Bell's palsy
Background
- Dysfunction of peripheral CN VII of unknown cause
- Maximal clinical weakness around 3wks; at least partial recovery by 6 months
- Always test CN VI function (should be normal) to rule-out CVA
Differential Diagnosis
- Amyloidosis
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
- Botulism
- CVA
- Guillain-Barré Syndrome
- HIV
- Intracranial Hemorrhage
- Lyme Disease
- Malignant Otitis Externa
- Meningitis
- Neurosyphilis
- Otitis Media (acute or chronic)
- Parotidtitis
- Ramsay Hunt syndrome
- Sarcoidosis
- Tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannomaa
- Parotid
- Sarcoma
Work Up
- Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)[1]
Clinical Features
- Acute onset (over hours) of unilateral facial paralysis
- No forehead sparing
- Mouth drawn to the non-affected side
- Incomplete closure of the eyelids on the affected side
- Can lead to corneal exposure keratitis
Treatment
- Cornea eye protection (Level X)[2]
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
- Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)[3]
Disposition
- Discharge with ophtho f/u for monitoring of the affected cornea
- Refer to a facial nerve specialist for:[6]
- New or worsening neurologic findings at any point
- Ocular symptoms developing at any point
- Incomplete facial recovery 3 months after initial symptom onset.
See Also
Source
- Tintinalli
References
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.