Bell's palsy
52957
222549220
2008-06-29T23:00:52Z
Koavf
205121
/* Epidemiology */
{{Infobox_Disease
| Name = Bell's Palsy
| Image = Gray781.png
| Caption =
| DiseasesDB = 1303
| ICD10 = {{ICD10|G|51|0|g|50}}
| ICD9 = {{ICD9|351.0}}
| ICDO =
| OMIM =
| MedlinePlus = 000773
| eMedicineSubj = emerg
| eMedicineTopic = 56
| eMedicine_plus = {{eMedicine2|neuro|413}} {{eMedicine2|ent|719}} {{eMedicine2|oph|508}}
| MeshID = D020330
}}
'''Bell's [[palsy]]''' is a paralysis of the [[facial nerve]] resulting in inability to control facial muscles on the affected side. Several conditions can cause a facial paralysis, ''e.g.'', [[brain tumor]], [[stroke]], and [[Lyme disease]]. However, if no specific cause can be identified, the condition is known as Bell's Palsy. Named after Scottish anatomist [[Charles Bell]], who first described it, Bell's palsy is the most common acute [[mononeuropathy]] (disease involving only one [[nerve]]), and is the most common cause of [[acute facial nerve paralysis]].
Bell's palsy is defined as an [[idiopathic]] unilateral facial nerve paralysis, usually self-limiting. The trademark is rapid onset of partial or complete palsy, usually in a single day.
It is thought that an inflammatory condition leads to swelling of the facial nerve ([[nervus facialis]]). The nerve travels through the skull in a narrow bone canal beneath the ear. Nerve swelling and compression in the narrow bone canal are thought to lead to nerve inhibition, damage or death. No readily identifiable cause for Bell's palsy has been found, but clinical and experimental evidence suggests herpes simplex type 1 infection may play a role.
Doctors may prescribe anti-inflammatory and anti-viral drugs. Early treatment is necessary for the drug therapy to have effect. The effect of treatment is still controversial. Most people recover spontaneously and achieve near-normal functions. Many show signs of improvement as early as 10 days after the onset, even without treatment.
Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the [[cornea]] may be permanently damaged resulting in impaired vision.
[[Image:JeanChrétien.jpg|200px|right|thumb|Former Canadian Prime Minister [[Jean Chrétien]] acquired Bell's palsy in his youth.]]
==Investigation==
'''Bell's palsy''' (or '''facial [[palsy]]''') is characterized by facial drooping on the affected half, due to malfunction of the [[facial nerve]] (VII [[cranial nerve]]), which controls the [[muscle]]s of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type.
The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial ([[stapes]]) muscles of the middle [[ear]] and carry taste sensations from the anterior two thirds of the tongue.
Clinicians should determine whether the [[forehead]] muscles are spared. Due to an anatomical peculiarity, forehead muscles receive [[innervation]] from both sides of the [[Human brain|brain]]. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain ([[central facial palsy]]). If the problem resides in the facial nerve itself ([[peripheral neuropathy|peripheral palsy]]) all nerve signals are lost, including to the forehead.
One disease that may be difficult to exclude in the [[differential diagnosis]] is involvement of the facial nerve in infections with the [[herpes zoster]] virus. The major differences in this condition are the presence of small blisters, or ''vesicles'', of the external ear and hearing disturbances, but these findings may occasionally be lacking ([[herpes zoster#zoster sine herpete|zoster sine herpete]]).
[[Lyme disease]] may produce the typical palsy, and may be easily diagnosed by looking for Lyme-specific [[antibodies]] in the blood. In endemic areas Lyme disease may be the most common cause of facial palsy.
The degree of nerve damage can be assessed using the [[House-Brackman Score]].
==Diagnosis==
Bell's palsy is a [[diagnosis of exclusion]]; by elimination of other reasonable possibilities. Therefore, by definition, no specific cause can be ascertained. Bell's palsy is commonly referred to as [[idiopathic]] or [[cryptogenic]], meaning that it is due to unknown causes. Being a residual diagnostic category, the Bell's Palsy diagnosis likely spans different conditions which our current level of medical knowledge cannot distinguish. This may inject fundamental uncertainty into the discussion below of [[etiology]], treatment options, recovery patterns etc. See also the section below on Other symptoms.
Studies<ref>Morris et al. (2002) ''Annualized Incidence and Spectrum of Illness from an Outbreak Investigation of Bell"s Palsy Neuroepidemiology'' Issue Vol.21 Issue.5 Page no. 255-261</ref> show that a large number of patients (45%) are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. A significant number of cases are misdiagnosed (ibid.). This is unsurprising from a diagnosis of exclusion, which depends on a thorough investigation.
==Pathology==
It is thought that as a result of [[inflammation]] of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell's palsy per se. Possible causes include [[tumor]], [[meningitis]], [[stroke]], [[diabetes mellitus]], head [[Physical trauma|trauma]] and inflammatory diseases of the cranial nerves ([[sarcoidosis]], [[brucellosis]], etc.). In these conditions, the neurologic findings are rarely restricted to the facial nerve. Babies can be born with facial palsy, and they exhibit many of the same symptoms as people with Bell's palsy; this is often due to a traumatic birth which causes irreparable {{Fact|date=April 2008}} damage to the facial nerve, i.e. [[acute facial nerve paralysis]].
In some research<ref>Murakami S et al. (1996) ''Bell’s palsy and herpes simplex virus: Identification of viral DNA in endoneurial fluid and muscle''. Ann Intern Med 1996;124:27–30</ref> the [[herpes simplex virus]] type 1 (HSV-1) was identified in a majority of cases diagnosed as Bell's palsy. This has given hope for anti-inflammatory and anti-viral drug therapy (prednisone and acyclovir). Other research<ref>Furuta et a. (2001) ''Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy''. Auris Nasus Larynx 28 (2001) S13–S17</ref> however, identifies HSV-1 in only 31 cases (18 percent), [[herpes zoster]] (zoster sine herpete) in 45 cases (26 percent) in a total of 176 cases clinically diagnosed as Bell's Palsy. That infection with herpes simplex virus should play ''a major role'' in cases diagnosed as Bell's palsy therefore remains a hypothesis that requires further research.
The herpes simplex virus type 1 (HSV-1) infection is associated with [[demyelination]] of nerves. This nerve damage mechanism is ''different'' from the above mentioned - that oedema, swelling and compression of the nerve in the narrow bone canal is responsible for nerve damage. Demyelination may not even be directly caused by the virus, but by an unknown [[immune system]] response. The quote below captures this hypothesis and the implication for other types of treatment:
<blockquote>
It is also possible that HSV-1 replication itself is not responsible for the damage to the facial nerves and that inhibition of HSV-1 replication by acyclovir does not prevent the progression of nerve dysfunction. Because the demyelination of facial nerves caused by HSV-1 reactivation, via an unknown immune response, is implicated in the pathogenesis of HSV-1-induced facial palsy, a new strategy of treatment to inhibit such an immune reaction may be effective.<ref> Furuta et a. (2001) ''Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy''. Auris Nasus Larynx 28 (2001) S13–S17 (page S16)</ref>
</blockquote>
[[Image:bells.jpg|thumb|right|The "Bell's smile" is characterized by an asymmetry caused by paralysis of one side of the face.]]
==Virus reactivation==
Some viruses <!-- "viruses" is correct English, not vira (used as proper pl. Latin in other languages), cf wiki article [[Plural of virus]] --> are thought to establish a persistent (or latent) infection without symptoms, e.g. the [[Herpes zoster#Pathophysiology | Zoster]] virus of the face<ref>[http://www.medicinenet.com/facial_nerve_problems/page3.htm Facial Nerve Problems and Bell's Palsy Information on MedicineNet.com<!-- Bot generated title -->]</ref> and [[Epstein-Barr virus| Epstein-Barr]] viruses, both of the herpes family. Reactivation of an existing (dormant) viral infection has been suggested<ref> Furuta et a. (2001) ''Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy''. Auris Nasus Larynx 28 (2001) S13–S17</ref> as cause behind the acute Bell's palsy. Studies<ref> Kasse et al. (2003) ''Clinical data and prognosis in 1521 cases of Bell’s palsy''. International Congress Series (2003) Issue Vol.1240 Page no. 641-647 ISSN 05315131 (page 646)</ref> suggest that this new activation could be preceded by trauma, environmental factors, and metabolic or emotional disorders, thus suggesting that stress - emotional stress, environmental stress (e.g. cold), physical stress (e.g. trauma) - in short, a host of different conditions, may trigger reactivation.
==Other symptoms==
Although defined as a [[mononeuropathy| mononeuritis]] (involving only one nerve), patients diagnosed with Bell’s palsy may have "myriad neurological symptoms" including "facial tingling, moderate or severe headache/neck pain, memory problems, balance problems, ipsilateral limb paresthesias, ipsilateral limb weakness, and a sense of clumsiness" that are "unexplained by facial nerve dysfunction".<ref>Morris et al. (2002) ''Annualized Incidence and Spectrum of Illness from an Outbreak Investigation of Bell"s Palsy '' Neuroepidemiology (2002) Issue Vol.21 Issue.5 Page no. 255-261 ISSN 02515350</ref> This is yet an enigmatic facet of this condition.
== Alternative medicine ==
In [[traditional Chinese medicine]], Bell's palsy is attributed to exposure to wind - more specifically due to wind-cold attacking the Shaoyang ([[Liver (Chinese medicine)|liver]], [[gall bladder (Chinese medicine)|gall bladder]]) and Yangming ([[Stomach (Chinese medicine)|stomach]], [[large intestine (Chinese medicine)|large intestine]]) channels as well as the tendons and muscles. This is thought to result in an obstruction of [[Qi]] (vital energy) and blood in these areas that leads to malnourishment of the tendons and muscles and thus a propensity for the facial muscles to become lax or paralyzed<ref>Pao, Fay-Meling von Moltke. (July 2005). [http://www.acupuncture.com/newsletters/m_july05/main2.htm "Bell's Palsy"] (Online newsletter). ''Points'', July 2005, Vol. 3, No. 7, via accupuncture.com. Retrieved on [[2007]]-[[09-06]].</ref>
Formal studies of the effects of acupuncture on Bell's Palsy are inconclusive (see below, [[Bell's palsy#treatment|Treatment]]).
==Epidemiology==
The annual [[incidence]] of Bell palsy is about 20 per 100,000 population, and the incidence increases with age.<ref>Ahmed (2005) ''REVIEW - When is facial paralysis Bell palsy? Current diagnosis and treatment'' Cleveland Clinic Journal of Medicine. (2005) 72(5):398-405</ref> Bell’s palsy affects about 40,000 people in the United States every year. It affects approximately 1 person in 65 during a lifetime.{{Fact|date=December 2007}}<!-- ball park figure appears OK but computation is not straightforward, needs expansion --> Familial inheritance has been found in 4–14% of cases.<ref>Döner and Kutluhan (2000) ''Familial idiopathic facial palsy'' European Archives of Oto-Rhino-Laryngology (2000) 257(3):117-119</ref> Bell's Palsy is three times more likely to strike pregnant women than non-pregnant women.<ref>Bender, Paula Gillingham. [http://pregnancyandbaby.com/read/articles/5398.htm "Facing Bell's Palsy while pregnant."] (Commercial website). ''Sheknows: Pregnancy and Baby''. Retrieved on [[2007]]-[[09-06]].</ref> It is also considered to be four times more likely to occur in diabetics than the general population.<ref>[http://www.bellspalsy.ws/ "Bell's Palsy InfoSite & Forums: Facial Paralysis FAQs"] (Website). Bell's Palsy Information Site. Retrieved on [[2007]]-[[09-06]].</ref>
A range of annual incidence rates have been reported in the literature: 15,<ref>Döner and Kutluhan (2000) ''Familial idiopathic facial palsy'' European Archives of Oto-Rhino-Laryngology (2000) 257(3):117-119</ref> 24,<ref>Wolf (1998) ''Current approaches in the diagnosis and management of idiopathic facial paresis'' HNO (1998) 46(9):786-798</ref> and 25-53<ref>Morris et al. (2002) ''Annualized Incidence and Spectrum of Illness from an Outbreak Investigation of Bell"s Palsy Neuroepidemiology'' Issue Vol.21 Issue.5 Page no. 255-261</ref> (all rates per 100,000 population per year). Bell’s palsy is not a reportable disease, and there are no established registries for patients with this diagnosis, which complicates precise estimation.
==Treatment==
Treatment of Bell's palsy is a matter of controversy. Two [[Cochrane review]]s from 2004 underlined the need for larger, properly designed [[clinical trials]] to evaluate [[antiviral drugs]]<ref name="pmid15266457">{{cite journal |author=Allen D, Dunn L |title=Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis) |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001869 |year=2004 |pmid=15266457 |doi=10.1002/14651858.CD001869.pub2}}</ref> or [[corticosteroids]]<ref name="pmid15495021">{{cite journal |author=Salinas RA, Alvarez G, Ferreira J |title=Corticosteroids for Bell's palsy (idiopathic facial paralysis) |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD001942 |year=2004 |pmid=15495021 |doi=10.1002/14651858.CD001942.pub2}}</ref> for Bell's palsy. The effect of treatment is difficult to evaluate experimentally because spontaneous recovery (without any treatment) is common. In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. Patients presenting with complete [[paralysis]], marked by an inability to close the eyes and mouth on the involved side, are usually treated. Early treatment (within 3 days after the onset) seems to be necessary for therapy to be effective.<ref name="pmid14600480">{{cite journal |author=Hato N, Matsumoto S, Kisaki H, ''et al'' |title=Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone |journal=Otol. Neurotol. |volume=24 |issue=6 |pages=948–51 |year=2003 |month=November |pmid=14600480 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1531-7129&volume=24&issue=6&spage=948}}</ref>
[[Prednisolone]], a corticosteroid, if used early in treatment of Bell's palsy, significantly improves the chances of complete recovery at 3 and 9 months when compared to treatment with the anti-viral drug [[acyclovir]] or no treatment at all.<ref name="Sullivan-NEJM">{{cite journal |author=Sullivan FM, Swan IR, Donnan PT, ''et al'' |title=Early treatment with prednisolone or acyclovir in Bell's palsy |journal=N. Engl. J. Med. |volume=357 |issue=16 |pages=1598–607 |year=2007 |month=October |pmid=17942873 |doi=10.1056/NEJMoa072006 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17942873&promo=ONFLNS19}}</ref>
The possible link between Bell's palsy and the [[herpes simplex]] and [[varicella zoster virus]] has led to the prescription of anti-viral medications (such as [[acyclovir]] or [[valaciclovir]]) to patients with unexplained facial palsy. Recently (2007), a large randomized clinical trial reported no additional benefit from acyclovir beyond that from prednisolone alone.<ref name="Sullivan-NEJM"/>
The efficacy of [[acupuncture]] remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).<ref name="acupuncture">{{cite journal |author=He L, Zhou MK, Zhou D, ''et al'' |title=Acupuncture for Bell's palsy |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD002914 |year=2007 |pmid=17943775 |doi=10.1002/14651858.CD002914.pub3}}</ref> [[Surgical]] procedures to decompress the facial nerve have been attempted, but have not been proven beneficial.
A 2005 practice parameter from the American Academy of Neurology states that "corticosteroids are safe and probably effective, and that acyclovir is safe and possibly effective".<ref>Ahmed (2005) ''REVIEW - When is facial paralysis Bell palsy? Current diagnosis and treatment'' Cleveland Clinic Journal of Medicine. (2005) 72(5):398-405</ref>
Physiotherapy is also a vital part of Bell's palsy since it is a nerologic condition. Facial kabat techniques and criostimulation along with exercises based on facial mimicry have shown good results in clinical practice{{Fact|Date_May 2008|date=May 2008}}.
== Recovery ==
Even without any treatment, Bell's palsy tends to carry a good prognosis. In a 1982 study<ref>Peitersen E: ''The natural history of Bell’s palsy''. Am J Otol 1982;4:107–111 qouted in Roob et al. (1999) ''Peripheral Facial Palsy: Etiology, Diagnosis and Treatment''. Eur Neurol 1999;41:3–9 </ref>, when no treatment was available, of 1,011 patients, 85% showed first signs of recovery within 3 weeks after onset. For the other 15%, recovery occurred 3–6 months later. After a follow-up of at least 1 year or until restoration, complete recovery had occurred in more than two thirds (71%) of all patients. Recovery was judged moderate in 12% and poor in only 4% of patients. Another study<ref>Peitersen and Andersen (no year) ''Spontaneous course of 220 peripheral non-traumatic facial palsies''. Acta Otolaryng. Suppl 224:296-300 </ref> finds that incomplete palsies disappear entirely, nearly always in the course of one month. The patients who regain movement within the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop [[sequela]]e. A third study<ref>Kasse et al. (2003) ''Clinical data and prognosis in 1521 cases of Bell’s palsy''. International Congress Series (2003) Issue Vol.1240 Page no. 641-647 ISSN 05315131</ref> found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis.
==Complications==
Major complications of the condition are chronic loss of taste ([[ageusia]]), chronic facial [[spasm]] and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete [[paralysis]]. Where the eye does not close completely, the reflex is also affected; great care should be taken to protect the eye from injury.
Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections which branch out to their proper destinations. During regrowth, nerves are generally able to track the original path to the right destination - but some nerves may sidetrack leading to a condition known as [[synkinesis]]. For instance, regrowth of nerves controlling muscles attached to the eye may sidetrack and also regrow connections reaching the muscles of the mouth. In this way, movement of one also affects the other. For example, when the person closes the eye, the corner of the mouth lifts involuntarily.
In addition, around 6%{{Fact|date=December 2007}} of patients exhibit [[Tears#Diseases and disorders|crocodile tear syndrome]] on recovery, where they will shed tears while eating. This is thought to be due to faulty regeneration of the facial nerve, a branch of which controls the lacrimal and salivary glands.
==Famous persons with Bell's palsy==
Well-known persons affected by Bell's palsy include:
<!-- (hidden text) Check the discussion page "Probation list of Famous persons with Bell's palsy" before adding a notability here. Make sure to include a reference, or the entry is likely to be deleted -->
*
*[[Stevie Benton]], Bassist for Texas rock band, [[Drowning Pool]]<ref name="Blabbermouth">([[2007]]-[[12-06]].) [http://www.roadrunnerrecords.com/blabbermouth.net/news.aspx?mode=Article&newsitemID=86265 "DROWNING POOL Bassist Rushed To Hospital, Diagnosed With Bell's Palsy."] ''Blabbermouth.net''. Retrieved on [[2007]]-[[12-10]].</ref>
*[[Pierce Brosnan]], Irish actor and producer<ref name="sussman2006" />
*[[Jean Chrétien]], former prime minister of Canada<ref>([[2000]]-[[11-28]].) [http://news.bbc.co.uk/2/hi/americas/1042917.stm "Jean Chrétien: Veteran fighter."] ''BBC News'' website. Retrieved on [[2007]]-[[09-19]].</ref>
*[[George Clooney]], American actor, director, producer and screenwriter<ref>([[2006]]-[[02-16]].) [http://transcripts.cnn.com/TRANSCRIPTS/0602/16/lkl.01.html "CNN.com Transcripts: Larry King Live, Interview with George Clooney."] ''CNN.com''. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Alexis Denisof]], American actor.<ref name="Denisof">[http://www.imdb.com/name/nm0219206/bio "Biography for Alexis Denisof."] ''IMDB.com.'' Retrieved on [[2007]]-[[12-10]].</ref>
*[[Graeme Garden]], British comedy writer and performer, who has written about his experiences with the condition<ref>Puttick, Helen. ([[2004]]-[[07-20]].) [http://www.bellspalsy.org.uk/garden.htm "Pioneering research looks to solve mystery and ease misery for Bell's palsy sufferers"] ''The Herald'' (Glasgow), p. 4, via LexisNexis.com. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Tony Gonzalez (football player)|Tony Gonzalez]], American [[National Football League|NFL]] football player.<ref>Glazer, Jay. [http://msn.foxsports.com/nfl/story/7207460 "Gonzalez happy to be alive."]
''Fox Sports'' website. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Amy Goodman]], American journalist and author.<ref name="Goodman">Goodman, Amy. ([[2007]]-[[10-30]].) [http://www.truthdig.com/report/item/20071030_for_whom_the_bells_palsy_tolls/ "For Whom the Bell's Palsy Tolls."] ''Truthdig.net''. Retrieved on [[2007]]-[[12-10]].</ref>
* [[Jane Greer]], American Actress, had the condition at age 15, may have contributed to her reportedly "quizzical gaze" and "enigmatic expression"
*[[Katie Holmes]], American Actress and star of ''[[Dawson's Creek]]''.
*[[Ralph Kiner]], American baseball player in the 1940s and 1950s<ref>([[1998]]-[[04-01]].) [http://query.nytimes.com/gst/fullpage.html?res=9F03E1D61E3BF932A35757C0A96E958260 "Baseball: Kiner fighting Bell's palsy."] ''The New York Times'' Archives via nytimes.com. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Curtis LeMay]], was a general in the United States Air Force and the vice presidential running mate of independent candidate George C. Wallace in 1968<ref>(2007) Nemesis: The Battle for Japan 1944-45 by Max Hastings</ref>
*[[Gordon Lightfoot]], Canadian singer
*[[Joe Mantegna]]<ref>[http://www.nndb.com/lists/952/000124580/ NNDB:Risk Factor: Bell's Palsy]</ref>, American actor, "the charm of his face is heightened by just a trace of lopsidedness, the result of Bell's palsy".<ref>Byrne, Bridget. [http://archive.southcoasttoday.com/daily/08-01/08-23-01/c14ae132.htm Joe Mantegna returns as private eye, Spenser] Associated Press. 23 Aug. 2001.</ref>
*[[Ralph Nader]], American author, activist, politician<ref name="sussman2006" />
*[[Jim Ross]], [[professional wrestling]] announcer for the [[World Wrestling Entertainment|WWE]]<ref>Baines, Tim. ([[2005]]-[[10-16]].) [http://slam.canoe.ca/Slam/Wrestling/2005/10/16/1264874-sun.html "An intimate look at WWE diva Victoria."] (Website.) ''Slam Sports'' Retrieved on [[2007]]-[[09-19]].</ref>
*[[Rick Savage]], British musician and [[bassist]] for [[Def Leppard]]<ref name="sussman2006">Sussman, Paul. ([[2006]]-[[03-28]].) [http://findarticles.com/p/articles/mi_qn4158/is_20060328/ai_n16180541 "Health: Losing face."] ''The London Indepenent'', via findarticles.com. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Ayrton Senna]]. Brazilian Formula 1 racecar driver.{{Fact|date=May 2008}}
*[[Jamey Sheridan]], American actor. His condition was written into the show ''[[Law and Order: Criminal Intent]]'' and his character Captain [[James Deakins]] also had Bell's palsy.<ref>Owen, Rob. ([[2005]]-[[05-20]].) [http://www.post-gazette.com/pg/05140/507385.stm "TV Q&A with Rob Owen."] ''Pittsburgh Post-Gazette'' via ''post-gazettenow'' website. Retrieved on [[2007]]-[[09-19]].</ref>
*[[Joseph C. Wilson]], American diplomat.<ref name="Goodman"/>
*[[Frenchie Dy]], [[Filipina]] singer, winner of [[Star in a Million]] Season 2.<ref>[http://pinoy.rickey.org/?p=567]</ref>, <ref>[http://abs-cbn-kapamilya-aficionado.blogspot.com/2006/10/frenchie-dy-is-recovering-from-bells.html]</ref>
==References==
{{reflist|2}}
==External links==
*{{DMOZ|Health/Conditions_and_Diseases/Neurological_Disorders/Cranial_Nerve_Diseases/Bell's_Palsy/}}
{{PNS diseases of the nervous system}}
[[Category:Neurological disorders]]
[[Category:Otolaryngology]]
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