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FOR EARLY treatment of Bell's palsy I feel, after reviewing many articles on the subject, that we do not have a conception of the real cause of the condition. These articles shoot close and all around the bull's eye but fail to hit it. They go as far as ischemia but miss the why of the ischemia.
The facial nerve is unique in that it is enclosed from the geniculate ganglion to the stylomastoid foramen in a close-fitting tunnel. Therefore, any traumatism, such as exposure to heat or to cold, causes the nerve to swell. The swelling is not due to infection, as Bell's palsy from otitis media is rare and microscopically necrosis instead of inflammation is found. The swelling of the nerve in the closed tunnel squeezes out its own blood supply, thus resulting first in ischemia, then necrosis, and finally fibrosis.
Similar situations are present in the contused
BUNNELL S. SUMMATION OF PAPERS ON MANAGEMENT OF FACIAL PARALYSIS. AMA Arch Otolaryngol. 1952;55(4):417–419. doi:10.1001/archotol.1952.00710010429003
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