View source for Bell's palsy

==Background==
*Dysfunction of peripheral CN 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>
*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 - AIDS (Main)|HIV]]
#[[Intracranial Hemorrhage]]
#[[Lyme Disease]]
#[[Malignant Otitis Externa]]
#[[Meningitis]]
#Neurosyphilis
#[[Otitis Media]] (acute or chronic)
#[[Parotitis]]
#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)<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>

==Clinical Features==
*Acute onset (over hours) of unilateral facial paralysis
**No forehead sparing
*Inability to raise eyebrows
**Drooping of angle of the mout
*Incomplete closure of the eyelids on the affected side
**Can lead to corneal exposure keratitis

===Associated Symptoms===
#Alterations in Taste
#Hyperacusis
#Inability to produce tears
#Subjective feeling of facial numbness although no demonstrable numbness

==Treatment==
#Cornea eye protection (Level X)<ref name="bells guidelines"></ref>
##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)<ref name="bells guidelines"></ref>
##Corticosteroids
###Prednisone 60-80mg qday x1wk<ref name="UpToDate Bells">UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref>
##Antivirals
###Valacyclovir 1000mg TID x1wk<ref name="UpToDate Bells"></ref>
####Or, Acyclovir 400mg 5x per day x 1wk

==Disposition==
*Discharge with ophtho f/u for monitoring of the affected cornea
*Refer to a facial nerve specialist for:<ref name="bells guidelines"></ref>
**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==
*[[CVA]]

==Source==
*Tintinalli

==References==
<references/> 

[[Category:Neuro]]
[[Category:Ophtho]]