Bell's palsy - Revision history

Rossdonaldson1: /* Evaluation */

2022-05-14T08:23:20Z

Evaluation

← Older revision		Revision as of 08:23, 14 May 2022
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	==Evaluation==		==Evaluation==
			===Workup===
			*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>

			===Diagnosis===
	*Clinical diagnosis		*Clinical diagnosis
	*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>		**Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Herpes zoster oticus\|Ramsay Hunt Syndrome]]
	*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Herpes zoster oticus\|Ramsay Hunt Syndrome]]		**Facial weakness progressing to paralysis over weeks to months, progressive twitching or facial spasm suggests a neoplasm affecting the facial nerve
	*Facial weakness progressing to paralysis over weeks to months, progressive twitching or facial spasm suggests a neoplasm affecting the facial nerve		**If facial paralysis + pulsatile tinnitus and hearing loss, suspect a glomus tumor or cerebellar pontine angle tumor
	*If facial paralysis + pulsatile tinnitus and hearing loss, suspect a glomus tumor or cerebellar pontine angle tumor

	==Management==		==Management==

Beren85: /* Prognosis */

2022-05-11T18:42:55Z

Prognosis

← Older revision		Revision as of 18:42, 11 May 2022
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	**71% of untreated patients recover completely		**71% of untreated patients recover completely
	**An additional 13% of untreated patients achieve near-normal function (a total of 84% achieve normal or near-normal function even without treatment)		**An additional 13% of untreated patients achieve near-normal function (a total of 84% achieve normal or near-normal function even without treatment)
			*Up to 10% of patients have a recurrence on the ipsilateral or controlateral side

	===Poor Prognostic Indicators===		===Poor Prognostic Indicators===

Beren85: /* Evaluation */

2022-05-11T18:41:44Z

Evaluation

← Older revision		Revision as of 18:41, 11 May 2022
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	*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>		*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
	*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Herpes zoster oticus\|Ramsay Hunt Syndrome]]		*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Herpes zoster oticus\|Ramsay Hunt Syndrome]]
			*Facial weakness progressing to paralysis over weeks to months, progressive twitching or facial spasm suggests a neoplasm affecting the facial nerve
			*If facial paralysis + pulsatile tinnitus and hearing loss, suspect a glomus tumor or cerebellar pontine angle tumor

	==Management==		==Management==

Elcatracho: /* Background */

2021-01-19T00:25:57Z

Background

← Older revision		Revision as of 00:25, 19 January 2021
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	*Maximal clinical weakness around 3 weeks; at least partial recovery by 6 months		*Maximal clinical weakness around 3 weeks; at least partial recovery by 6 months
	*Always test CN VI function (should be normal) to rule-out [[CVA]]		*Always test CN VI function (should be normal) to rule-out [[CVA]]
			*Bilateral Bell's palsy associated with [[Lyme disease]]

	==Clinical Features==		==Clinical Features==

Elcatracho: /* Background */

2021-01-19T00:23:27Z

Background

← Older revision		Revision as of 00:23, 19 January 2021
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	[[File:Cranial nerve VII.png\|thumb\|Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for [[stroke]] but not Bell's palsy (or other peripheral facial nerve injury).]]		[[File:Cranial nerve VII.png\|thumb\|Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for [[stroke]] but not Bell's palsy (or other peripheral facial nerve injury).]]
	*Dysfunction of peripheral [[cranial nerve]] VII of unknown cause due to Inflammation at geniculate ganglion <ref>Greco A. et al. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12 622-627</ref>		*Dysfunction of peripheral [[cranial nerve]] VII of unknown cause due to Inflammation at geniculate ganglion <ref>Greco A. et al. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12 622-627</ref>
			**Thought that may be associated with [[herpes simplex virus]]
	*Maximal clinical weakness around 3 weeks; at least partial recovery by 6 months		*Maximal clinical weakness around 3 weeks; at least partial recovery by 6 months
	*Always test CN VI function (should be normal) to rule-out [[CVA]]		*Always test CN VI function (should be normal) to rule-out [[CVA]]

Elcatracho: /* Evaluation */

2021-01-19T00:21:03Z

Evaluation

← Older revision		Revision as of 00:21, 19 January 2021
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	*Clinical diagnosis		*Clinical diagnosis
	*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>		*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
	*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Ramsay Hunt Syndrome]]		*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Herpes zoster oticus\|Ramsay Hunt Syndrome]]

	==Management==		==Management==

Elcatracho: /* Evaluation */

2021-01-19T00:20:36Z

Evaluation

← Older revision		Revision as of 00:20, 19 January 2021
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	*Clinical diagnosis		*Clinical diagnosis
	*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>		*Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy ([[EBQ:Evidence Levels\|Level C]])<ref name="bells guidelines">Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
			*Must performed detail ear exam to rule out [[otitis media\|ear infection]] and [[Ramsay Hunt Syndrome]]

	==Management==		==Management==

NadavNahumi: /* Clinical Features */

2020-03-28T22:35:14Z

Clinical Features

← Older revision		Revision as of 22:35, 28 March 2020
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	*Acute onset (over hours) of unilateral [[facial paralysis]]		*Acute onset (over hours) of unilateral [[facial paralysis]]
	**No forehead sparing		**No forehead sparing
	*Inability to raise ~~eyebrows~~		*Inability to raise eyebrow on affected side
	*Drooping of angle of the mouth		*Drooping of angle of the mouth
	*Incomplete closure of the eyelids on the affected side		*Incomplete closure of the eyelids on the affected side

Ihearttroponin: /* See Also */

2020-03-22T19:29:36Z

Ihearttroponin: /* Others */

2020-03-22T19:28:58Z

Others

← Older revision		Revision as of 19:28, 22 March 2020
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	===Others===		===Others===
	*Amyloidosis		*[[Amyloidosis]]
	*[[Botulism]]		*[[Botulism]]
	*[[Guillain-Barré Syndrome]] (bilateral palsy)		*[[Guillain-Barré Syndrome]] (bilateral palsy)
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	*[[Malignant Otitis Externa]]		*[[Malignant Otitis Externa]]
	*[[Meningitis]]		*[[Meningitis]]
	*Neurosyphilis		*[[Neurosyphilis]]
	*[[Otitis Media]] (acute or chronic)		*[[Otitis Media]] (acute or chronic)
	*[[Parotitis]]		*[[Parotitis]]

← Older revision		Revision as of 19:29, 22 March 2020
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	*[[Facial paralysis]]		*[[Facial paralysis]]
	*[[Cranial nerve abnormalities]]		*[[Cranial nerve abnormalities]]
			*[[Lyme disease]]

	==References==		==References==