Bell’s palsy

Definition & clinical manifestations

• Acute idiopathic unilat. facial nerve palsy (CN VII), often presumed HSV reactivation
• P/w unilateral facial muscle weakness, hyperacusis, ↓ taste, lacrimation, & salivation
• Risk factors: pregnancy (preeclampsia), obesity, HTN, diabetes, preceding URI

Diagnosis (Otol Head Neck Surg 2013;149:656)

• Labs, imaging, EMG not needed in routine cases
• Ddx: Bilateral: Lyme, GBS, sarcoid. Additional neuro sx: stroke, tumor. Rash: herpes zoster. Other: otitis media, HIV, Sjögren.

Treatment and Prognosis (CMAJ 2014;186:917)

• 70% recover spontaneously w/in 6 mos, >80% recover with glucocorticoid treatment
• Oral corticosteroids started w/in 72 hrs of sx onset improve odds of recovery; dose varies based on severity (House-Brackmann grading). No conclusive data on antivirals.
• If eyelid closure is compromised, eye protection is crucial to prevent trauma