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Clinical Challenges in Otolaryngology
July 1998

Bell Palsy: A Herpes Simplex Mononeuritis?

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Otolaryngol Head Neck Surg. 1998;124(7):823-824. doi:10.1001/archotol.124.7.823

An increasing amount of evidence associates the herpes simplex virus with what we have come to recognize clinically as Bell palsy. In time, Bell palsy may well be reclassified as a herpes simplex mononeuritis of the facial nerve. The designation of a causative agent to this most common form of facial paralysis, however, does not rule out the possibility that other origins may exist or negate the role that entrapment plays in the degeneration of the nerve. A popular hypothesis circulating among otologists is that the herpes simplex virus, dormant in the geniculate ganglion cells, reactivates and replicates, thereby inciting inflammation primarily in the geniculate ganglion and the labyrinthine segment of the facial nerve. These inflammatory events (evident on magnetic resonant imaging) result in entrapment and ischemia, which, in turn, lead to neurapraxia or degeneration of the facial nerve distal to the meatal foramen.