Bell's palsy

Question 1

What are the features of Bell’s palsy?

Answer 1

A LMN disease

Complete paralysis of 1/2 of the face
As it is a LMN disease, it affects all facial muscles. In UMN lesions, forehead is spared

Other symptoms include:
Pain around the ear
Difficulty chewing 
Incomplete eye closure
Drooling
Change in taste

These symptoms occur as facial nerve innervated muscles of facial expression, stapedius in the ear, the anterior 2/3rds of tongue, lacrimal glands and salivary glands

Question 2

What nerve is paralysed in Bell’s palsy?

Answer 2

Facial nerve

Question 3

What is the management for Bell’s palsy?

Answer 3

Prednisolone 1mg/kg for 10 days + ibuprofen within 72hrs of onset
Most completely recover within 4-6 months

Question 4

What is the difference between facial weakness in stroke and Bell’s palsy?

Answer 4

Forehead is spared in stroke but not in Bell’s palsy

Question 5

What is Ramsay-Hunt syndrome?

Answer 5

A condition caused by reactivation of the Varicella zoster virus in the geniculate ganglion of the facial nerve leading to shingles of the ear and facial nerve palsy

Question 6

What are the features of Ramsay-hunt syndrome?

Answer 6

Ipsilateral facial paralysis
Ear, face or head pain
Some have rash or blisters in or around the ear, scalp or hair line, or even the mouth
Hearing loss on affected side, dizziness, vertigo and tinnitus
Altered taste on affected side of tongue

Question 7

What is the management for Ramsay-hunt syndrome?

Answer 7

Oral aciclovir and corticosteroids

Analgesia