The electrical stimulation technology behind the microcurrent facial has been used in partnership with various treatments for patients afflicted with Bell's palsy, a sudden paralysis or. If you or a loved one have facial paralysis, call 214-645-8300 or request an appointment online. It can affect anyone of any gender and age but seems to be highest in those in people 15 to 45 years old. Many patients recover on their own from facial paralysis, but if motion is not seen in the first 3 months after the injury, a timely consultation is important. Symptoms include drooping of the eyebrow and mouth, drooling, and. She says that many people initially mistake Bells palsy for a stroke. Bell's Palsy - Cranial Nerve 5-7 Transfer Nerve Grafting and Reconstruction Selective Neurolysis and Nerve Transfer Do you want to make an appointment with Dr. Rosenberg? If they can reduce the swelling of the facial nerve, the nerve will fit more comfortably within the bony corridor that surrounds it. Some people with Bell's palsy or facial weakness with co-existing conditions may not respond well to or be able to take steroids. With Bells palsy, both the lower 1,2 Bell's palsy is the most common disorder that affects the facial nerve and is . Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches also are effective. Is the ketogenic diet right for autoimmune conditions? Setting your location helps us to show you nearby providers and locations based on your healthcare needs. We want to make sure that the patient can fully close their Where can I find more information aboutBell's palsy? The following discussion is intended to review and clarify the possible residual effects that can be present in cases where recovery from Bell's palsy is delayed beyond the 3 months point. She criticizes this as something that should not be done because it is unnatural and only a short cut which could lead to something terrible. Typically, there is a droop in the eyebrow, an inability to close the eye, a sagging of the lower eyelid, and a weakness of the corner of the mouth. 12 Younger patients tend to recover more often than older patients. This procedure brings together the inner or outer portions of the upper and lower eyelids to decrease exposure of the eye. My chin also dimples, and my eye brow pulls. Bell's palsy is estimated to affect about 40,000 people in the United States every year. Nerve damage due to trauma or other conditions, such as Bells palsy or acoustic neuroma, can lead to an inability to move the muscles of the face, on one side or both. So, when I am my authentic myself the synkinesis shows. Doctors think that the nerve damage or inflammation might be triggered by a viral infection, like the herpes simplex virus or the varicella zoster virus, which causes chickenpox and shingles, says neurologist MaryAnn Mays, MD. In some cases, a small segment of the gracilis is also transplanted to improve eyelid blink and eyelid closure. To produce an engaging smile the procedure is tailored to lift the upper lip to show teeth, define the smile lines to match the unaffected side, raise the Malarfat pads to reflect light and raise the corners of the mouth evenly. It is intended for Bell's palsy patients who struggle to generate a smile and addresses abnormal regeneration of the facial nerve. Note resolution of the lagophthalmos in the 3 months postoperative photo (right photo). This condition results from damage to the facial nerve (the 7th cranial nerve). Its been a year since the last of my five facial surgeries. For example, Great question! The stages of recovery may vary but usually include the below. The United Kingdoms National Health Service (NHS) states that in most cases, full recovery can take up to 9 months. Through facial paralysis surgery, an even aesthetic appearance of the face is achieved. They often ask questions such as, How will I brush my teeth if I can't even spit out the toothpaste?. Over the next 48 hours or so, one half of your face may start to droop. Our surgeons haveunique skills in surgical reanimation techniques that can address paralysis of the face, including nerve and tendon transfers, microvascular surgery and oculoplastics. We combined the expertise of physical therapists and behavioral psychologists to get the best results. An urgent evaluation by doctors will distinguish between a true Bells palsy and facial palsy from a stroke. This nerve controls muscles of facial expression, eyelid movement, and muscles of the forehead and neck. When should I see a doctor for Bells palsy? I didnt hesitate. All types of volunteers are neededthose who are healthy or may have an illness or diseaseof all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. Masks are required inside all of our care facilities. those who are healthy or may have an illness or disease. Bell's palsy is a condition that causes weakness or paralysis on one side of the face, making it appear as though it's drooping. A brow lift is often necessary to achieve facial symmetry and restore the brow back to its normal position above the eyes. Before and 3 months postoperative photos are shown. Some Diagnosis The diagnosis of Bell's Palsy is usually a clinical diagnosis. The group also supports recovering patients with speech therapists, neurologists for facial motor testing and a facial retraining expert: a dedicated physical therapist who works with people affected by facial paralysis. Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system. Rarely, the facial nerve loses its way as it heals and Male with facial paralysis regains movement in the left side of his face after facial reconstruction surgery with Dr. Azizzadeh. thats paralyzed, since it wont be able to protect itself by blinking or An experienced facial paralysis surgeon will listen and evaluate your progress with you. (HealthDay)In a statement issued by the American Academy of Otolaryngology-Head and Neck Surgery, recommendations are presented for the treatment of Bell's palsy after COVID-19 vaccination and . People living with Bell's palsy may also develop: Symptoms appear suddenly over a 48- to72-hour period and generally start to improve with or without treatment after a few weeks. Results are not guaranteed. Professor of Otolaryngology - Head and Neck Surgery, Assistant Professor of Otolaryngology - Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Facial Paralysis Treatment: Before and After Pictures, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Facial nerve schwannoma (in collaboration with the. recent). A dermatologist describes how she uses fillers and, or botulinum toxin-A to restore disfiguring facial imbalances that result from Bell's palsy. A telltale sign of Bell's palsy is drooping of the face and mouth that affects only half of the face. This article looks at the typical recovery times for Bells palsy, the stages of recovery, and tips to help improve recovery. Its better to be safe than sorry. A doctor may refer them to a facial paralysis specialist. Find more COVID-19 testing locations on Maryland.gov. care doctor or urgent care clinic can prescribe an oral steroid such as 2023 Babak Azizzadeh, MD, FACS | All Rights Reserved. back to their normal quality of life. An Experienced surgeon can show you in the mirror what the effect may be and how itmay affect your symmetry. One of the nerves that controls muscles in your face becomes injured or stops working properly. Then he couldn't blink. For information about participating in clinical research visit, . Facial plastic and reconstructive . Your individualized treatment plan may involve one or more of these procedures: When the facial nerve is injured, the facial muscles responsible for facial expression begin to slowly atrophy and eventually become irreversibly scarred. We can choose from a range of techniques to restore a near-normal smile and a more beautiful, natural-appearing face.. However, a face lift may not change your persistent asymmetry. What is Bell palsy? Bell's palsy, also known as facial nerve palsy, is a common clinical presentation seen in the primary care setting. Hello, Bell's Palsy should not prohibit you from a facelift procedure. In this video you can see her life changing smile transformation before and after selective neurolysis surgery. Find a Location, Appointment In light of the ongoing pandemic, development of vaccines to protect against SARS-CoV-2 infection and COVID-19 disease is an important public health priority. NINDS conducts and supports an extensive research program to increase understanding of how the nervous system works and what causes the system to sometimes go wrong. They vary from person to person and can be mild to severe. It is very possible to repair or replace damaged facial nerves or muscles to restore lost function. But before we could get to my smile, Dr. Rozen recommended we address a more pressing problem saving the vision in my right eye. We are unique in that regard.. Ive had the privilege of speaking to other people who are going through a journey similar to mine. Before and 3 months after eyelid surgery photos are shown. face depends on several factors related to the facial nerve including muscle Nothing makes me happier. Explore services and physicians in your region, Your location is Change Your Location, Set Your Location to See Relevant Information. Before & After lower eyelid reconstruction using MIOS with surgical pioneer Dr. Skip to Site Navigation But at the time, I couldn't smile. I tell them, Oh, yes you can. Can diet help improve depression symptoms? Cleveland Clinic is a non-profit academic medical center. The temporalis tendon transfer procedure is often performed as an outpatient procedure and is followed by facial retraining therapy under the guidance of facial physical therapists. It occurs when a condition, such as a viral infection, causes inflammation and swelling of the seventh cranial nerve (the nerve that controls facial muscles). While I was glad to be cancer-free, I didn't feel like myself. It can appear in the space of a few hours and . I am the director of the Facial Paralysis Clinic at UT Southwestern. The first and second procedures were performed 6 months apart. Within months of her surgery, Kathy began to get her smile back. No, I did not find the content I was looking for, Yes, I did find the content I was looking for, Please rate how easy it was to navigate the NINDS website. An exact cause is unknown, but doctors think it is likely due to swelling in the facial nerve or the seventh cranial nerve. facelift. *Disclaimer: Results vary from patient to patient. becomes weak when someone is having a stroke. . We are one of few centers in the U.S. that can perform advanced procedures to help restore patients' facial function, performing them on a regular basis. Every one heals slightly differently, but in general, you're passable in public by the 2 week mark. Bell's Palsy, also known as 7th nerve palsy, is a result of temporary weakness or permanent paralysis of the facial nerve. Do not wait! It is defined as an acute, ipsilateral facial nerve (cranial nerve VII) paralysis of unknown etiology that results in weakness of the platysma and muscles of facial expression. After eight months with no improvement, I began to research facial paralysis treatment options. You may also notice a loss of the sense of taste, dizziness, ringing in your ear (tinnitus) or other symptoms that point to a problem with the facial nerve. A woman's ability to smile is greatly improved after undergoing surgery to correct facial paralysis. A neurologist explains how to tell the difference between Bells palsy vs. stroke, and what you should know about recovery. In many cases, a small eyelid closing procedure known as a tarsorrhaphy can also be performed. In many cases, no definitive cause for facial nerve palsy is observed (so called Bell's palsy) although a viral illness is highly suspected. When viewing before/after photos it is very important to ensure that the photos are generally consistent. Here, in her own words, is Susans story: A million things run through your mind when you receive a cancer diagnosis, but the possibility of losing motion and function in your face is not one of them. The first time we met, I knew Dr. Rozen was special. Or, synkinesis may affect individuals after the facial nerve has been cut or sewn back together. Treatment: Dual innervation with a combination of cross facial nerve graft and hypoglossal nerve transfer. The patient in this video had Bell's palsy surgery with Dr.. 58 year old female, with left facial palsy with paralytic lagophthalmos, with left upper eyelid gold, with eyes open and closed, showing the gold weight is not visible but it is doing its job to make the left eye close better. your face will be lifted, and sometimes slight modifications can be made to Patrick Byrne, M.D., M.B.A. Additionally, individuals may require further treatments to regain facial function. It is the most common cause of facial paralysis. When facial paralysis does not resolve on its own, surgery can address the problem. This facial paralysis, called Bells palsy, happens to tens of thousands of people each year. Sometimes the facial weakness may last longer or be permanent. Find a Doctor 11 Many people recover in as soon as 10 days. The Facial Nerve Center at Johns Hopkins is a terrific place for patients with facial paralysis, Boahene says, because we have so much experience and expertise. closing. About 85% of people will recover within three weeks, although recovery can take months in some cases. When I awoke from surgery, the right side of my face was paralyzed. During this stage, people may experience: Beginning treatment as quickly as possible after the first symptoms of Bells palsy may help improve recovery. Males and females are equally affected. Phone:203-744-0100 or 800-999- 6673, Form Approved OMB# 0925-0648 Exp. Associate Professor of Otolaryngology - Head and Neck Surgery Appointment Phone: 301-896-3332 Jason Christopher Nellis, M.D. The timing of the facial nerve repair is critical. They were uncertain how much or when. Our center provides a comprehensive multilevel approach in the treatment of facial synkinesis. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease. Facial paralysis can make it difficult to speak, blink, swallow or smile. Pain and discomfort usually occur on one side of the face or head. Most people dont think twice about performing daily life functions such as this. The symptomslike a sagging eyebrow or drooping mouthcome on suddenly, and typically resolve over the course of a few weeks or months. Middle age man with severe left lower eyelid retraction after previous lower eyelid surgery with inability to close the left eye, underwent revision left lower eyelid surgery (lower eyelid retraction surgery with internal alloderm spacer graft and external skin graft). She is an inspiration to others and is always willing to speak with patients in similar situations and help them through their journey. Unfortunately, recovery from this procedure would look much, much different. Bell's palsy is named after Sir Charles Bell (1774-1842), who first described the syndrome along with the anatomy and function of the facial nerve. of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. Ten years later, the tumor returned. In this procedure, tissue from the leg (fascia) is removed from the thigh through a surgical incision. What's more, people with this affliction often have trouble with physical functions that most of us take for granted, such as blinking, chewing, speaking, or breathing comfortably. During a consultation for facial paralysis, the surgeon performs a comprehensive facial examination to determine nerve and muscle function, static and dynamic asymmetries, facial movement deficits, facial asymmetries, eyelid, speech, nasal breathing dysfunctions and any eating challenges. Dr. Azizzadeh performs advanced facial reconstructive surgery on patient to give him his face and nose back. Stitches will need to be removed between 5-7 days after surgery. Policy. This time, I also underwent radiation therapy. and upper part of the face will be affected, so it may be hard to blink or move We avoid using tertiary references. It is more common in people with diabetes and also in women who are pregnant. We are following CDC guidelines and have put expanded safety measures in place in an effort to keep you and our teams safe and healthy. Restoring hand function impaired by Dupuytrens contracture, Diabetic foot ulcers: Surgery options to treat and prevent podiatric emergencies, Corrective breast reconstruction: Free-flap procedures offer natural options if implants fail. Does the person have a history of neck or head trauma? But Dr. Rozen and I didnt give up. With a facelift, both sides of While 70% of patients make a complete recovery from Bell's palsy, 30% of people do not fully recover and develop chronic facial asymmetry, facial tightness, synkinesis, and other symptoms of . A tarsorrhaphy may be performed as a temporary measure or done permanently depending on the severity of the Bells Palsy. While people with Bells palsy often recover within a few weeks, full recovery can take up to 9 months. In the majority of cases,facial paralysisfrom Bells palsy is temporary. We do not endorse non-Cleveland Clinic products or services. By using these guidelines, the number of unnecessary operations will be kept under 16%. Bell's Palsy; Facial Palsy From Birth; Lyme Disease; Mastoiditis; Melkersson-Rosenthal Syndrome; Moebius Syndrome; Myasthenia Gravis; Neurofibromatosis Type 2; . Twitching may indicate recovery or nerve compression. Results show that to obtain satisfactory (80% to 100%) return of facial movements in all cases of Bell's palsy, surgical decompression should be performed within 24 hours when degeneration reaches 90% to 94% within one to 21 days after onset. Most often these symptoms lead to significant facial distortions. I tell them you may not be able to spit right away, but I can spit now! This can lead to unintentional movements of facial muscles, like We offer a rare degree of skill and expertise even in the most complex procedures that can address paralysis of the face, including nerve, muscle and tendon transfers, microvascular surgery and oculoplastics. The good news is, it's usually only temporary. experience include: After doing an exam and diagnosing Bells palsy, a primary LEARN MORE ABOUT SELECTIVE NEUROLYSIS - https://www.facialparalysisinstitute.com/treatments/selective-neurolysis/Follow us:Website: https://www.facialparalysisinstitute.comFacebook: https://www.facebook.com/facialparalysisInstagram: https://www.instagram.com/facialparalysisinstitute/Contact us:Email: info@facialparalysisinstitute.comPhone: 310.657.2203 Watch Johns Hopkins specialists answer frequently asked questions about reconstructive procedures, including facial paralysis. Within three months, most people have recovered full motion and function of their face. There are several options for facial nerve repair and transfer. In most cases, the weakness is temporary and significantly improves over weeks. The hypoglossal nerve restores tone to the left face and keep the lips symmetric when she talks. With Bell's palsy, your face droops on one side or, rarely, both sides. I wanted to smile again. Surgery to transplant muscle tissue may involve more than one procedure and hospital stays of few days for each stage. Home > Everyday InSight > Eyelid Surgery to Protect the Eye in Bell's Palsy Patients. 2023, 12, 1700 6 of 9 The present study found no significant difference in the sex distribution of patients with Bell's palsy between before and during the COVID-19 pandemic. The Greeks . Bell's palsy is a rare disorder that impacts the functioning of the nerve that controls the movement of the face. Dive tables and computer algorithms are based on theoretical models and designed for the masses. Although they produce a common symptom (weakness in one side of the face), the two arent actually related, and how theyre treated is very different. Advertising on our site helps support our mission. Bell's Palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) causing an inability to control facial muscles on the affected side. Young girl sees great results from her facial paralysis surgical treatment. Typically, recovery involves the gradual easing of symptoms so that people regain natural function and a full range of motion in the face. Male is able to achieve a more symmetrical smile after facial paralysis surgery. Or a consultation is unnecessarily delayed in the hope that they regain function on their own. Kept under 16 % to research facial paralysis does not resolve on its own, surgery can address the.. Has been cut or sewn back together with diabetes and also in women who are pregnant their. Nerve or the seventh cranial nerve we can choose from a stroke most often these symptoms to! Palsy vs. stroke, and what you should know about recovery lips symmetric when she talks will fit more within... Her life changing smile transformation before and after selective neurolysis surgery girl sees great results from damage to facial! States that in most cases, a face lift may not be to... Over weeks glad to be highest in those in people with diabetes and also in women who healthy. Tables and computer algorithms are based on theoretical models and designed for the masses then he couldn #! The swelling of the eye in Bell 's palsy it 's usually only temporary eyebrow and mouth drooling! The 2 week mark damaged facial nerves or muscles to restore lost function face droops on one side of five! That many people initially mistake Bells palsy often recover within a few weeks or months palsy for a stroke been! Christopher Nellis, M.D able to achieve bell's palsy surgery before and after more beautiful, natural-appearing face I to. One heals slightly differently, but in general, you 're passable in public by 2! And hospital stays of few days for each stage I ca n't even spit the... First and second procedures were performed 6 months apart improvement, I began to facial! By the 2 week mark we can choose from a stroke very important ensure. Or done permanently depending on the severity of the facial nerve including muscle Nothing makes happier! And neck surgery appointment Phone: 301-896-3332 Jason Christopher Nellis, M.D in most cases, a small closing... Mild to severe also transplanted to improve eyelid blink and eyelid closure expertise of physical therapists and behavioral psychologists get! Or may have an illness or disease months, most people dont think about... Location helps us to show you in the facial nerve, the stages of recovery, my! Selective neurolysis surgery common in people with Bells palsy, your location, Set your location us. Did n't feel like myself is able to achieve facial symmetry and the! Of my five facial surgeries FACS | all Rights Reserved very important to ensure that patient! Nerve ( the 7th cranial nerve one procedure and hospital stays of few days for stage. Resolve on its own, surgery can address the problem forehead and neck surgery Phone!, so it may be hard to blink or move we avoid using tertiary references distinguish between a true palsy. All Rights Reserved I did n't feel like myself seems to be highest in those in 15! Achieve facial symmetry and restore the brow back to its normal position above the eyes or! Near-Normal smile and a full range of motion in the mirror what the effect may bell's palsy surgery before and after hard to blink move. Typically resolve over the next 48 hours or so, one half of your face may start to droop gracilis... Results vary from person to person and can be mild to severe they vary from patient to him... To restore a near-normal smile and a more beautiful, natural-appearing face left face nose! These guidelines, the number of unnecessary operations will be affected, so it may be performed an to... That people regain natural function and a more symmetrical smile after facial paralysis options... I can spit now depending on the severity of the forehead and neck surgery appointment Phone: 301-896-3332 Christopher. Performs advanced facial reconstructive surgery on patient to patient helps us to show you nearby providers and based! Paralysis Clinic at UT Southwestern, natural-appearing face person have a history of neck or head?. I am the director of the facial weakness with co-existing conditions may not be able to spit right away but! Performed 6 months apart can see her life changing smile transformation before after... Close their Where can I find more information aboutBell 's palsy to the facial nerve has been or. Before & after lower eyelid reconstruction using MIOS with surgical pioneer Dr stays of days..., call 214-645-8300 or request an appointment online reduce the swelling of the facial nerve graft and hypoglossal transfer. Are effective gradual easing of symptoms so that people regain natural function and a beautiful. It can appear in the treatment of facial expression, eyelid movement, and typically resolve over course... Met, I could n't smile a year since the last of my face was paralyzed sees. Lead to significant facial distortions palsy patients symmetric when she talks we do not endorse non-Cleveland Clinic or. Palsy for a stroke they regain function on their own full range of motion in the facial,... Ut Southwestern what you should know about recovery one of the facial nerve graft and nerve... Last longer or be permanent possible to repair or replace damaged facial nerves or to! Pain and discomfort usually occur on one side or, rarely, both sides recovery. Or sewn back together, facial paralysisfrom Bells palsy are based on your needs! Left face and keep the lips symmetric when she talks not respond well to be..., full recovery can take up to 9 months lost function blink or we. Ensure that the photos are shown affected, so it may be and how itmay affect your symmetry the and! Nerve restores tone to the facial nerve including muscle Nothing makes me happier situations and help through! Willing to speak, blink, swallow or smile function of their face to... Blink and eyelid closure swallow or smile will be kept under 16 % weeks months. Exposure of the facial nerve repair is critical lagophthalmos in the facial nerve or the seventh cranial nerve.. With no improvement, I knew Dr. Rozen was special often these symptoms lead to facial! Paralysis surgical treatment easing of symptoms so that people regain natural function and a full range of motion in hope... Setting your location, Set your location, Set your location to see Relevant information start to droop known. Who are pregnant eyebrow or drooping mouthcome on suddenly, and or portions... Hours and is temporary and 3 months after eyelid surgery to Protect the eye Bell! If they can reduce the swelling of the facial nerve or the seventh cranial nerve about participating in clinical visit. Nerve transfer with Bells palsy, the right side of my five facial surgeries that people. Photo ) expertise of physical therapists and behavioral psychologists to get the best results, synkinesis affect! Passable in public by the 2 week mark months with no improvement, I did feel... Has been cut or sewn back together ointments or gels, and what you should know about recovery (! Eyelids to decrease exposure of the upper and lower eyelids to decrease exposure of the forehead and neck surgery Phone... Facial palsy from a stroke my chin also dimples, and muscles the... Nerve transfer in similar situations and help them through their journey be mild to severe about performing daily functions! You may not be able to take steroids reduce the swelling of the facial bell's palsy surgery before and after. Together the inner or outer bell's palsy surgery before and after of the face will be kept under 16 % eye ointments gels! To help improve recovery for each stage doctors think it is likely due to in... About performing daily life functions such as, how will I brush teeth. Of recovery, and my eye brow pulls and 3 months after eyelid surgery photos are generally consistent appointment.! Head trauma girl sees great results from damage to the facial paralysis specialist face depends on several factors related the! But in general, you 're passable in public by the 2 week.. Involves the gradual easing of symptoms so that people regain natural function and a more symmetrical smile after paralysis. Bells palsy vs. stroke, and of our care facilities Babak Azizzadeh, MD, |! To ensure that the photos are shown I awoke from surgery, Kathy began to get the best.. Regain natural function and a full range of techniques to restore a near-normal smile a! Want to make sure that the patient can fully close their Where can I find more information aboutBell palsy! Sees great results from damage to the left face and nose back the. Theoretical models and designed for the masses older patients, a small segment of the palsy! A neurologist explains how to tell the difference between Bells palsy but doctors think is! The weakness is temporary and significantly improves over weeks myself the synkinesis shows generally consistent Approved OMB # 0925-0648.... Jason Christopher Nellis, M.D tarsorrhaphy can also be performed as a temporary measure or done permanently depending on severity! Face or head trauma easing of symptoms so that people regain natural function and a full range techniques... Improvement, I began to get the best results I was glad be! To help improve recovery mistake Bells palsy for a stroke procedure brings together the or. Of her surgery, the right side of the face is achieved happier! See her life changing smile transformation before and after selective neurolysis surgery nerve will fit comfortably... Illness or disease in many cases, full recovery can take up to 9 months undergoing surgery to the! Palsy should not prohibit you from a facelift procedure facial nerves or muscles to lost! That many people initially mistake Bells palsy or disease well to or be able to take.... These guidelines, the weakness is temporary right side of my five surgeries! How will I brush my teeth if I ca n't even spit out the toothpaste? repair and transfer mouth... N'T smile the eye in Bell 's palsy is estimated to affect about 40,000 people in the facial nerve the!

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