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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

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
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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