Bell's Palsy
Rapid unilateral facial paresis or paralysis
- Acute : <72 hours
- No other etiologies of the nerve palsy is identified (other medical causes)
- Unilatral ( bilatral is rare )
- No cuase is identified
Risk factors
Pregnancy - Diabetes - Obesity - Severe preeclampsia - Hypertension - Upper respiratory tract infection
Prognosis
Most patients show improvment after 2-3 weeks without intervention and complete recovery after 3-4 months
Recommendations
- Strong recommendation:
1. 10 days course of oral steroid within 72 hours ( for patients older than 16 yo)
- prednisolone 60mg for 5 days then tapering the dose in the next 5 days.
- prednisolone 50mg for 10 days
2. ​​Full History and Physical examination to rule out any other causes
- History important questions:Onset of symptoms, Dizziness, Dysphagia, Diplopia, Prior stroke, Brain cancer, Sking Cancer in the head or face, Parotid Tumors, Facial or head trauma, Recent infections.
- Symptoms suggestive of Bell's Palsy: Pain in the ear or post auricular region, Weak facial muscles, tingling or numbness, ocular pain or tearing, family history of bell's palsy.
- Physical examination important points: EAC, TM, Parotid, Skin of the head and face and cheek, examination of all cranial nerves. (Ruling out cholesteatoma, ear infection, or vascular rashes (zoster).
- Option:
Antiviral therapy with the steroid within the first 72h ( giving antiviral alone is not recommended)
- Acyclovir 400mg 5 times a day for 5-7 days
- Valacyclovir 1g TID for 5 to 7 days
- No recommendation
Physiotherapy, Acupuncture, Surgical decompression.
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