Bell's palsy
Background
- Dysfunction of peripheral CN VII of unknown cause due to Inflammation at geniculate ganglion [1]
- 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)
- 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)[2]
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)[2]
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
Steroids[2]
- Level B evidence
- Prednisone 60-80mg qday x1wk[3]
Antivirals
- for patients <72 hours of symptom onset
- Valacyclovir 1000mg TID x1wk[3] 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:[2]
- 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