Bell's Palsy

Question 1

What is Bell’s palsy defined as?

Answer 1

An acute, unilateral, idiopathic, facial nerve paralysis

Question 2

Aetiology of Bell’s palsy?

Answer 2

The aetiology is unknown although the role of the herpes simplex virus has been investigated previously. The peak incidence is 20-40 years and the condition is more common in pregnant women.

Question 3

Clinical features of Bell’s palsy?

Answer 3

lower motor neuron facial nerve palsy → forehead affected
- in contrast, an upper motor neuron lesion ‘spares’ the upper face

patients may also notice
- post-auricular pain (may precede paralysis)
- altered taste
- dry eyes
- hyperacusis

Question 4

Management of Bell’s palsy

Answer 4

there is consensus that all patients should receive oral prednisolone within 72 hours of onset of Bell’s palsy

there is an ongoing debate as to the value of adding in antiviral medications CKS
- NICE Clinical Knowledge Summaries state: ‘Antiviral treatments alone are not recommended. Antiviral treatment in combination with a corticosteroid may be of small benefit, but seek specialist advice if this is being considered.’

• UpToDate recommends the addition of antivirals for severe facial palsy

Eye care is important to prevent exposure keratopathy
- prescription of artificial tears and eye lubricants should be considered
- If they are unable to close the eye at bedtime, they should tape it closed using microporous tape

Question 5

Follow-up for Bell’s palsy

Answer 5

if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

a referral to plastic surgery may be appropriate for patients with more long-standing weakness e.g. several months

Question 6

Prognosis of Bell’s palsy?

Answer 6

most people with Bell’s palsy make a full recovery within 3-4 months

if untreated around 15% of patients have permanent moderate to severe weakness