Bell's Palsy

Question 1

What is 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

What are the risk factors for Bell’s Palsy?

Answer 2

> Intranasal influenza vaccine
> Pregnancy
> URTI
> FHx
> Diabetes

Question 3

What are the signs and symptoms of bells palsy?

Answer 3

> Single episode
> Unilateral
> Involvement of all nerve branches
> keratoconjunctivitis sicca
> Pain
> Synkinesis
> Ipsilateral hyperacusis or dysgeusia

Question 4

What is the epidemiology of bell’s palsy?

Answer 4

The reported incidence is 23 to 32 cases per 100,000 per year.

Question 5

What investigations would you do for bell’s palsy?

Answer 5

> Clinical diagnosis
electroneuronography or eEMG
EMG (absence of voluntary motor unit potentials)
Serology for Borrelia burgdorferi (neg)

Question 6

What is the management of Bell’s Palsy?

Answer 6

> Corticosteroids (e.g. prednisolone)
Eye protection
Concurrent antiviral therapy

Question 7

What are the complications of Bell’s Palsy?

Answer 7

> keratoconjunctivitis sicca, exposure keratopathy, and ulcerative keratitis

> Ectropion (saggy eyelid)

> Contracture and synkinesis

> Gustatory hyperlacrimation

Question 8

What is the prognosis of Bell’s palsy?

Answer 8

The extent of facial palsy following complete evolution of Bell’s palsy (i.e., within 72 hours of onset) is the parameter most predictive of ultimate recovery outcome. Of those who present with incomplete paralysis on clinical examination, 94% will fully recover, as compared to 61% of those who present with complete paralysis.