Bell's palsy
| LMN Facial nerve palsy - abrupt, isolated, unilateral, peripheral facial paralysis without detectable cause. | |
|---|---|
| Etiology | We often don't know, but possibly: - viral - microvascular e.g. diabetic - inflammatory |
| Clinical presentation | Rapid onset (within 72h), unilateral facial paralysis over upper AND lower half Dry eye, change in taste, hyperacusis, drooling |
| Pathogenesis | |
| Diagnostic investigations | Bell's palsy is a clinical diagnosis of exclusion. |
| Management | Prednisolone if pt presents within 72h - e.g. 50 mg daily for 10 days Advise eye care - tear substitutes, tape eye shut, safety netting for corneal injury Complications: corneal drying |
red flags - should prompt investigation into ddx
copied shamelessly from CKS:
- Sparing of brow function (ability to raise the eyebrow on the affected side) — may indicate an upper motor neurone lesion (such as stroke).
- Insidious onset, pain within facial nerve distribution, persistent facial paralysis for over 6 months, or ipsilateral hearing loss — may indicate head or neck cancer.
- Paralysis of individual branches of the facial nerve or other cranial nerve involvement.
- Parotid mass
- Uneven distribution of weakness across facial zones — if this occurs in the acute phase it is highly suggestive of a neoplasm in the parotid, or along the course of the facial nerve.
- Bilateral signs! - Lyme disease, sarcoidosis
- Vesicular or ulcerating skin lesions