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Lyme Disease and other
Infectious / Inflammatory / Metabolic Disorders
Many infectious and inflammatory processes can affect
facial nerve function. This occurs either through direct effects on the
nerve, or because generalized inflammation causes swelling in the tight
bony canal through which the facial nerve runs, “choking”
the nerve, and causing it to malfunction. Some diseases affect the facial
nerve in well understood ways, and others are poorly understood. Below
are outlined some of the diseases whose pathophysiologic effects on the
facial nerve are understood.
Lyme Disease
Lyme disease is a spirochetal infection caused by the organism Borrelia
Burgdorferi. It is ordinarily transmitted through a deer tick vector,
and is recognized by a characteristic “Bull’s Eye” lesion
at the site of the tick bite. In the acute phase of the disease, this
round red macule with a pale center is classic, though in up to 50% of
infected individuals the lesion goes unrecognized or does not develop
at all. The second phase of the disease, 3-6 weeks after infection, is
characterized by migrating joint pains, fatigue, generalized weakness,
and cranial neuropathies. It is during this phase that facial palsy may
occur. This can affect one or both sides of the face. It can be isolated,
or occur in conjunction with dysfunction of other cranial nerves. A blood
test for the detection of Lyme disease is available, and confirmation
of the disease requires antibiotic therapy.
Multiple Sclerosis
Multiple Sclerosis (MS) is a demyelinating disease in which the sheaths
surrounding myelinated motor nerves are broken down, preventing them from
conducting signals appropriately. It can affect any motor nerve, including
the facial nerve. It tends to wax and wane substantially, so that nerve
function fluctuates according to the activity of the disease. During periods
of disease remission, neural function often returns to normal.
Diabetes Mellitus
Diabetes Mellitus (DM) is a lack of internal control over blood sugar
levels, based on failure of the islet cells in the pancreas to produce
insulin. Blood sugar levels are critical for maintaining proper homeostasis
(balance of internal milieu), and lack of proper control over these levels
causes many organ systems to develop disease prematurely. Amongst these
systems is the nervous system; neuropathies are common in later stages
of DM. The facial nerve, like any other nerve, is susceptible to malfunction
on the basis of this DM-associated neuropathy.
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