| Peripheral
facial paralysis occurs typically within the course
of minutes to hours. It is manifested by a deviation
of the corner of the mouth towards the unaffected
side, with flattening of the affected side of
the face and furrowing of the nasogenial fold;
an inability to close the eye on the affected
side (in contrast with central paralysis), with
decreased lacrimation, and occasionally hiperacusia
and loss of taste.
Predisposing factors include the peripartum period
and diabetes. Among its causes are direct exposure
to cold (refrigeration palsy), viral infection
with Herpes 1, Herpes Zoster, Cytomegalovirus,
Epstein Barr Virus, adenovirus, rubeola, measles,
Influenza B, and coxsackievirus, Rickettsiales
and ehrlichiosis infections. Sarcoidosis can also
cause facial hemiplegia. 50% of cases are idiopathic
(Bell’s paralysis).
Figure 1: deviation of the corner of the mouth
with fall of the affected side
Figure 2: an inability to close the eye of the
affected side, allowing one to see the sclera
due to the synergistic ascent of the eye by the
musculature orbicular (Bell’s sign)
Answer the autotest 
Author:
Juan I Pérez Calvo
Servicio de Medicina Interna
Hospital Clínico Universitario
Translation: Kelly
Watt
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