Bell’s palsy

Last Updated on by FRCEM Intermediate

Bell’s palsy: Acute idiopathic unilateral paralysis of the facial nerve.

Etiology is most commonly vascular, inflammatory or viral. Risk factors include pregnancy, obesity, hypertension and diabetes

Signs/Symptoms

  • Drooping of the eyelid or an inability to completely close the eye
  • Drooping of the corner of the mouth
  • Unable to raise an eyebrow or wrinkle the forehead
  • Dry eye with epiphora (excessive tearing)
  • Ipsilateral loss of taste sensation
  • Hyperacusis

Differential diagnosis

  • Central Lesion of the facial nucleus of the brain stem, UMNL (Lower motor neuron – forehead is involved)
  • Ramsy Hunt syndrome (Herpes Zoster oticus), painful rash in ear
  • Ramsay-Hunt syndrome
  • Cholesteatoma
  • Parotid tumour
  • Malignant otitis externa
  • Otitis media
  • Lyme disease
  • Guillain-Barre syndrome
  • Sarcoidosis
  • Note: Can present as a polyneuritis involving trigeminal, glossopharyngeal, 2nd cervical or vagal nerve.

Course and treatment

  • Usually self-limiting and resolves after 12 weeks.
  • Steroids help in severe cases (early complete paralysis) improves recovery time.
  • Most important supportive treatment is eye protection!

 

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