. Increasing evidence in the literature demonstrates multiple potential clinical conditions and pathologies known to manifest, at least in part, with a period of unilateral facial paralysis. The literature has highlighted several viral illnesses such as herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus.
Option C: Providers may ambiguously (and incorrectly) refer to a diagnosis of BP in the setting of a potentially known etiologic mechanism. This can occur, for example, in the setting of known associations (e.g. Ramsay-Hunt syndrome and Lyme disease).
Option D: While there are many potential causes, including idiopathic, traumatic, neoplastic, congenital, and autoimmune, about 70% of facial nerve palsies wind up with a diagnosis of BP.
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