Bell's Palsy

Question 1

Define Bell’s palsy.

Answer 1

Bell’s palsy is an acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable, consisting of deficits affecting all facial zones equally that fully evolve within 72 hours.

Question 2

Explain the aetiology/risk factors of Bell’s palsy.

Answer 2

Intranasal influenza infection

Pregnancy

Question 3

Summarise the epidemiology of Bell’s palsy.

Answer 3

Bell’s palsy is the most common aetiology of unilateral facial palsy among those 2 years of age or older. It is most prevalent in people between 15 and 45 years of age. The reported incidence is 23 to 32 cases per 100,000 per year.

Question 4

Recognise the presenting symptoms of Bell’s palsy. Recognise the signs of Bell’s palsy on physical examination.

Answer 4

Facial drooping on one side
Absence of constitutional symptoms
Involvement of all nerve branches
Keratoconjunctivitis sicca
Pain
Synkinesis

Question 5

What is keratoconjuctivitis sicca?

Answer 5

Keratoconjunctivitis sicca (dry eye) is common in Bell’s palsy and occurs acutely due to loss of adequate blink function, with parasympathetic dysfunction to the lacrimal gland a contributing factor. It may lead to ulcerative keratitis (corneal ulcer) and subsequent blindness.

Question 6

Identify appropriate investigations for Bell’s palsy and interpret the results.

Answer 6

Diagnosis can usually be made by examination. However, EMG may be used in order to test the tone of the facial muscles.

Question 7

Generate a management plan for Bell’s palsy.

Answer 7

Prednisolone
Valaciclovir

Surgical intervention may be required in severe cases. Eye drops may also be given in order to stop the eyes from drying out.