Bell's Palsy Research Articles

Facial expression detection using posterior-auricular muscle surface-electromyographic activity

IntroductionFollowing Bell's palsy, 25% of sufferers are left with chronic, difficult to treat involuntary muscle movements (synkinesis). Surface-electromyography (sEMG) biofeedback has an established role in improving muscular coordination. The vestigial posterior auricular muscle (PAM) is the first muscle re-innervated by the facial nerve. This study measured the sEMG signal from PAM in facial animation in healthy subjects and explored the possibility of using PAM in a wearable rehabilitative device. Material and methodsPAMs activity was recorded using sEMG in 41 healthy volunteers during the performance of a set range of facial expressions. To compare results between participants and expressions, the percentage increase from baseline were used. ResultsPAMs activity increased significantly from baseline in response to smiling (110.98%) compared with other facial expressions: closing eyes (7.85%); blowing out cheeks (39.35%); whistling (11.84%), and showing lower teeth (38.24%). PAMs activity increased in proportion to smile intensity: lips together smile (55.18%); open smile (111.98%); full denture smile (130.07%); and, laughing (269.42%). ConclusionThis study demonstrates that measurement of smile intensity is possible via the sEMG signal from the PAM. Further studies investigating the applicability of measuring PAM activity during smiling to enhance and guide facial palsy rehabilitation are ongoing.

Clinical course, complications, immunization status and outcome of mumps in children

Background: Mumps is a self-limiting viral disease in children which usually resolve within 10 days. It is characterized by fever, constitutional symptoms and swelling of the parotid gland(s) and may lead to serious complications. The most common complication is orchitis, followed by meningitis. Less common complications include pancreatitis, encephalitis, deafness, mastitis, oophoritis, and facial Bell palsy. Methods: This is a hospital-based Prospective observational study where children age ≤18 years who presented with mumps were studied for immunization status, clinical course, complications and outcome. Results: Fever was the most common presentation followed by parotid involvement. The mean duration of illness was 9±2 days. Constitutional symptoms like headache, myalgia or fatigue were seen in 90 patients (60%). The most common complication seen was orchitis and tonsilitis, 4 cases (2.7%) each followed by pancreatitis (2%), febrile seizures (2%) and meningitis (2%). The least common was myocarditis (0.7%). Only 10 (6.7%) of the patients were hospitalized and none died. All the patients were cured within 2 weeks and without any sequels. The average loss of school days (school absentee) were 8 days. These complications were seen only in non- immunized patients. Conclusions: The benefits of vaccination against mumps in addition to rubella and measles would be a logical public health intervention that would have a significant clinical and economic benefits and to prevent complications of mumps.

Assessment of Nerve Conduction in Patients With Lower Motor Neuron Facial Paralysis.

Introduction Bell's palsy (BP), a lower motor neuron facial paralysis, commonly causes dysfunction of muscles of facial expression. Nerve conduction electrodiagnostic studies differentiate early-stage minor conduction blocks from later-stage Wallerian degeneration. Nerve conduction studies (NCSs) assess facial nerve function by delivering supramaximal electrical stimulus at the stylomastoid foramen. The amplitude loss percentage of the affected side is calculated with reference to the normal side. Aim The study's aim was to characterize the ncs in BP cases and to evaluate the correlation between the Compound Muscle Action Potential (CMAP) of the muscles affected. Materials and methods One hundred and four NCS data of BP cases were retrospectively collected over the period of two years. Statistical analyses of variables were done using the Chi-square test, one-way ANOVA, and Pearson correlation coefficient. Result The greater amplitude loss was seen in the orbicularis oris muscle innervated by buccal and mandibular branches of the facial nerve. The bivariate correlation between the Right Nasalis versus Right Orbicularis Oculi and Left Orbicularis Oculi versus Left Nasalis showed a highly significant moderately Strong Positive Correlation with an R-value of 0.687 and 0.558, respectively. The amplitude drop percentage was statistically significant in the affected left and right sides with P values of 0.008 and 0.007 respectively (P value < 0.05). The amplitude drop between the nasalis, orbicularis oculi and orbicularis oris muscles of both sides was statistically significant with a P value of 0.001. Conclusion NCS should be mandatorily included as an assessment protocol in BP cases for quantification of nerve degeneration and as a prognostic tool during the course of treatment.

Risk and characteristics of Bell's palsy in adults as an adverse event following COVID-19 vaccination: a retrospective study.

Although an association between COVID-19 vaccination and Bell's palsy (BP) has been reported, a clear causal relationship has not been elucidated. We investigated the risk and clinical characteristics of BP after COVID-19 vaccination. This retrospective chart review evaluated the association between COVID-19 vaccination and BP by comparing the number of patients diagnosed with BP during the pre-COVID-19 vaccination period (March 2018-February 2021) and the COVID-19 mass vaccination period (March 2021-February 2022). We then compared vaccine-related (time between vaccination and BP onset < 42days) and -unrelated (time interval ≥ 42days or non-vaccination) clinical characteristics in newly diagnosed patients with BP. BP occurred more during the COVID-19 vaccination period than in the previous three pre-vaccination years. Thirteen patients developed BP within 42days of vaccination. All patients, except one, developed BP after mRNA-based vaccination, with most cases (9/13, 69.2%) occurring after the second or third dose. Thirteen patients with vaccine-related BP were younger (age 43.92 ± 13.14 vs. 54.32 ± 16.01years; p = 0.033) and more frequently experienced taste changes (58.8% vs. 10.9%; p = 0.002) than 52 patients with vaccine-unrelated BP. Patients with vaccine-related BP had a greater likelihood of good and faster (p = 0.042) facial nerve function recovery than those with vaccine-unrelated BP (100% vs. 78%). COVID-19 vaccines, especially mRNA-based vaccines, may be associated with BP cases with distinctive clinical characteristics, which occur more frequently in young individuals, are frequently accompanied by taste changes, and have fast and good recovery.

Carotid body tumors: A retrospective case series of 11 patients.

Carotid body tumors (CBTs) are uncommon neuroendocrine tumors located near the carotid bifurcation within the carotid body. CBTs are slow-growing; affected individuals may remain asymptomatic for years and are often diagnosed incidentally following imaging studies. When present, symptoms are nonspecific. Because incidence is low, retrospective review of CBT case series is an ideal study design for investigating common symptomology, identifying successful diagnostic tools, and evaluating treatment outcomes. This article describes a case series of 11 patients treated for CBTs at an academic medical center in the Southeastern US. A retrospective chart review of 11 patients who had been discharged from the hospital following treatment for CBTs between 2017 and 2021 was conducted. Descriptive statistics were used to delineate the case series. There were four males (36%) and seven females (64%) included in the retrospective case series. The age range was 34 to 79 with a mean of 56.73 (standard deviation 16.038). Three patients were found to have a neck mass on physical exam. Additional symptoms included vocal cord paralysis, facial paralysis, ischemic stroke, Bell palsy, dysphonia, and dizziness. Two patients had familial CBTs. Ten patients underwent surgical excision. This case series showed that patients with CBTs should be assessed with a combination of history and physical exams along with imaging studies to confirm the diagnosis. Because CBTs may become malignant and metastasize, it is important for NPs to be knowledgeable about presenting symptoms and appropriate diagnostic studies to be able to refer patients to vascular surgeons early to prevent complications.

Analysis of Ear Nose Throat Consultations Requested From the Pediatric Emergency Service in a Tertiary Hospital.

The aim of this study is to examine the reasons and the methods of approach to the patients for the ear nose and throat (ENT) consultations requested from the patients who applied to the pediatric emergency department. The files of 351 patients who applied to the pediatric emergency outpatient clinic and were asked for consultation from the ENT clinic were reviewed retrospectively. Demographic data, complaints on admission, diagnostic examinations, diagnoses, treatment methods, and hospitalizations were recorded. Of the patients included in the study, 190 (54.1%) were female and 161 (45.9%) were male. The median age of the patients was 4.0 years (3.0-8.0 years). The most common diagnoses after ENT examination are; 120 patients (34.2%) had foreign body (FB) in the nose, 58 patients (16.5%) had FB in the ear, 16 patients (4.6%) had FB in the throat, 16 patients (4.6%) had epistaxis, and 15 patients (4.3%) had Bell's palsy. According to age group, it was determined that FB in the nose and ear was more common in the 0- to 5- and 6- to 11-year age group, and Bell's palsy, FB in the ear and epistaxis were more common in the 12- to 17-year age group. A normal examination was also an important finding in 83 of the patients (23.6%). Foreign bodies are the most common reason for admission to the emergency services in children, and it is frequently seen between 0 and 5 years of age. Informing and raising awareness of parents on this topic will reduce both unwanted complications and ENT consultations along with admission to pediatric emergency services.

Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell's Palsy in Adults-A Systematic Review and Meta-analysis.

Bell's palsy is typically treated with oral corticosteroids (40-60 mg daily). Concomitant antivirals are currently not recommended. The objective of this systematic review and meta-analysis was to examine the effect of high-dose versus standard-dose corticosteroids, without antivirals, in the management of Bell's palsy. Embase, MEDLINE, PubMed, CINAHL, Cochrane Library. A systematic review and meta-analysis was performed according to PRISMA guidelines. Studies comparing high-dose (≥80 mg) or standard-dose (40-60 mg) corticosteroid therapy for Bell's palsy were included. Exclusion criteria were coexisting antiviral treatment, nonoral drug delivery, and facial palsy due to other causes. Risk of bias was assessed using ROBINS-I. A weighted estimate of treatment effects across trials as odds ratios (OR) using a Mantel-Haenzel random-effects model was calculated. Three articles were included in the analysis, representing 485 patients. There was a significant decrease in nonrecovery with high-dose, compared with standard-dose, corticosteroids at 6 months follow-up (OR = 0.17, 95% confidence interval = 0.05-0.56, p = 0.004). Overall adverse events were 5.8% (n = 28), all reported in one study in the high-dose group (transient elevated liver enzymes and fecal occult blood). Our analysis shows a favorable effect of high-dose corticosteroid in the treatment of Bell's palsy. It is the first to evaluate this effect without the use of antivirals in keeping with current treatment recommendations. As all included studies had a serious risk of bias, future research should focus on larger trials with more robust methodology. This will allow for more up-to-date and large-scale analyses where more valid conclusions can be drawn that may potentially influence treatment protocols.

Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case-Control Study of 182 Patients.

To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors. Retrospective case-control study. University Hospital, Stockholm, Sweden. All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age-matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression. In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person-years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one-third of the pregnant women received corticosteroid treatment. The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one-third of the pregnant women received this treatment.

Ramsay Hunt Syndrome: An Introduction, Signs and Symptoms, and Treatment.

Ramsay Hunt syndrome is the complication of the virus varicella-zoster and the infection caused by it, which shows apparent geniculate ganglion involvement. This article discusses the etiology, epidemiology, and pathology of Ramsay Hunt syndrome. Clinically it may be presented as a vesicular rash on the ear or even in the mouth, pain in the ear, and facial paralysis. Some other rare symptoms may also be present, which are also discussed in this article. Skin involvement is also seen in some cases as patterns due to anastomoses between cervical and cranial nerves. This article provides an overview of how the varicella-zoster virus causes facial paralysis and other neurological symptoms. Knowing about this condition and its clinical features is essential to make an early diagnosis and, thus, provide a good prognosis. A good prognosis is required to reduce the nerve damage, prevent further complications, and start an early therapy of acyclovir and corticosteroid. This review also presents a clinical picture of the disease and its complications. The incidence of Ramsay Hunt syndrome has gradually decreased over time because of the development of the varicella-zoster vaccine and better health facilities. The paper also talks about how the diagnosis of Ramsay Hunt syndrome is made and the various treatment options available. Facial paralysis in Ramsay Hunt syndrome presents differently than Bell's Palsy. If not treated for too long, it may cause permanent muscle weakness and may also cause a loss of hearing. It may be confused with simple herpes simplex virus outbreaks or contact dermatitis.

COVID-19 vaccines adverse events: potential molecular mechanisms.

COVID-19 is an infectious disease caused by a single-stranded RNA (ssRNA) virus, known as SARS-CoV-2. The disease, since its first outbreak in Wuhan, China, in December 2019, has led to a global pandemic. The pharmaceutical industry has developed several vaccines, of different vector technologies, against the virus. Of note, among these vaccines, seven have been fully approved by WHO. However, despite the benefits of COVID-19 vaccination, some rare adverse effects have been reported and have been associated with the use of the vaccines developed against SARS-CoV-2, especially those based on mRNA and non-replicating viral vector technology. Rare adverse events reported include allergic and anaphylactic reactions, thrombosis and thrombocytopenia, myocarditis, Bell's palsy, transient myelitis, Guillen-Barre syndrome, recurrences of herpes-zoster, autoimmunity flares, epilepsy, and tachycardia. In this review, we discuss the potential molecular mechanisms leading to these rare adverse events of interest and we also attempt an association with the various vaccine components and platforms. A better understanding of the underlying mechanisms, according to which the vaccines cause side effects, in conjunction with the identification of the vaccine components and/or platforms that are responsible for these reactions, in terms of pharmacovigilance, could probably enable the improvement of future vaccines against COVID-19 and/or even other pathological conditions.

Agreement of Clinician-Administered and Modified Parent-Administered House-Brackmann Scales in Children with Bell's Palsy.

Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy. Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years). Multicenter study at pediatric hospitals with recruitment in emergency departments. Children were recruited within 72 hours of symptom onset and assessed using the clinician-administered and the parent-administered modified HB scales at baseline, and at 1, 3, and 6 months until recovered. Agreement between the 2 scales was assessed using intraclass coefficient (ICC) and a Bland-Altman plot. Data were available for 174 of the 187 children randomized from at least 1 study time point. The mean ICC between clinician and parent HB scores across all time points was 0.88 (95% confidence interval, CI: 0.86, 0.90). The ICC for the data collected at baseline was 0.53 (95% CI: 0.43, 0.64), at 1 month was 0.88 (95% CI: 0.84, 0.91), at 3 months was 0.80 (95% CI: 0.71, 0.87) and at 6 months was 0.73 (95% CI: 0.47, 0.89). A Bland-Altman plot indicated a mean difference between the 2 scores (clinician-reported minus parent-reported) of only -0.07 (95% limits of agreement -1.37 to 1.23). There was good agreement between the modified parent-administered and the clinician-administered HB scales.

Diabetes Mellitus and Bell's Palsy.

The aim of the present brief review was to discuss Bell's palsy (BP) in diabetes mellitus (DM). The risk of BP is increased in DM. DM subjects with BP are more prone to severe facial nerve degeneration. Further characteristics of BP in DM include: a) infrequent taste impairment; b) more frequent and more marked facial nerve subclinical electrophysiological impairment; c) more frequent BR impairment; d) potentially concurrent distal symmetrical sensorimotor polyneuropathy; e) more frequent alternating BP with recurrent episodes affecting different sides of the face.

Background rates of adverse events of special interest for COVID-19 vaccine safety monitoring in the United States, 2019-2020.

The U.S. Food and Drug Administration (FDA) Biologics Effectiveness and Safety (BEST) Initiative conducts active surveillance of adverse events of special interest (AESI) after COVID-19 vaccination. Historical incidence rates (IRs) of AESI are comparators to evaluate safety. We estimated IRs of 17 AESI in six administrative claims databases from January 1, 2019, to December 11, 2020: Medicare claims for adults ≥ 65 years and commercial claims (Blue Health Intelligence®, CVS Health, HealthCore Integrated Research Database, IBM® MarketScan® Commercial Database, Optum pre-adjudicated claims) for adults < 65 years. IRs were estimated by sex, age, race/ethnicity (Medicare), and nursing home residency (Medicare) in 2019 and for specific periods in 2020. The study included >100 million enrollees annually. In 2019, rates of most AESI increased with age. However, compared with commercially insured adults, Medicare enrollees had lower IRs of anaphylaxis (11 vs 12-19 per 100,000 person-years), appendicitis (80 vs 117-155), and narcolepsy (38 vs 41-53). Rates were higher in males than females for most AESI across databases and varied by race/ethnicity and nursing home status (Medicare). Acute myocardial infarction (Medicare) and anaphylaxis (all databases) IRs varied by season. IRs of most AESI were lower during March-May 2020 compared with March-May 2019 but returned to pre-pandemic levels after May 2020. However, rates of Bell's palsy, Guillain-Barré syndrome, narcolepsy, and hemorrhagic/non-hemorrhagic stroke remained lower in multiple databases after May 2020, whereas some AESI (e.g., disseminated intravascular coagulation) exhibited higher rates after May 2020 compared with 2019. AESI background rates varied by database and demographics and fluctuated in March-December 2020, but most returned to pre-pandemic levels after May 2020. It is critical to standardize demographics and consider seasonal and other trends when comparing historical rates with post-vaccination AESI rates in the same database to evaluate COVID-19 vaccine safety.

The role of a conjunctival biopsy in the diagnosis of eosinophilic granulomatosis with polyangiitis with ocular involvement

A 33-year-old Asian man presented with redness, swelling, and blurring of vision in both eyes for 1 month associated with headache and pain. The patient had a history of allergic rhinitis with a progressive hearing loss for 3 months, followed by bell's palsy. Given his elevated serum cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) and erythrocyte sedimentation rate (ESR) levels as well as computed tomography head, orbit, and peripheral nervous system that showed marked bilateral mastoiditis with opacification of the right middle ear canal and enlargement of the bilateral lacrimal gland, the suspicion of small vessel vasculitis with ocular and ear involvement was high. Because there was no significant lung or kidney involvement, a conjunctival biopsy was attempted, which revealed small capillaries surrounded by eosinophils and plasma cells. Because there are no validated diagnostic tests for eosinophilic granulomatosis with polyangiitis (EGPA), a conjunctival biopsy can be valuable and minimally invasive in the early diagnosis and treatment of small vessel vasculitis.

Bell Palsy Incidence in Patients with Post-COVID: A Retrospective Study

Bell Palsy Incidence in Patients with Post-COVID: A Retrospective Study

Comparison of laser therapy and galvanic stimulation on facial appearance and function in Bell’s palsy among south Indian population

Introduction and Aim: Bell’s palsy is an instantaneous lower motor neurons injury of 7th cranial nerve associated with infection and swelling. It produces unexpected unilateral weakness of facial muscles, progresses rapidly and attains peak symptoms within a week. The most common age of incidence is between 20 to 40 years. Although facial paralysis in Bell’s palsy is self-limited, only 80% of the patients make a full recovery. There are studies stating that both galvanic electrical stimulation and laser therapy speed up the recovery of facial paralysis, but the extent of complete recovery is unknown. Hence, this study is an attempt to understand and compare how laser therapy and galvanic electrical stimulation affect facial appearance and facial muscle functions in Bell's palsy. Materials and Methods: This study included thirty subjects with acute onset of Bell’s palsy aged between 20-40 years. They were randomly grouped into A and B. Galvanic electrical stimulation and low-level laser therapy were given to group A and group B respectively for 6 weeks (3 sessions/week) along with facial exercises. Facial disability index scale was used to measure facial muscle function and Sunny brook scale was used to measure facial symmetry in pre- and post-treatment periods. Results: When comparing the pre- and post-mean values of groups A and B on the Sunny Brook facial grading and the facial disability index (physical, social), group B (with low level laser therapy) showed a highly significant difference in mean values at p 0.001. Conclusion: Low-level laser therapy can be used as an adjective in treating the patients with Bell’s palsy.

Belly's Palsy with Clinical Manifestation and Diagnosis- A Review

Bell's Palsy is one of communal disease of effected to seventh cranial nerve that causes paralysis of one or two side of the face which occur within (72 hours), the etiology unknown but different causes such as psychological, physical condition, viral infection, ischemia of blood vessels, and autoimmune inflammation. The individuals are more susceptible to effected such as pregnancies, severe preeclampsia, obese persons, hypertensive patients, diabetic mellitus, it suspected for both sex male and female, also occur in all age but increase within ages that very important to determined type of treatments . During the clinical examination, the Bell's Palsy patient suffer from weakness of muscle of the face, wrinkling forehead, hyper-acusis blink, the face became asymmetrical and the lip ruck up, the corner of the mouth move upward, the naso-labial folds obliterated, weakness of buccinator muscles that lead to the food stay in labial, buccal vestibule in upper and lower jaw, half of face drooped causes of expression altered severely occur like mask. The aim of review bring attention for determined the etiology of Bell's Palsy, early diagnosis of disease by clinical examination to reach perfect therapy and acceleration recovery time and decreased complete facial paralysis. Conclusion: the authors conclude that it is important to evaluate the drug act to regenerate the nerve and modify the treatment to get effected drug with little symptom, also modification of physical therapy to accelerate healing. Dental management for this patient by motivation of them to maintain oral hygiene and modification dental treatment to return mastication of food, brushing, whistling and using dental prosthesis to restore facial function. Also help the psychological condition of the patient to get positive energy to withstand the disease and get ride.

Ayurvedic management of Ardita with special reference to Bell’s palsy: A case study

Arddita (Bell's palsy) is considered as one among the eighty Vata Nanatmaja Vyadh is in Ayurveda. It can be correlated with the disease 'Bell's palsy. Bell's palsy is a condition that developed; facial palsy the paralysis of facial nerve also affects the movement of facial muscles and shows similar symptoms. A 17 years old male patient approached to OPD who was suffering from complaints of deviated face on left side, unable to chew from right side, improper blinking of right eyes and slurred speech since 20 days. He was clinically diagnosed as Bell's palsy and managed through Panchkarama&amp; palliative treatment for27 days. The patient got complete relief in all symptoms with appreciable changes. Bell's palsy can be managed by giving comprehensive management of Panchkarma and palliative treatment which reflects that it is good remedy for Bell's palsy. Bell’s palsy is characterised by the sudden weakness in the muscles of one half of the face due to the inflammation or compression of facial nerve which is commonly unilateral. Bell’s palsy can be correlated to Arddita mentioned in Ayurvedic classics. Arddita is included among Vatavyadhi. The aggravated Vata will produce symptoms like deviation of half of the face, Tremulousness in the head, Speech difficulty, deformities in eyes etc. A 17 year old male patient reported in the outpatient department with sudden onset of deviation of angle of mouth towards right before 2 weeks. The complaints are associated with speech difficulty, drooling of saliva from the left side, inability to close the left eye, reduced taste sensation, heaviness &amp; mild swelling over the affected side of the face. The case was clinically diagnosed as Bell’s Palsy/Arddita. The patient is treated with Kaphahara/Sophahara followed by Vatahara medicines and procedures. The case was assessed with ‘House and Breckmann’ assessment scale. The result showed significant improvement in motor factions and asymmetry of face. After the treatment, the ‘House and Breckmann’ gradation improved from grade 4 to grade1. This case report shows that classical Arddita treatment is effective in Bell’s palsy.

Facial palsy in a newborn: A case report

Unilateral congenital facial palsy in the newborn occurs more often as isolated than in the context of syndromes or developmental defects. Recognition of the etiological factor, the severity of the clinical presentation, the dynamics of recovery are a guide for a multidisciplinary approach, a range of investigations and treatment. In a non-therapeutic approach, unsupported by sufficiently reliable data from the literature, there is a dilemma whether and how long one has to wait and observe the improvement of clinical results, before determining the range of examinations in the newborn. In facial paresis of prenatal or perinatal origin, identical to non-congenital Bell's palsy, infectious and anatomical-structural causes should initially be excluded. This paper presents a case of a symmetrical hypotrophic premature infant with a manifestation of acute Bell's palsy at birth, with negative biomarkers for infectious etiology and a normal brain ultrasound. The newborn underwent a special neonatal care with targeted local treatment. Towards the end of the first postnatal week, there was an evident withdrawal of clinical symptomatology.&#x0D;

Ayurvedic management of Ardita with special reference to Bell's palsy: A case study

Ayurvedic management of Ardita with special reference to Bell's palsy: A case study