bells palsy 1/12

Question 1

symptoms CN7 - sensory or motor?

Answer 1

• acute onset sensory and motor deficits in facial nerve distribution
• motor - PARALYSIS upper & lower face, ear, eye mouth
• Facial droop
• Muscles of facial expression on ONE side are weak or paralyzed
• difficulty eating
• Loss of control of salivation or lacrimation (drooling, tearing)
• Drooping of corner of mouth, eyelids don’t close (may tape eye, wear eye patch)
• Decreased taste
• maybe increased auditory sensitivity

Question 2

what causes CN7 bells palsy?

Answer 2

Edema or Acute inflammatory process > leads to

compression of facial nerve in temporal bone

Question 3

CN7 lesion prognosis - when most severe? recovery timeline?

Answer 3

• Acute onset, max severity in hrs-days
• self-limiting, not life threatening
• spontaneous, Full recovery in weeks-months

Question 4

bells palsy unilateral or bilateral?

Answer 4

unilateral

starts as feeling of generalized stiffness or tightness

Question 5

what does CN7 do?

Answer 5

• sensory - taste anterior tongue
• motor- facial expression, voluntary motor most facial muscles
• autonomic - lacrimal, submandibular, sublingual glands

Question 6

whats glands does CN7 innervate?

Answer 6

saliva- submandibular, sublingual glands

lacrimal

Question 7

common contributing factor to bell palsy

Answer 7

• typically viral- esp herpes simplex virus,
• also - Epstein-barr, varicella zoster, HIV
• may be dormant for some time
• infects schwann cells around nerve triggering inflammatory response > abnormal pressure on nerve

Question 8

bells palsy imaging studies

Answer 8

• MRI or CT to identify infection or structure abnormality causing pressure on nerve
• Blood tests - rule out other conditions eg. Lyme disease, CVA

Question 9

bells palsy what to include in exam

Answer 9

functional assessment of facial muscles- smile, frown, raise eyebrows, frown, close eyes, bare teeth, puff out cheeks,

Question 10

focus of treatment of patient with bells palsy

Answer 10

• education
• monitor
• anti-inflammatory medication, eg NSAIDs
• if unable close eye- eye protection, lubricating drops
• maintain muscle length and strength during period of paralysis - massage, stretch, moist heat, biofeedback, NMES