Bell’s Palsy a unilateral facial paralysis of acute onset exclusively involving the facial nerve (CN 7).
- 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.
- Lyme disease
- No diagnostic studies confirm the diagnosis.
- Electromyographic evidence of denervation indicates a worse prognosis for complete recovery.
- 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.
Dr. Zachary Lahlou