Bell’s Palsy

  • Bell’s Palsy a unilateral facial paralysis of acute onset exclusively involving the facial nerve (CN 7).

 ETIOLOGY/ PATHOGENESIS

  • Cause is unknown
  • An immune-mediated demyelination of the facial nerve may develop due to a nonspecific vial infection.
  • Commonly associated with diabetes, pregnancy, herpes zoster, immunodeficiency

 PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS

  • Abrupt onset of facial paresis usually upon awakening  which progresses over 24-48 hours.
  • Facial paralysis may be heralded or accompanied by pain behind the ear which lasts 2-3 days.
  • Patients may complain of face feeling stiff, have difficulty eating.
  • Ipsilateral restriction of eye closure may be present.

 PERTINENT PHYSICAL EXAM FINDINGS

  • Clinical evaluation reveals no abnormalities beyond deficits in the motor function of cranial nerve VII.
  • Patients may demonstrate impairment of taste, lacrimation or hyperacusis.

 DIFFERENTIAL DIAGNOSIS

  • Tumor
  • Lyme disease
  • AIDS
  • Sarcoidosis

 DIAGNOSTIC EVALUATIONS

  • No diagnostic studies confirm the diagnosis.
  • Electromyographic evidence of denervation indicates a worse prognosis for complete recovery.

 MEDICAL MANAGEMENT

  • 60% of cases resolve spontaneously and require no treatment although the course may extend from a few days to months.
  • A course of oral prednisone may be given within 5-7 days of the onset of symptoms. However, the use of steroids is controversial.
  • Acyclovir can be considered in patients with a poor prognosis.
  • Protect eye with lubricating ointment and patch closed at night.
  • A poor prognosis is associated with severe pain and complete palsy, hyperacusis and advanced age, loss of taste, marked diminished lacrimation

SURGICAL MANAGEMENT (when applicable)

  • Not applicable

 EMERGENCY MANAGEMENT (when applicable)

  • Nor applicable

PATIENT EDUCATION/ MAINTENANCE – PREVENTION

  • Eye care: protect the eye from foreign objects and sunlight.Keep the eye well lubricated.
  • Educate the patient to report new ocular findings such as pain, discharge, or visual changes.

bells-palsy-1-8signs_of_facial_paralysis

Dr. Zachary Lahlou

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