Bells Palsy

Question 1

Definition bells palsy

Answer 1

Condition involving a lesion on the facial nerve. It results un flaccid paralysis of muscles of fasmcial expression on same side as lesion

Question 2

Causes

Answer 2

Not understood but may be:
-compression from edema
-pregnancy, diabetes, hypothyroid
-conditions that affect the parotid gland
-inflammation due to mumps, cancer
-compression due to inflammation secondary to trauma
-blow/stab wound to side of head/neck
-forceps at birth
-exposure to a chill/draft
-while driving, sleeping with window open

Question 3

Signs + symptoms

Answer 3

-Usually between 20-50 years
-Specific symptoms vary depending on lesion site
-before geniculate ganglion- all functions (motor, sensory, autonomic) affected
-along pathway from ganglion to stylomastoid foramen (motor loss + varying degrees of sensory/ autonomic
-after stylomastoid foramen- only motor affected
-most distinguished feature of bells palsy is unable to close eye

Question 4

Difference between bells palsy and stroke?

Answer 4

Stroke affects lower muscles of the face only, no frontalis or muscles around eye

Question 5

Recovery

Answer 5

●Depends on severity of damage
-with only compression- 2-8 weeks recovery
-complete lesion- prognosis poorer
●with nerve regeneration- irregular
●with motor- nerve that closes eyes may also affect mms around mouth. When closing eye mouth may twitch
●with autonomic- nerve for salivary gland may regenerate to lacrimal when salivate, tearing occurs

Question 6

Treatment examples

Answer 6

-Often no medical treatment given- spontaneous recovery up to 70%
-May wear eye patch- prevent damage to eye
-Steroids only with pain
-splint to relieve strain on facial muscles

Question 7

Symptom picture

Answer 7

Rapid onset- Unilateral weakness, followed by flaccid paralysis of muscles of facial expression

Question 8

If sensory/autonomic affected

Answer 8

-decrease salivation
-sensativity to hearing (especially low tones) “hyperacusis”
-sagging of face/eyelid
-pulling toward unaffected side
-normal folds dissappear- smooth appearance

Question 9

Is there pain with bells palsy

Answer 9

Pain is usually not a primary symptom
-if present usually a predictory of poor prognosis for full recovery