Bell's Palsy

Question 1

Define Bell’s palsy

Answer 1

Acute unilateral peripheral facial nerve palsy, diagnosis of exclusion.

Question 2

What are risk factors for Bells palsy

Answer 2

Intranasal influenza vaccine
Pregnancy
URTI
Cold climate

Question 3

What is aetiology of Bells

Answer 3

Unknown
Possible viral
Reactivation of HSV-1 in geniculate ganglion

Question 4

Epidemiology of Bells?

Answer 4

Most commonly 15-45
Equal distribution of sexes

Question 5

What are presenting symptoms of Bells

Answer 5

Single episode of unilateral facial palsy
Absence of constitutional symptoms
All nerve branches affected equally
Dry eye - Keratoconjucitivitis sicca

Question 6

What are red flag symptoms that suggest alternative diagnosis?

Answer 6

Gradual onset (more than 72 hours) facial paralysis

Uneven distribution of weakness across facial zones on presentation

Frontal headache, fever, or general malaise

Bilateral involvement

Prior episode of facial palsy on the ipsilateral side

Persistence of complete flaccid paralysis at 3-4 months

Presence of other cranial or peripheral neuropathies

Presence of otological symptoms other than mild to moderate otalgia, hyperacusis, and post-auricular pain (e.g., hearing loss, vertigo).

Question 7

What does sparing of brow suggest?

Answer 7

Upper motor neuron lesion

Question 8

What are investigations for Bells?

Answer 8

Clinical diagnosis

Question 9

How should Bells be managed?

Answer 9

Corticosteroids if within 72 hours of symptom onset.
Can offer some eye protection for dry eyes

Question 10

What are complications of Bells?

Answer 10

Keratoconjunctivitis sicca
Exposure keratopathy
Ulcerative keratitis
Ectropion (sagging eyelid)

Question 11

What is prognosis for Bells?

Answer 11

Good - 95% full recovery if incomplete paralysis
65% if full paralysis
Over 6 month period everyone show some sort of recovery