Difference between revisions of "Bell's palsy"

(Work Up)
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==Treatment==
 
==Treatment==
#Cornea
+
#Cornea eye protection (Level X)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
 
##Artificial tears qhr while pt is awake AND
 
##Artificial tears qhr while pt is awake AND
 
##Ophthalmic ointment at night
 
##Ophthalmic ointment at night
 
##Protective glasses or goggles
 
##Protective glasses or goggles
#Corticosteroids
+
#Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
##Give to all pts
+
##Corticosteroids
##Prednisone 60-80mg qday x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref>
+
###Prednisone 60-80mg qday x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref>
#Antivirals
+
##Antivirals
##Controversial efficacy; may have benefit in pts w/ severe palsy
+
###Valacyclovir 1000mg TID x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref>
##Valacyclovir 1000mg TID x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref>
+
####Or, Acyclovir 400mg 5x per day x 1wk
###Or, Acyclovir 400mg 5x per day x 1wk
 
  
 
==Disposition==
 
==Disposition==
 
*Discharge with ophtho f/u for monitoring of the affected cornea
 
*Discharge with ophtho f/u for monitoring of the affected cornea
 +
*Refer to a facial nerve specialist for:<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</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==
 
==See Also==

Revision as of 21:39, 8 April 2014

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

  1. Lyme Disease
  2. HIV
  3. Otitis Media
  4. Sarcoidosis (esp if b/l)

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

  1. Cornea eye protection (Level X)[2]
    1. Artificial tears qhr while pt is awake AND
    2. Ophthalmic ointment at night
    3. Protective glasses or goggles
  2. Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)[3]
    1. Corticosteroids
      1. Prednisone 60-80mg qday x1wk[4]
    2. Antivirals
      1. Valacyclovir 1000mg TID x1wk[5]
        1. 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:[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

  1. Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
  2. Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
  3. Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
  4. UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
  5. UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
  6. Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.