Bell s palsy
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Bell’s Palsy. Dr. Ali Tahir. Facial nerve. Sir Charles Bell (1774-1842) first studied the facial nerve anatomy A mixed nerve, with motor, sensory, special sensory & secretomotor fibers Motor  muscles of facial expression Sensory  concha and retro-auricular skin

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Bell’s Palsy

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Bell s palsy

Bell’s Palsy

Dr. Ali Tahir


Facial nerve

Facial nerve

  • Sir Charles Bell (1774-1842) first studied the facial nerve anatomy

  • A mixed nerve, with motor, sensory, special sensory & secretomotorfibers

  • Motor  muscles of facial expression

  • Sensory  concha and retro-auricular skin

  • Special Sensory  taste sensation

  • Secretomotor  lacrimal, sublingual, submandibular glands & some in nose & palate


Branches

Branches

  • Greater superficial petrosal nerve:

  • Nerve to stapedius:

  • Chorda tympani:

  • Communicating branch:

  • Posterior auricular nerve:

  • Muscular branches:

  • Peripheral branches: “Pesanserinus”


Bell s palsy1

Bell’s palsy

Bells palsy is an acute lower motor neuron paralysis of the face

  • Idiopathic

  • Diagnosis of exclusion

  • 10-30 per 100,000

  • Usually young adults

  • Peripheral neuropathy


Pathophysiology

Pathophysiology

  • Exact cause unknown

  • Inflammation/oedema of facial nerve with demyelination, usually in stylomastoid canal

  • May be immunologically mediated & associated with infection, usually HSV

  • Other causative micro-organisms can be VZV, EBV, CMV, HHV-6, HIV, HTLV-1 or bacterial otitis media, lyme disease

  • Vascular ischemia


Predisposing factors

Predisposing factors

  • Pregnancy

  • Hypertension

  • Diabetes

  • Lymphoma

  • Hereditary


Clinical features

Clinical Features

  • Twitching, weakness, paralysis of face, dryness of eyes/mouth, disturbance of taste/hearing

  • Acute onset

  • Generally Unilateral

  • Acute onset < 48 hours

  • Paralysis of upper and lower face

  • Diminished blinking

  • Dryness, erosion, ulceration of cornea & potential loss of the eye


Clinical features1

Clinical features

  • occasionally:

    • Pain in ear or jaw may precede the palsy

    • Facial numbness

    • If lesion is proximal to stylomastoid canal, there may be hyperacusis, loss of taste/lacrimation

    • Upto 10% have family history

    • Upto 10% have recurrent episodes


Bell s palsy2

Bell’s palsy


Bell s palsy3

Bell’s palsy


Diagnosis

Diagnosis

  • Exclude other causes of facial palsy such as

    • Stroke

    • Trauma to facial nerve

    • Tumours affecting the facial nerve

    • Inflammatory disorder affecting the facial n.

      • Multiple sclerosis

      • Connective tissue disease

      • Sarcoidosis

      • MelkerssonRoenthal Syndrome


Examination

Examination

  • A full neurological examination to exclude a stroke or lesions involving other cranial nerves

  • Examination of facial nerve

    • Corneal reflex

    • Close eyes against resistance

    • Raise eyebrows

    • Raise lips to show teeth

    • Try to whistle


Examination1

Examination

  • Ear & mouth examination to rule out Ramsay-Hunt Syndrome which causes lesions in the palate & ipsilateral ear & facia palsy

  • Ear examination for any discharge or middle ear infections


Investigations

Investigations

  • Test for degree of nerve damage

    • Facial nerve stimulation

    • Needle electro-myography

  • Test for loss of hearing

    • Pure tone audiometry

  • Test for loss of taste

  • Test for balance

  • Schirmer’s test

  • CT/MRI to rule out any tumour

  • B.P

  • Blood complete


Investigations1

Investigations

  • Blood sugar

  • Tests for HSV, HIV or other viral infections

  • Serum ACE to rule out sarcoidosis

  • Serum ANA to exclude connective tissue disease

  • ELIZA to rule out lyme disease


Management

Management

  • Observation

  • Upto 85% improve spontaneously within a few weeks

  • Medical treatment

    • Steroid such as prednisolone (80-90% recovery)

    • Anti-viral agents (aciclovir)

  • Facial rehabilitaion


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