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

  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.