Bell palsy

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Bell palsy



Bell palsy


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High Yield Notes

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Bell palsy

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USMLE® Step 2 style questions USMLE

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A 45-year-old man comes to the office to evaluate right-sided facial heaviness for the past 10 hours. He also reports decreased tear production on the right side and the inability to tolerate loud sounds that started simultaneously. Medical history is remarkable for a right-sided parotid gland adenoma which was surgically resected one month ago. The patient has no hearing loss, ringing sensation in the ears, or difficulty walking. Vitals are within normal limits. Physical examination findings are shown in the image below.


Examination of the right auditory canal and auricle is noncontributory. Which of the following is the most likely cause of the findings seen in this patient?

External References

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Bell palsy

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Bell’s palsy, named after the surgeon Charles Bell who first described it, is when there’s weakness or paralysis of the muscles on one side of the face, caused by damage to the seventh cranial nerve, which is the facial nerve.

The underlying cause of cranial nerve damage is idiopathic which means it’s unknown, so when there’s facial nerve a paralysis from a known cause like a stroke, a tumor, or trauma, it’s not considered a Bell’s palsy.

George Clooney had this disorder for nine months when he was a teenager.

Broadly speaking, the nervous system has two parts: the central nervous system, which consists of the brain, brainstem, and spinal cord, and the peripheral nervous system, which consists of all of the nerves that fan out from the central nervous system.

Peripheral nerves that emerge from the brain and brainstem are called cranial nerves, and there are a total of 12 pairs of cranial nerves.

The seventh cranial nerve, the facial nerve, emerges from the brainstem, and then enters the temporal bone where it travels through a narrow, Z-shaped canal, called the facial canal.

The facial nerve exits the skull through a tiny hole called the stylomastoid foramen.

From there, the facial nerve branches off to different facial muscles that help with facial expression, like the ones you use while whistling to your favorite song.

Ultimately, control of each side of the face comes from a region of the brain called the motor cortex.

For example, let’s start with the lower half of the right side of the face. An upper motor neuron extends down from the left motor cortex, goes across the midline in the brainstem to the right side, and then meets with a right lower motor neuron which hitches a ride on the right facial nerve.


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  2. "Modern management of facial palsy: a review of current literature" British Journal of General Practice (2013)
  3. "The neurologist’s dilemma: A comprehensive clinical review of Bell’s palsy, with emphasis on current management trends" Medical Science Monitor (2014)
  4. "Bell Palsy and Herpes Simplex Virus: Identification of Viral DNA in Endoneurial Fluid and Muscle" Annals of Internal Medicine (1996)
  5. "Robbins Basic Pathology" Elsevier (2017)
  6. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  7. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  8. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)

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