Bell's palsy

Question 1

What is Bell’s palsy?

Question 2

What can bell’s palsy be confused with?

Answer 2

Stroke

Question 3

What infections are associated with Bell’s palsy?

Question 4

Describe the different innervation of the upper and lower facial nerves

Question 5

What would happen if there is an upper motor lesion?

Question 6

What would happen if there is a lower motor neurone lesion?

Answer 6

The upper face has lost ipsilateral and contralateral motor cortex innervation. And the lower face has lost normal contralateral motor cortex innervation.

Therefore there will be a loss of ALL of the muscles on the side of the affected nerve

Question 7

What are the risk factors for bell’s palsy?

Answer 7

1. Age
2. Diabetes Mellitus
3. Female (^^ risk if pregnant)

Question 8

what are some complications of Bell’s palsy?

Answer 8

Synkinesis (involuntary muscle movement), dysgeusia (distorted taste), dysesthesia (unpleasant/ abnormal touch), oral incompetence

Question 9

What are the symptoms of Bell’s palsy?

Answer 9

Abrupt onset over night with complete unilateral facial weakness

• Dryness of affected eye/ side of the mouth (as the facial nerve innervates the submandibular, sublingual and lacrimal glands)
• Hypersensitivity to loud noises (hyperacusis)
• Loss of taste (in the anterior 2/3 of tongue) dysgeusia
• Ipsilateral numbness/ pain around the ear
• Eyes do not close

Question 10

What are the signs of Bell’s palsy (O/E)

Answer 10

1. Patients unable to wrinkle their forehead signifying an LMN lesion
2. Patient will not be able to whistle
3. Absence of the nasolabial fold
4. Unilateral drooping of the eyelid
5. Unilateral drooping of the mouth
6. Drooling saliva
7. Speech difficulties
8. Palpebral oculogyric reflex- attempted eyelid closure causing upward eye deviation

Question 11

How do you diagnose Bell’s palsy?

Answer 11

Rule out other causes of facial palsy.

Bloods- FBC, ESR, glucose, test for Borellia antibodies (lyme disease) or VZV antibodies in Ramsay-Hunt syndrome.

CT- to rule out space occupying lesions, stroke, multiple sclerosis

Question 12

What is the management of Bell’s Palsy?

Answer 12

May resolve spontaneously over 3 weeks

• Prednisolone- 1mg/kg for 10days ( should be prescribed within the first 72 hours of Bell’s palsy onset)
• Acyclovir- not really massively helpful
• Consider prescription of artificial tears (hypromellose) and eye lubricants
• Post 72 hours, not really sure, but use corticosteroids
• Consider physical therapy (facial exercises and neuromuscular retraining)