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. 1982 Jul;45(7):652–655. doi: 10.1136/jnnp.45.7.652

Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy?

P Pecket, A Schattner
PMCID: PMC491483  PMID: 7119834

Abstract

In a series of 126 patients with Bell's palsy, chemical or overt diabetes mellitus was found in 39% of the cases. A high frequency of disturbances of taste was found in the patients who had no diabetes (83%), as compared to only 14% of diabetic patients whose taste was affected (p less than 0 .001). Thus, the usual site of facial nerve lesion in diabetics appears to be distal to the chorda tympani, while in patients whose glucose tolerance is normal, no such selectivity exists. This may only be explained by a diabetes-related pathogenesis and a vascular rather than a generalised "metabolic" impairment is postulated, leading to a localised facial nerve ischaemia in the distal part of the Fallopian canal. Thus, some cases of Bell's palsy may in fact be a diabetic mononeuropathy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adour K. K., Bell D. N., Wingerd J. Bell palsy. Dilemma of diabetes mellitus. Arch Otolaryngol. 1974 Feb;99(2):114–117. doi: 10.1001/archotol.1974.00780030120009. [DOI] [PubMed] [Google Scholar]
  2. Adour K. K., Byl F. M., Hilsinger R. L., Jr, Kahn Z. M., Sheldon M. I. The true nature of Bell's palsy: analysis of 1,000 consecutive patients. Laryngoscope. 1978 May;88(5):787–801. doi: 10.1002/lary.1978.88.5.787. [DOI] [PubMed] [Google Scholar]
  3. Adour K. K. Cranial polyneuritis and Bell palsy. Arch Otolaryngol. 1976 May;102(5):262–264. doi: 10.1001/archotol.1976.00780100048003. [DOI] [PubMed] [Google Scholar]
  4. Adour K. K., Wingerd J. Idiopathic facial paralysis (Bell's palsy): factors affecting severity and outcome in 446 patients. Neurology. 1974 Dec;24(12):1112–1116. doi: 10.1212/wnl.24.12.1112. [DOI] [PubMed] [Google Scholar]
  5. Adour K., Wingerd J., Doty H. E. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell's palsy). Diabetes. 1975 May;24(5):449–451. doi: 10.2337/diab.24.5.449. [DOI] [PubMed] [Google Scholar]
  6. Anson B. J., Warpeha R. L., Donaldson J. A., Rensink M. J. The facial nerve, sheath and blood supply in relation to the surgery of decompression. Ann Otol Rhinol Laryngol. 1970 Aug;79(4):710–727. doi: 10.1177/000348947007900404. [DOI] [PubMed] [Google Scholar]
  7. BLUNT M. J. The blood supply of the facial nerve. J Anat. 1954 Oct;88(4):520–526. [PMC free article] [PubMed] [Google Scholar]
  8. Calcaterra T. C., Rand R. W., Bentson J. R. Ischemic paralysis of the facial nerve: a possible etiologic factor in Bell's palsy. Laryngoscope. 1976 Jan;86(1):92–97. doi: 10.1288/00005537-197601000-00019. [DOI] [PubMed] [Google Scholar]
  9. Chaco J. Subclinical peripheral nerve involvement in unilateral Bell's palsy. Am J Phys Med. 1973 Aug;52(4):195–197. [PubMed] [Google Scholar]
  10. Clarke J. A. An x-ray microscopic study of the arterial supply to the facial nerve. J Laryngol Otol. 1965 Nov;79(11):987–994. doi: 10.1017/s0022215100064689. [DOI] [PubMed] [Google Scholar]
  11. DREYFUS P. M., HAKIM S., ADAMS R. D. Diabetic ophthalmoplegia; report of case, with postmortem study and comments on vascular supply of human oculomotor nerve. AMA Arch Neurol Psychiatry. 1957 Apr;77(4):337–349. [PubMed] [Google Scholar]
  12. ELLENBERG M., KRAINER L. Diabetic neuropathy; review of literature and a case report with post-mortem findings. Diabetes. 1959 Jul-Aug;8(4):279–283. doi: 10.2337/diab.8.4.279. [DOI] [PubMed] [Google Scholar]
  13. FAGERBERG S. E. Diabetic neuropathy: a clinical and histological study on the significance of vascular affections. Acta Med Scand Suppl. 1959;345:1–97. [PubMed] [Google Scholar]
  14. FAJANS S. S., CONN J. W. The early recognition of diabetes mellitus. Ann N Y Acad Sci. 1959 Sep 25;82:208–218. doi: 10.1111/j.1749-6632.1959.tb44901.x. [DOI] [PubMed] [Google Scholar]
  15. Fraser D. M., Campbell I. W., Ewing D. J., Clarke B. F. Mononeuropathy in diabetes mellitus. Diabetes. 1979 Feb;28(2):96–101. doi: 10.2337/diab.28.2.96. [DOI] [PubMed] [Google Scholar]
  16. GOLDENBERG S., ALEX M., JOSHI R. A., BLUMENTHAL H. T. Nonatheromatous peripheral vascular disease of the lower extremity in diabetes mellitus. Diabetes. 1959 Jul-Aug;8(4):261–273. doi: 10.2337/diab.8.4.261. [DOI] [PubMed] [Google Scholar]
  17. GOLDSTEIN J. E., COGAN D. G. Diabetic ophthalmoplegia with special reference to the pupil. Arch Ophthalmol. 1960 Oct;64:592–600. doi: 10.1001/archopht.1960.01840010594018. [DOI] [PubMed] [Google Scholar]
  18. GYDELL K., SKANSE B. A rare type of femoral-sciatic neuropathy in diabetes mellitus. Acta Med Scand. 1956 Nov 5;155(6):463–468. doi: 10.1111/j.0954-6820.1956.tb14395.x. [DOI] [PubMed] [Google Scholar]
  19. Groves J., Gibson W. P. Significance of taste and electrogustometry in assessing the prognosis of Bell's (idiopathic) facial palsy. J Laryngol Otol. 1974 Sep;88(9):855–861. doi: 10.1017/s0022215100079469. [DOI] [PubMed] [Google Scholar]
  20. JOHNSON E. W., WAYLONIS G. W. FACIAL NERVE CONDUCTION DELAY IN PATIENTS WITH DIABETES MELLITUS. Arch Phys Med Rehabil. 1964 Mar;45:131–139. [PubMed] [Google Scholar]
  21. Korczyn A. D. Bell's palsy and diabetes mellitus. Lancet. 1971 Jan 16;1(7690):108–109. doi: 10.1016/s0140-6736(71)90842-7. [DOI] [PubMed] [Google Scholar]
  22. Kudo H., Nori S. Topography of the facial nerve in the human temporal bone. Acta Anat (Basel) 1974;90(3):467–480. doi: 10.1159/000144351. [DOI] [PubMed] [Google Scholar]
  23. LARSON D. L., AUCHINCLOSS J. H. Multiple symmetric bilateral cranial nerve palsies in patients with unregulated diabetes mellitus; report of three cases. Arch Intern Med (Chic) 1950 Feb;85(2):265–271. doi: 10.1001/archinte.1950.00230080069003. [DOI] [PubMed] [Google Scholar]
  24. Lasjaunias P., Moret J., Doyon D., Vignaud J. Exploration artériographique du nerf facial intra-pétreux: Embryologie et aspect radio-anatomiques normaux. Neuroradiology. 1978;16:246–248. doi: 10.1007/BF00395262. [DOI] [PubMed] [Google Scholar]
  25. Lasjaunias P., Moret J. Normal and non-pathological variations in the angiographic aspects of the arteries of the middle ear. Neuroradiology. 1978 Aug 18;15(4):213–219. doi: 10.1007/BF00327529. [DOI] [PubMed] [Google Scholar]
  26. Lundgren A., Odkvist L. M., Hendriksson K. G., Larsson L. E., Karlberg B. E., Jerlvall L. Facial palsy in diabetes mellitus--not only a mononeuropathy? Adv Otorhinolaryngol. 1977;22:182–189. doi: 10.1159/000399502. [DOI] [PubMed] [Google Scholar]
  27. May M., Hardin W. B. Facial palsy: interpretation of neurologic findings. Laryngoscope. 1978 Aug;88(8 Pt 1):1352–1362. doi: 10.1288/00005537-197808000-00019. [DOI] [PubMed] [Google Scholar]
  28. May M., Hardin W. B., Sullivan J., Wette R. Natural history of bell's palsy: the salivary flow test and other prognostic indicators. Laryngoscope. 1976 May;86(5):704–712. doi: 10.1288/00005537-197605000-00011. [DOI] [PubMed] [Google Scholar]
  29. May M., Schlaepfer W. M. Bell's palsy and the chorda tympani nerve: a clinical and electron microscopic study. Laryngoscope. 1975 Dec;85(12 Pt 1):1957–1975. doi: 10.1288/00005537-197512000-00002. [DOI] [PubMed] [Google Scholar]
  30. McGovern F. H. A review of the experimental aspects of Bell's palsy. Laryngoscope. 1968 Mar;78(3):324–333. doi: 10.1288/00005537-196803000-00003. [DOI] [PubMed] [Google Scholar]
  31. Moret J., Lasjaunias P., Doyon D., Vignaud J. Etude angiographique des paralysies faciales. Neuroradiology. 1978;16:308–310. doi: 10.1007/BF00395284. [DOI] [PubMed] [Google Scholar]
  32. RICHARDS R. L. Ischaemic lesions of peripheral nerves: a review. J Neurol Neurosurg Psychiatry. 1951 May;14(2):76–87. doi: 10.1136/jnnp.14.2.76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. ROSS A. T. Recurrent cranial nerve palsies in diabetes mellitus. Neurology. 1962 Mar;12:180–185. doi: 10.1212/wnl.12.3.180. [DOI] [PubMed] [Google Scholar]
  34. RUCKER C. W. Paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1958 Dec;46(6):787–794. doi: 10.1016/0002-9394(58)90989-9. [DOI] [PubMed] [Google Scholar]
  35. Raff M. C., Sangalang V., Asbury A. K. Ischemic mononeuropathy multiplex associated with diabetes mellitus. Arch Neurol. 1968 May;18(5):487–499. doi: 10.1001/archneur.1968.00470350045004. [DOI] [PubMed] [Google Scholar]
  36. Safman B. L. Bilateral pathology in Bell's palsy. Arch Otolaryngol. 1971 Jan;93(1):55–57. doi: 10.1001/archotol.1971.00770060087010. [DOI] [PubMed] [Google Scholar]
  37. Spritz N. Nerve disease in diabetes mellitus. Med Clin North Am. 1978 Jul;62(4):787–798. doi: 10.1016/s0025-7125(16)31773-4. [DOI] [PubMed] [Google Scholar]
  38. Ward J. D., Barnes C. G., Fisher D. J., Jessop J. D., Baker R. W. Improvement in nerve conduction following treatment in newly diagnosed diabetics. Lancet. 1971 Feb 27;1(7696):428–430. doi: 10.1016/s0140-6736(71)92415-9. [DOI] [PubMed] [Google Scholar]
  39. Winegrad A. I. Diabetic neuropathy. N Engl J Med. 1972 Jun 8;286(23):1261–1262. doi: 10.1056/NEJM197206082862310. [DOI] [PubMed] [Google Scholar]

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