Bell’s Palsy: Synopsis by an Otologist

Abstract

Prior to 1931, patients with Bell’s palsy were most often evaluated and treated in the Departments of Neurology and Physical Medicine. Treatments were empiric and usually reserved for those with delayed recovery. In 1931, Arthur Duel, based on collaborative work with Sir Charles Ballance, performed the first facial nerve decompression for Bell’s palsy [2]. The operation suggested by Ney in 1922 [24] and Martin in 1931 [16] was based on the assumption that entrapment of the facial nerve in the temporal bone caused the paralysis. The primary ischemic theory of pathogenesis postulated dysfunction of the autonomic nervous system, producing arteriolar spasm and thrombosis in the vessels supplying the nerve within the rigid bony fallopian canal. Later a secondary ischemic hypothesis suggested a primary inflammatory, viral, or immunologic edema causing disturbances of the microcirculation, leading to loss of nerve conductivity. Both concepts suggest that these processes lead to anoxia, followed by compensatory dilation of the vessels and transudation, further increasing the vascular compression effect.