Bell's Palsy

Question 1

What are the differential diagnoses of Bell’s palsy?

Answer 1

1. Infectious disease - herpes zoster, Lyme’s disease and Epstein- Barr, Otitis Media, HIV
2. Infiltrates - invasive tumor or Sarcoidosis

Question 2

What tests do you take to diagnose Bell’s palsy?

Answer 2

CBC
Erythrocyte sedimentation rate
EBV/Lymes titer
HIV test

Question 3

Describe the management of Bell’s palsy in children?

Answer 3

1. Artificial tears to left eye 2 drops tid
2. Eye patch during night time if eye is not closing properly.
3. Educate patient and family about disease process, therapeutic interventions and anticipated course of the disease.
4. Follow-up in 1 week for reevaluation with pediatric neurology or sooner if any other problems occur

Question 4

Describe the management of Bells palsy in adults?

Answer 4

medication and physiotherapy with facial exercises
> Complete resolution of symptoms in 2 weeks
Note: recovery occurs in most patients without treatment

Question 5

What is Bell’s palsy?

Answer 5

• The most common disorder of the facial nerve
• It is an acute lower motor neurone disorder (LMNL) and is the most common
  > It is associated with viral infection and facial nerve swelling within the facial canal but in most cases cause is not known

Question 6

Describe the presentation of Bell’s palsy?

Answer 6

1. painless loss of power on one side of the face
2. The patient becomes very aware of his facial appearance and may have difficulties smiling, speaking or initiating swallowing and closing the eye on the affected side
3. It associated ache around the ear.

Question 7

What are the functions of the facial nerve?

Answer 7

1. Parasympathetic innervation to the lacrimal gland as well as mucous glands of thenasal cavity,maxillary sinusandpalate
2. Nerve to stapedius muscle
3. Special visceral afferent/taste sensationfrom the anterior two-thirds of thetongue
4. control Muscles of facial expression

Question 8

What is the medication used to manage Bell’s palsy?

Answer 8

1. Steroids
   > prednisolone 60 mg/po/daily for 7 days
2. Antiviral
   > aciclovir 400 mg/po/tds for 7 days

Question 9

How do you prevent corneal damage in Bells Palsy?

Answer 9

1. artificial tears
2. eye cover patch
3. glasses with side protection
4. Severe cases may need a temporary tarsorrhaphy.

Question 10

What are the signs of Bells palsy?

Answer 10

1. drooping of the corner of the mouth
2. loss of eye closure & absence of wrinkling
   > loss of eye closure and wrinkling distinguish it from an UMN facial nerve lesion

Question 11

Frequency of Bell’s palsy is increased in?

Answer 11

HIV infection

> patients should have a screening HIV test