Bell Palsy (Facial Nerve Palsy)

Last updated 10.08.12

 

Definition

-  Typically unilateral facial nerve palsy

 

Features

-  Typically resolves within several months (up to a year)

-  Typically around 6 weeks

- 90% patients get full recovery

-  10% patients some degree of permanent defecit: higher risk if HTN

- Named after the physician who described it

- One of most common cranial nerve pathologies

- Increased incidence in DM & pregnancy

 

Causes

- Swelling of facial nerve as it exits the skull through the stylomastoid foramen

-  Idiopathic

- Infection?

- Viral: HSV, VZV, cold virus..

- OM

- Parotiditis

- Mastoiditis

- AID?

 

DDx

- CNS cause will effect lower muscles of face only

-  Trauma

- Stroke

- CNS Tumour

 

Associated S/S

- Onset usually over 48hrs

- Paralysis/weakness of facial muscles

-  Inability to fully close eye

- Mouth droop

- Asymtetrical eyebrow raise

-  Facial pain

- Otalgia or posterior auricular pain

- Facial numbness

- Altered taste

- Hyperacusis

 

Bells

 

Ix

-  Cranial nerve examination

- Ear exam

- +/- CT or MRI Brain: if >8 weeks then consider

 

Mx

-  Eye Care if cannot close eye

- Artificial tears

- Eye patch

- Analgesia

- Corticosteroids: Prednisolone

- Adult: 60mg/day for 6/7 then taper over another 4 days

- Children: controversial - 1mg/kg for 6/7

- Mx of suspected cause

- Surgery

-  Facial nerve decompression

- Facial nerve graft

- ... 

 

 

 

References

 

Better Health Channel: Bells Palsy

RCH Bells Palsy

eMedicine: Bells Palsy

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