The following drugs, medications, substances or toxins are some of the possible
causes of Bell's Palsy as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Bell's Palsy may be found in:
Physiologic
–Commonly seen in children less than 4 years old
- Infectious
–Viral and bacterial rhinosinusitis: Nasal congestion and obstruction lead to chronic mouth opening and contribute to drooling
–Adenotonsillar hypertrophy may cause drooling via nasal obstruction leading to persistent mouth opening to breathe
–Severe pharyngotonsillitis/tonsillitis causes an obstruction of swallowing
–Retropharyngeal or peritonsillar abscess similarly causes a physical obstruction of the swallowing mechanism
–Epiglottitis: Severe, life-threatening illness caused by Haemophilus influenzae type B, which causes rapid enlargement of the epiglottis; classic symptoms include drooling, a “perched” posture, respiratory distress
-
Inflammatory
–Allergic rhinitis
–Nasal polyposis
-
Congenital lesions
–Craniofacial syndromes
–Midline nasal masses, e.g., encephalocele
and glioma, may obstruct nasal breathing and require mouth breathing and therefore reduced swallowing
- Neurologic
–Cerebral palsy: Significant persistent drooling may occur secondary to impaired neuromotor control
–Cricopharyngeal achalasia and esophageal dysmotility are conditions of neuromotor dysgenesis in the smooth muscle
-
Trauma
–Caustic ingestion causes an increase in saliva production
–Laryngeal trauma may damage the structures necessary for swallowing
-
Dental
–Teething may cause an increase in drooling in an infant or a young child
–Dental caries may cause drooling because of pain and local irritation
-
Foreign body
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Facial Paralysis:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Acquired
-
Bell palsy
–A diagnosis of exclusion; 40% of cases
-
Acute otitis media
–From erosion or dehiscence of facial canal
-
Chronic otitis media
–Nerve compression from granulation tissue
-
Herpes zoster oticus
–Often infects eighth nerve as well, with hearing loss and vertigo
-
Lyme disease
–Usually several weeks after inoculation
-
Tumors
–Temporal bone leukemia,
rhabdomyosarcoma of head and neck
-
Melkersson-Rosenthal syndrome
–Relapsing alternating facial paralysis
–Recurrent facial edema
–Fissured tongue
-
Temporal bone fracture
–Although most cases involve longitudinal fractures, transverse may also result in hearing loss and vertigo
-
Facial wounds
–Early repair if clean wound
–Tag nerve for delayed repair if dirty wound
-
Iatrogenic
–After otologic or parotid surgery
Congenital
-
Traumatic (associated with prolonged and difficult labor)
-
Inherited disorders
–Myotonic dystrophy: Progressive muscle weakness, facial paresis at birth
–Albers-Schönberg disease: Osteopetrosis increases bone density, compresses nerve
- Developmental abnormalities
–Möbius syndrome: Facial paralysis with 6th cranial nerve palsy
–Association with coloboma, heart defect, choanal atresia, genital hypoplasia, ear anomalies (CHARGE)
–Goldenhar syndrome, also known as oculoauriculovertebral (OAV) syndrome: First and second branchial arch abnormalities
–Asymmetric crying facies: Also called congenital unilateral lower lip palsy (CULLP)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Drooling:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Bell's palsy.
With Bell's palsy, drooling accompanies the gradual onset of facial hemiplegia. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (the distance between the upper and lower eyelids) widens. The patient usually complains of pain in or behind the ear. Other cardinal signs and symptoms include unilateral diminished or absent corneal reflex, decreased lacrimation, Bell's phenomenon (upward deviation of the eye with attempt at lid closure), and partial loss of taste or abnormal taste sensation.
Esophageal tumor
With an esophageal tumor, copious and persistent drooling is typically preceded by weight loss and progressively severe dysphagia. Other signs and symptoms include substernal, back, or neck pain and blood-flecked regurgitation.
Ludwig's angina.
With Ludwig's angina, moderate to copious drooling stems from dysphagia and local swelling of the floor of the mouth, causing tongue displacement. Submandibular swelling of the neck and signs of respiratory distress may also occur.
Myotonic dystrophy.
Facial weakness and a sagging jaw account for constant drooling in this disorder. Other characteristic findings include myotonia (inability to relax a muscle after its contraction), muscle wasting, cataracts, testicular atrophy, frontal baldness, ptosis, and a nasal, monotone voice.
Peritonsillar abscess.
A severe sore throat causes dysphagia with moderate to copious drooling in this abscess. Accompanying signs and symptoms are a high fever, rancid breath, and enlarged, reddened, edematous tonsils that may be covered by a soft, gray exudate. Palpation may reveal cervical lymphadenopathy.
Pesticide poisoning.
Toxiceffects of pesticides may include excess salivation with drooling. Other effects are diaphoresis, nausea and vomiting, involuntary urination and defecation, blurred vision, miosis, increased lacrimation, fasciculations, weakness, flaccid paralysis, signs of respiratory distress, and coma.
Rabies
When this acute central nervous system infection advances to the brain stem, it produces drooling, or “foaming at the mouth.” Drooling stems from excessive salivation, facial palsy, or extremely painful pharyngeal spasms that prohibit swallowing. Rabies is accompanied by hydrophobia in about 50% of cases. Seizures and hyperactive deep tendon reflexes may also occur before the patient develops generalized flaccid paralysis and coma.
Seizures (generalized).
Generalized seizures are tonic-clonic muscular reactions that cause excessive salivation and frothing at the mouth accompanied by loss of consciousness and cyanosis. In the unresponsive postictal state, the patient may also drool.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bell's palsy:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Bell’s palsy blocks the seventh cranial nerve, which is responsible for motor innervation of the muscles of the face. The conduction block is due to an inflammatory reaction around the nerve (usually at the internal auditory meatus), which may be associated with infections or can result from hemorrhage, tumor, meningitis, local trauma, hypertension, sarcoidosis, Lyme disease, or infarction of the nerve.
Bell’s palsy affects all age groups and males and females nearly equally, although females are slightly more likely to develop it during their late teens and early 20s. In the United States, incidence is 23 cases per 100,000 people.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Drooling:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Achalasia
Progressively severe dysphagia may cause copious drooling late in this disorder. When the patient lies down, food and saliva in the dilated esophagus flow back to the pharynx and mouth, resulting in drooling. Coughing or choking and aspiration may follow regurgitation. Other findings include weight loss and, possibly, spasms or substernal pain after eating.
Acoustic neuroma
When this malignant tumor involves the facial nerve, it produces facial weakness or paralysis with scant to copious drooling. The drooling is followed by tinnitus, unilateral hearing loss, and vertigo. Other symptoms include dysphagia, poor balance, and ear or eye pain.
Amyotrophic lateral sclerosis
Brain stem involvement in this degenerative disorder weakens muscles of the face and tongue, resulting in constant scant to copious drooling. The drooling is accompanied by dysarthria and difficulty chewing, swallowing, and breathing. Fasciculations are common along with muscle atrophy and weakness, especially in the forearms and hands, and hyperreflexia and spasticity in the legs.
Bell’s palsy
Drooling accompanies the gradual onset of facial hemiplegia in Bell’s palsy. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (distance between upper and lower eyelids) widens. The patient usually complains of pain in or behind the ear. Other cardinal signs and symptoms include a unilateral diminished or absent corneal reflex, decreased lacrimation, Bell’s phenomenon (upward deviation of the eye with attempt at eyelid closure), and partial loss of taste or abnormal taste sensation.
Diphtheria
In this infection, moderate drooling results from dysphagia associated with sore throat. The hallmark of diphtheria, however, is a bluish white, gray, or black membrane over the mucous membranes of the tonsils, pharynx, larynx, soft palate, and nose. This membrane causes pooling of saliva, which aggravates drooling. Other signs and symptoms include fever, pallor, tachycardia, halitosis, noisy respirations, cervical lymphadenopathy, purpuric skin lesions, drowsiness, and delirium.
Esophageal tumor
In this type of tumor, copious and persistent drooling is typically preceded by weight loss and progressively severe dysphagia. Other signs and symptoms include substernal, back, or neck pain and blood-flecked regurgitation.
Glossopharyngeal neuralgia
Drooling may accompany the sharp paroxysms of pain that characterize this rare disorder. The pain may be precipitated by swallowing, talking, chewing, or coughing or by external pressure on the ear; it may affect the posterior pharynx, the ear, or the base of the tongue or jaw. Associated findings include hoarseness, soft palate deviation to the unaffected side, absent gag reflex, partial loss of taste, and trapezius and sternocleidomastoid muscle weakness.
Guillain-Barré syndrome
The hallmark of this polyneuritis is ascending muscle weakness that typically starts in the legs and extends to the arms and face within 24 to 72 hours. Facial diplegia and dysphagia set the stage for scant to copious drooling, which is accompanied by dysarthria, nasal voice tone, and a diminished or absent corneal reflex. Other signs and symptoms include paresthesia, signs of respiratory distress, and signs of sympathetic dysfunction, such as orthostatic hypotension, loss of bowel and bladder control, diaphoresis, and tachycardia.
Hypocalcemia
The chief feature of hypocalcemia is tetany, characterized by muscle twitching, cramps, and seizures; carpopedal spasm; and positive Chvostek’s and Trousseau’s signs. Moderate to copious drooling may accompany the resultant dysphagia. In severe hypocalcemia, the patient may have laryngeal spasm with stridor, cyanosis, and generalized tonic-clonic seizures.
Ludwig’s angina
In this disorder, moderate to copious drooling stems from dysphagia and local swelling of the floor of the mouth, causing tongue displacement. Submandibular swelling of the neck and signs of respiratory distress may also occur.
Myasthenia gravis
Facial and pharyngeal muscle weakness causes scant to copious drooling that’s accompanied by difficulty swallowing, chewing, and speaking. Typically, drooling is preceded by diplopia and ptosis. The patient displays a masklike face and myasthenia snarl (smile with lips elevated but not retracted). Other features include a weak tongue with bilateral furrowing (trident tongue) and a sagging jaw if masseter muscles are affected. Skeletal muscle weakness is characteristic; muscles typically weaken throughout the day, especially after exercise.
Myotonic dystrophy
Facial weakness and a sagging jaw account for constant drooling in this disorder. Other characteristic findings include myotonia (inability to relax a muscle after its contraction), muscle wasting, cataracts, testicular atrophy, frontal baldness, ptosis, and a nasal, monotone voice.
Paralytic poliomyelitis
When this infection involves the brain stem, it may produce facial paralysis and dysphagia, resulting in scant to copious drooling. Typically, the drooling is preceded by fever, headache, nuchal rigidity, and intense muscle aches. The patient then develops fasciculations and usually asymmetrical paralysis in the lower legs and trunk that’s associated with transient urine retention.
Parkinson’s disease
In this degenerative disorder, the neck is flexed forward, so saliva isn’t directed to the back of the mouth; the result is drooling. Other cardinal features include a pill-rolling tremor, rigidity, bradykinesia, a shuffling gait, stooped posture, masklike facies, dysarthria, and a high-pitched, monotone voice.
Peritonsillar abscess
A severe sore throat causes dysphagia with moderate to copious drooling in this type of abscess. Accompanying signs and symptoms are high fever, rancid breath, and enlarged, reddened, edematous tonsils that may be covered by a soft gray exudate. Palpation may reveal cervical lymphadenopathy.
Rabies
When this acute central nervous system infection advances to the brain stem, it produces drooling (commonly referred to as “foaming at the mouth”) from excessive salivation, facial palsy, or extremely painful pharyngeal spasms that prohibit swallowing. It’s accompanied by hydrophobia in about 50% of patients. Seizures and hyperactive deep tendon reflexes (DTRs) may also occur before the patient develops generalized flaccid paralysis and a coma.
Retropharyngeal abscess
This disorder causes painful swallowing, resulting in moderate to copious drooling. The patient complains of a lump in his throat that he can’t swallow and of dyspnea in the sitting position that disappears when he lies down. Other cardinal signs and symptoms include coughing, snoring, choking, noisy breathing, and a “cry of a duck” voice tone. Cervical lymphadenopathy, pharyngeal edema and redness, and a high fever may also occur.
Seizures (generalized)
This tonic-clonic muscular reaction causes excessive salivation and frothing at the mouth accompanied by loss of consciousness and cyanosis. In the unresponsive postictal state, the patient may also drool.
Stroke
Facial paralysis associated with stroke results in scant to copious drooling. Other signs and symptoms include diplopia, visual field deficits, dysarthria, hearing loss, paresthesia, paralysis, ataxia, headache, dizziness, confusion, nausea, vomiting, unilateral or bilateral hyperactive DTRs, and a positive Babinski’s reflex.
Tetanus
This acute infection may produce scant to copious drooling associated with dysphagia. Typically, drooling is preceded by restlessness and pain and stiffness in the jaw, abdomen, and back that progress to tonic spasms. A locked jaw and a grotesque grinning expression (risus sardonicus) are characteristic signs. Profuse sweating, low-grade fever, and tachycardia are also common.
Other causes
Drugs
Such drugs as clonazepam, ethionamide, and haloperidol can all cause excessive salivation, which may result in drooling.
Envenomation
Some snakebites trigger excess salivation, resulting in drooling. The drooling is accompanied by other neurotoxic effects, such as diaphoresis, chills, weakness, dizziness, nausea, vomiting, paresthesia, fasciculations, and tender lymphadenopathy. Local swelling, pain, and ecchymoses may occur.
Pesticide poisoning
Toxic effects of pesticides may include excess salivation with drooling, diaphoresis, nausea and vomiting, involuntary urination and defecation, blurred vision, miosis, increased lacrimation, fasciculations, weakness, flaccid paralysis, signs of respiratory distress, and coma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Bell's palsy:
Causes
(Handbook of Diseases)
The seventh cranial nerve is responsible for motor innervation of the facial muscles. With Bell’s palsy, the nerve is blocked by an inflammatory reaction around the nerve (usually at the internal auditory meatus). This is commonly associated with infections (most likely herpes simplex) and can result from hemorrhage, tumor, meningitis, or local trauma.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Drooling:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Bell's palsy.With Bell's palsy, drooling accompanies the gradual onset of facial hemiplegia. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (the distance between the upper and lower eyelids) widens. The patient usually complains of pain in or behind the ear. Other cardinal signs and symptoms include unilateral diminished or absent corneal reflex, decreased lacrimation, Bell's phenomenon (upward deviation of the eye with attempt at lid closure), and partial loss of taste or abnormal taste sensation.
Esophageal tumor.With an esophageal tumor, copious and persistent drooling is typically preceded by weight loss and progressively severe dysphagia. Other signs and symptoms include substernal, back, or neck pain and blood-flecked regurgitation.
Ludwig's angina.With Ludwig's angina, moderate to copious drooling stems from dysphagia and local swelling of the floor of the mouth, causing tongue displacement. Submandibular swelling of the neck and signs of respiratory distress may also occur.
Myotonic dystrophy.Facial weakness and a sagging jaw account for constant drooling with this disorder. Other characteristic findings include myotonia (inability to relax a muscle after its contraction), muscle wasting, cataracts, testicular atrophy, frontal baldness, ptosis, and a nasal, monotone voice.
Peritonsillar abscess.A severe sore throat causes dysphagia with moderate to copious drooling with this abscess. Accompanying signs and symptoms are a high fever, rancid breath, and enlarged, reddened, edematous tonsils that may be covered by a soft, gray exudate. Palpation may reveal cervical lymphadenopathy.
Pesticide poisoning.Toxic effects of pesticides may include excess salivation with drooling. Other effects are diaphoresis, nausea and vomiting, involuntary urination and defecation, blurred vision, miosis, increased lacrimation, fasciculations, weakness, flaccid paralysis, signs of respiratory distress, and coma.
Rabies.When this acute central nervous system infection advances to the brain stem, it causes drooling, or “foaming at the mouth.” Drooling stems from excessive salivation, facial palsy, or extremely painful pharyngeal spasms that prohibit swallowing. Rabies is accompanied by hydrophobia in about 50% of cases. Seizures and hyperactive deep tendon reflexes may also occur before the patient develops generalized flaccid paralysis and coma.
Seizures (generalized).Generalized seizures are tonic-clonic muscular reactions that cause excessive salivation and frothing at the mouth accompanied by loss of consciousness and cyanosis. In the unresponsive postictal state, the patient may also drool.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Bell Palsy:
Bell Palsy - pathophysiology
(The 5-Minute Pediatric Consult)
Nearly all cases of true Bell palsy are believed to arise from a viral infection of the facial nerve and, in particular, the geniculate ganglion.
Bell Palsy - etiology
- Idiopathic: Pregnancy related
- Infectious:
- Herpes simplex virus 1
- Human herpes virus 6
- Herpes zoster (without Ramsay-Hunt syndrome)
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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