| Abstract | Bellova se pareza definira kao iznenadna, izolirana i jednostrana periferna pareza lica uzrokovana oštećenjem ličnog živca nepoznatog uzroka, zbog čega se naziva i idiopatskom. Ime je dobila prema škotskom liječniku sir Charlesu Bellu koji je u prvoj polovici 19. stoljeća objavio niz radova o perifernoj paralizi ličnog živca. Najčešća je to periferna pareza ličnog živca čija se incidencija u općoj populaciji kreće između 13 i 53,3 na 100.000 stanovnika u godini dana. Može se pojaviti u bilo kojoj dobnoj skupini, a najčešće zahvaća onu od 15. do 45. godine života. Točan joj se uzrok ne zna, no u literaturi su najzastupljenije dvije etiološke hipoteze – virološka i autoimuna. Brojne su histološke promjene ličnog živca (unutar njegova koštanog kanala) prisutne kod pacijenata oboljelih od Bellove pareze, poput upalnog infiltrata, edema i demijelinizacije. Bolest se očituje karakterističnom slabosti mimičnih mišića, no zbog brojnih funkcija ličnog živca mogu biti prisutni i drugi pridruženi simptomi (retroaurikularna bol, smetnje suzenja i okusa, hiperakuzija), čija prisutnost ovisi o tome na kojoj je razini živčanog toka došlo do oštećenja. Temelj dijagnostike Bellove pareze jesu iscrpna anamneza i detaljan klinički pregled čime se pokušava isključiti pareza facijalisa poznatog uzroka. Također, potrebno je odrediti stupanj funkcije ličnog živca koristeći se nekom od dostupnih ljestvica za procjenu, primjerice House-Brackmannovom (HB) ljestvicom ili Sunnybrook (SB) sustavom procjene. Liječenje ove bolesti jest multidimenzionalno, a temelj mu čini medikamentozna terapija kortikosteroidima. Uz njih, neizostavan dio terapije su i potporne mjere, poput zaštite oka, kao i vježbe mimične muskulature radi očuvanja tonusa mišića. |
| Abstract (english) | Bell's palsy is defined as a sudden, isolated and unilateral peripheral facial palsy. It is caused by facial nerve damage of unknown origin and therefore called idiopathic. It was named after the Scottish physician, Sir Charles Bell, who had published several papers on the topic in the first half of the 19th century. It is the most common of all peripheral facial palsies, with an annual incidence in the general population of 13 to 53.3 cases per 100,000 people. It is most common in people aged 15–45, but it may affect any age. Even though its exact cause is unknown, two main etiological hypotheses are represented in medical literature: viral and autoimmune. There are numerous histological changes to the intraosseous segment of facial nerve present in patients with Bell’s palsy, such as inflammatory cell infiltration, edema, and demyelination. The disease presents with typical weakness of facial muscles. However, due to numerous facial nerve functions, several other symptoms may be present, such as retroauricular pain, altered taste, decreased tearing, or hyperacusis. Their presentation depends on the localization of the facial nerve lesion. An extensive clinical examination and thorough patient history are the two key elements in the diagnostics of Bell's palsy, as they will eliminate the identifiable causes of facial palsy. Moreover, the facial nerve function has to be evaluated using one of the common scoring systems, e.g., the House-Brackmann (HB) facial nerve grading system or the Sunnybrook (SB) facial grading system. The treatment of Bell's palsy is multimodal but always includes the administration of corticosteroids. Besides medication, supportive measures, such as eye protection and mime therapy (muscle tone preservation exercises) are also vital parts of the aforementioned multimodal treatment. |
