Bells Palsy Disease

BASICS

DESCRIPTION

Paralysis or weakness of the muscles supplied by the facial nerve, typically unilaterally, due to inflammation and swelling of the facial nerve within the facial canal

Bell's palsy: Idiopathic
Ramsay Hunt syndrome: Bell's palsy associated with vesicles within the outer ear canal or behind the ear, due to herpes zoster infection
Facial diplegia: The simultaneous development of bilateral Bell's palsy is highly unusual and conditions such as Guillain-Barré syndrome and chronic meningitis should be considered as possible explanations.
System(s) affected: Nervous
Genetics: There is a familial tendency toward Bell's palsy
Incidence/Prevalence in USA: 25 in 100,000
Predominant age: Affects all ages. Most common in individuals over 30 years of age.
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Sudden onset or onset over days
Unilateral total or partial paralysis of the facial muscles
Mild "numbness" on the affected side
Ipsilateral inadequate tear production; ipsilateral tearing
Ipsilateral loss of taste
Ipsilateral ear ache

CAUSES

Bell's palsy
- Inflammation of the facial nerve within the facial canal
- Exposure to cold
- Probably viral
Ramsay Hunt syndrome
- Herpes zoster
- Rarely Herpes simplex
Diabetes mellitus

RISK FACTORS

Age over 30
Exposure to cold

DIAGNOSIS

LABORATORY

CSF protein - mildly elevated in 1/3 of cases
CSF cells - mildly elevated in 10% of cases, with a mononuclear cell predominance

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Edema of the facial nerve
Occasional hemorrhagic streaks
Dilatation of the vasa nervorum
Infiltration of mononuclear cells in some cases
Atrophy of the facial nerve

SPECIAL TESTS

Electromyography in the first three weeks after onset of the condition manifests a decreased or absent interference pattern on the affected side, which reflects a reduction or absence of function of the facial motor units. After three weeks, denervation potentials (fibrillations) are typically seen. Eventually, with recovery, low-amplitude, short-duration, polyphasic (nascent) motor units may appear in previously denervated areas. Recovery may be incomplete.
Nerve conduction velocities may reveal absence or attenuation of the evoked potential, slowing of the conduction velocity or a normal conduction velocity and amplitude (variable due to varying severity and duration of condition)
Blink reflex - the electrophysiological equivalent of the corneal reflex, should be abnormal in all cases

IMAGING

MRI to rule out posterior fossa lesions and intracanalicular 8th nerve tumors if clinical suspicion is high. Bell's palsy can be mimicked by small brainstem strokes.

DIAGNOSTIC PROCEDURES

Spinal tap may reveal an elevated protein or cell count, however, it is usually not necessary

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient except for surgical decompression (very controversial and largely abandoned)

GENERAL MEASURES

Close and patch ipsilateral eye
Methylcellulose eye drops

SURGICAL MEASURES

N/A

ACTIVITY

Fully active. Due to patching, use caution in activities requiring keen depth perception.

DIET

No special diet

PATIENT EDUCATION

Explanation and reassurance when appropriate

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Unmasking of subclinical infection (such as tuberculosis) by steroid usage
Steroid-induced psychological disturbances
Steroid-induced avascular necrosis of hips, knees and/or shoulders
Corneal abrasion and ulceration

EXPECTED COURSE AND PROGNOSIS

Complete, partial or no recovery of function. Patients with partial denervation typically fully recover. Patients with total denervation usually partially recover, but may exhibit aberrant regeneration (e.g., crocodile tears) or hemifacial spasm as long term complications.

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Use steroids cautiously in pregnancy. Consult with obstetrician.

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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