Bell's palsy

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Background

  • Dysfunction of peripheral CN VII of unknown cause
  • Maximal clinical weakness around 3wks; at least partial recovery by 6 months

DDX

  1. Lyme Disease
  2. HIV
  3. Otitis Media
  4. Sarcoidosis (esp if b/l)

Clinical Features

  • Acute onset (over hours) of unilateral facial paralysis
    • No forehead sparing
    • Mouth drawn to the non-affected side
  • Incomplete closure of the eyelids on the affected side
    • Can lead to corneal exposure keratitis

Treatment

  1. Cornea
    1. Artificial tears qhr while pt is awake; ophthalmic ointment at night
    2. Protective glasses or goggles
  2. Corticosteroids
    1. Give to all pts
    2. Prednisone 60-80mg/day x1wk
  3. Antivirals
    1. Controversial efficacy; may have benefit in pts w/ severe palsy
    2. Valacyclovir 1000mg TID x1wk

Disposition

  • Discharge with ophto f/u for monitoring of the affected cornea

Source

Tintinalli

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