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Bell's Palsy

Most common form of Facial paralysis.

Clinical features :

  • Pain behind the ear may preced the palsy for one or two days.
  • Onset is abrupt and maximal weakness is attained by 48 hours.
  • Loss of taste sensation unilaterally (on one side).
  • Hyperacusis may be present.
  • Mild cerebrospinal fluid Lymphocytosis may be present.
  • Presence of incomplete paralysis in first week is most favorable sign.
  • 80% patients recover in few weeks to months.
Pathophysiology :
Bell's palsy is associated with presence of Herpes Simplex type I DNA in endonueral fluid and posterior auricular muscle.This indicates that reactivation of this virus may have some role.However this is not proven yet.

Differenctial Diagnosis :
Other causes of Facial Palsy -

1. Tumours of temporal bone - Carotid body tumor, Cholesteotoma, Dermoid cysts.The course is insidious and progressive.

2. Ramsay Hunt Syndrome -
Due to Herpis zoster of geniculate ganglion.Consists of : Severe facial palsy; eruptions in pharynx, external auditory canal and other parts of cranial integument; Eighth nerve is commonly involved.

3. Acoustic Neuromas -
These cause facial paralysis by compresion of facial nerve.

4.Bilateral Facial Paralysis -
This is seen in Guillain Bare syndrome and Uveoparotid fever (Heerfordt syndrome), a form of Sarcoidosis.

5.Pontine lesions -
Infarcts; Demyelinating lesions of Multiple sclerosis and tumours.

6.Milkersson Rosenthal syndrome -
This consists of the triad Facial paralysis; Recurrent (and later permanent) facial edema (particularly of lips); Plication of tongue.

7.Leprosy.

8.Diabetes mellitus.

All the above lesions are Nuclear or Peripheral forms of Facial palsy.In Supranuclear facial palsy, Frantalis and orbicularis occuli muslces are less involved.This is because, muscles in upper part of the face are innervated by nerves from Motor cortices of both sides (So if one nerve is paralysed, the muscle gets nervous supply from the other nerve).The muscles of lower face are supplied by nerves of the opposite hemisphere.

In Supranuclear lesions, there is dissociation of emotional and voluntary facial movements.There is some degree of arm and leg and an aphasia may also noted.

Diagnosis :
All other diseases (mentioned above) are ruled out first.
MRI reveals swelling and uniform enhancement of Geniculate ganglion or facial nerve can me noticed.Sometimes, entrapment of swollen nerve in temporal bone can be observed.

Treatment :
Glucocorticoids (Prednisolone) is given in the dose of 60 - 80 mg/day for first 5 days then the dose is slowly decreased.
Acyclovir (400 mg five times a day for 10 days) given along with Prednisolone has shown to give better results than prednisolone alone.

More reading on Bell's Palsy :
http://www.bellspalsy.ws/
http://www.entnet.org/healthinfo/topics/bells.cfm
http://www.bellspalsy.org.uk/

Comments

Bell's Palsy is a miserable affliction that can go away within days, or linger around for years.

If you'd like more info on treating Bell's Palsy, check out my Free Bell's Palsy Treatment Guide

If you're looking for an effective natural Bell's Palsy Treatment, check out Vedic Relief

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