Imaging in Acute Facial Nerve Paralysis

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Bell's palsy is an acute type of facial nerve (cranial nerve VII) paralysis, but not all facial nerve palsies are of the Bell's palsy type.1 Most cases of Bell's palsy, which accounts for nearly 75% of cases of acute facial nerve paralysis, are thought to be virally induced or mediated.2 Strict criteria must be followed to make the correct clinical diagnosis of Bell's palsy. Imaging is not needed for diagnosis in most patients, unless the facial nerve paralysis has atypical features such as slow onset, bilaterality, significant facial pain, or recurrence. The clinical onset of Bell's palsy is acute, distinguishing it from other acute facial paralyses in which the progression of symptoms is slower. The facial nerve may be affected anywhere along its course; therefore, cerebral lesions as well as lesions involving the base of the skull may be responsible for the clinical findings of facial nerve paralysis.3 Tumors or infections in the temporal bone, including the middle ear cavity, are well known to produce acute facial paralysis. Occasionally, lesions in the parotid gland or in the vicinity of the upper mandible also may lead to acute facial nerve paralysis.

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