Bell's palsy is probably caused by herpes type 1 and herpes zoster virus
Early (before 72 hours) treatment with combined oral Acyclovir and Prednisolone is probably effective
1/5 cases of acute facial palsy have another cause that should be managed appropriately
A unilateral facial nerve palsy of sudden onset that is not associated with other cranial nerve abnormalities. The paralysis may be partial or complete.
Symptoms & signs
- Most 5 - 45 years old, M=F
- Incidence 20/100,000 [higher in pregnancy](1 in 60 people affected during their life).
- Characteristically the patient wakes with a facial droop.
- Dribbling from the mouth - problems when eating.
- Changes in hearing (often hyperacousis on effected side) and taste.
- Fullness in ear or mild retroauricular pain (severe pain = Ramsey Hunt).
- Exposure and drying of the cornea (also decreased tear production)
- Check mouth and ear for vesicles(Ramsey Hunt syndrome)
- Exclude trauma and parotid gland pathology
- Slow onset, other nerve involvement or headache suggest other pathology
- Facial N lesion with rash suggests Lyme disease
- Some patients with Bell's have altered trigeminal sensation (not motor fxn), reduced C2 sensation and vagal motor weakness.
- If in doubt please ask the ED Duty doctor for advice.
- Cause unknown. Suspected viral infection leading to swelling of facial nerve in bony canal of skull.
- Partial, uncomplicated palsy : no treatment required.
- Complete recovery in vast majority
- GP review in 10 - 14 days to ensure no progression to complete palsy
- Complete palsy : may require early high dose steroids [Bandolier]
- Vesicles present : start high dose antivirals (contact duty doctor for advice, then refer to neurology).
- Inability to close eye on effected side - refer to ophthalmology.
- Acyclovir alone and surgery for facial nerve decompression are unproven.[Bandolier]
- IN CUH, please refer all facial palsies to the next ED physio clinic (they will arrange early speech and language follow up).