Bell's Palsy

Question 1

what is bell’s palsy

Answer 1

temporary facial paralysis due to damage/trauma to CN 7 (facial)

Question 2

causes of bell’s palsey

Answer 2

• viral meningitis
• herpes simplex virus (cold sores)
• infection causing inflammation (pressure increase within fallopian canal)
• also associated with chronic middle ear infections, HTN, DM, sarcoidosis, tumors, lyme disease (common)
• may be reactivation of latent virus vs acute

Question 3

what population is bell’s palsy more common in

Answer 3

• women > men
• any age
• people with Dm or viral infections (flu/cold)

Question 4

symptoms of bell’s palsy

Answer 4

• u/l facial paralysis/weakness (rarely B/L)
• inability to blink/close eye
• taste impaired on anterior 2/3 of tongue
• impaired salivary gland secretion
• impaired tear formation (lacrimal gland)
• drooping of eyelid and corner of mouth
• impaired speech
• difficulty eating/drinking
• exaggerated perception of sound

Question 5

how to diagnose bell’s palsy

Answer 5

• dx of exclusion
• NO FOREHEAD SPARING (r/o central pathology)
• EMG
• Ramsey-Hunt: shingles virus affecting CN 7 and 8 (blisters in ears/mouth, reduced hearing/vertigo)
• lyme disease hx

Question 6

grade I house brackmann facial paralysis scale

Answer 6

normal

Question 7

grade II house brackmann facial paralysis scale

Answer 7

mild dysfunction (slight weakness, normal symmetry at rest)

Question 8

grade III house brackmann facial paralysis scale

Answer 8

moderate dysfunction (obvious but not disfiguring weakness with synkinesis, normal symmetry at rest); complete eye closure with maximal effort, good forehead movement

Question 9

garde IV house brackmann facial paralysis scale

Answer 9

moderately severe dysfunction (obvious and disfiguring asymmetry, significant synkinesis), incomplete eye clossure, moderate forehead movement

Question 10

grave V house brackmann facial paralysis scale

Answer 10

severe dysfunction (barely perceptible motion)

Question 11

grade VI house brackmann facial paralysis scale

Answer 11

total paralysis (no movement)

Question 12

treatment bell’s palsy

Answer 12

• mild cases resolve in 2 weeks
• mod/sev - high dose steroids (prednisone)
• eye protection (lubricating eye drops)
• PT (e-stim INEFFECTIVE, facial mm do not atrophy like normal skeletal mm, surface EMG, mirror effect PLUS protocol, rest, pt education)
• facial massage
• acupuncture
• decompression surgery

Question 13

what is true bell’s palsy caused by

Answer 13

viral infection