Bell's palsy Flashcards
List possible causes of a facial palsy.
Bells palsy (idiopathic) stroke Ramsey-Hunt syndrome (VZV) Inner ear disease: cholesteatoma, otitis media) Parotid disease: parotid tumour, parotitis Tumour Multiple sclerosis Diabetes
what is Bell’s palsy?
rapid onset (<72 hourS) of unilateral facial weakness of unknown cause
what are the presenting features of Bell’s palsy?
Unilateral facial weakness Spares the forehead, extraoccular muscles and muscles of mastication post-auricular otalgia Hyperacusis Altered taste Dry mouth
Name 1 sign that may be found on clinical examination of a patient with Bell’s palsy.
Bell’s sign
- Upward and outwards movement of the eye on attempt to close the eye
How is Bell’s palsy managed?
50mg Prednisolone daily for 10 days then tapered down thereafter.
What grading system is used to assess functional recovery from a facial palsy?
House-Brackmann system
List the stages of the House-Brackman system for grading a facial palsy.
grade I: normal facial function
grade II: slight weakness
grade III: obvious weakness, complete eye closure
grade IV: marked weakness, incomplete eye closure
grade V: barely perceptible, incomplete eye closure
grade VI: total paralysis
what are features of a facial palsy that make it more likely to be Ramsey Hunt syndrome than Bell’s palsy?
vesicular rash at external auditory meatus, palate or tongue
prominent otalgia
how is Ramsey-Hunt syndrome managed?
Aciclovir
what is the natural history of Bell’s palsy?
majority of patients make a full recovery within 4 months.
refer if no improvement within 3 weeks.
list a possible complication of Bell’s palsy.
aberrant reinnervation
- synkinesis: voluntary contraction of one muscle leads to involuntary contraction of another muscle.
- due to regenerating collateral nerves
what are the branches of the facial nerve?
temporal zygomatic buccal mandibular cervical
