Bell’s palsy

What is Bell’s palsy?

It is a LMN type of facial palsy.
Sir Charles Bell(1774-1842), Scottish surgeon anatomist

Causes of Bell’s palsy?

Idiopathic in 95% cases; it may be related to viral infection due to
reactivation of latent herpes simplex virus I.
• It is more common following upper respiratory tract infections, during
pregnancy, and in patients with diabetes, immunosuppression and
hypertension.
Site of lesion in Bell’s palsy?
Facial canal, in petrous part of temporal bone (in stylomastoid foramen).

Clinical feature:
Symptoms usually develop subacutely over a few hours, with pain around
the ear preceding the unilateral facial weakness. Patients often describe
the face as 'numb' but there is no objective sensory loss (except to taste, if
the chorda tympani is involved).
• Hyperacusis may occur if the nerve to stapedius is involved and
impairment of parasympathetic fibres may cause diminished salivation
and tear secretion.
• Examination reveals an ipsilateral lower motor neuron facial nerve
palsy (no sparing of forehead muscles). Vesicles in the ear or on the
palate may indicate primary herpes zoster infection. A clinical search
for signs of other causes of lower motor neuron facial nerve weakness,
such as parotid or scalp lesions, trauma or skull base lesions, is
justified.
Bell’s phenomenon?
On attempting to close the eyes, the eyeball rolls upwards and outwards,
and is called Bell phenomenon. It is a normal phenomenon, but cannot
be seen when eyes closed. It is only seen in Bell’s palsy. Because eyes
cannot be closed in BP.
Treatment :
• Prednisolone 40-60 mg daily for 1 week should be given within 72 hr.
• In severe case, prednisolon plus antiviral (acyclovir or valaciclovir)
may be given within 72 hours
• Physiotherapy: Facial exercise and electro stimulation within 14 days.
• Protection of eye during sleep (shut with tape, or even tarsoraphy),
artificial tears or ointment.
• Residual paralysis may occur in 10% cases.
• Cosmetic surgery may be helpful.
• During recovery, aberrant reinnervation may occur producing
unwanted facial movement and tear during salivation (called crocodile
tear).
Prognosis of Bell palsy?
• Spontaneous improvement begins in 2nd week, 70-80% cure within 12
weeks.
• May take 12 months.
• Less than 10% may have residual weakness.
• Prognosis can be detected by EMG: Reduction of amplitude of facial
muscle action potential in the 1st week indicates slow or incomplete
recovery.
Ramsay hunt syndrom

It is the herpes zoster of geniculate ganglia characterized by:

• Ipsilateral VII th cranial nerve palsy (lower motor neuron).
• Rash (herpetic vesicles) in the external auditory meatus and soft palate.
• Ipsilateral loss of taste and buccal ulceration.
• Deafness and Vth nerve lesion may also occur.

Treatment: Antiviral like famciclovir may be given.

However, complete recovery is less likely than Bell palsy.
Thank You