Bells Palsy

Aetiology

 Most cases unknown

 Most likely cause is viral
Incidence

 Commonest in age group 10-40yrs

 20 cases per 100,000 people
Examination

 Differentiate between upper and lower motor

neurone lesion
 UML: frontalis is spared allowing normal
furrowing of brow and eye blinking
 LML: all muscles of facial expression are
affected
Examination continued

 Check no other cranial nerves involved (BP

is an isolated VII lesion)
 Look for a painful rash over the ears
(Ramsay Hunt caused by H zoster)
Red flags which may necessitate
referral

 Bilateral BP
 Recurrent BP
 Association with rash elsewhere or with
feeling generally unwell (sarcoid or Lyme
disease)
 Previous episode which might have been
demyelination
 ?SOL
Treatment

 Prednislone 1mg/kg up to 80mg max per day

tailing off in second week (reduces oedema)
 Aciclovir 800mg 5x daily for 5days given
within first 72hrs (prevents viral replication)
 Consider tape/eye pad so patient can sleep
 Consider prescription for artificial tears
 Reassure patient that he hasn’t had a CVA
Follow up

 2/3rds of patients have spontaneous

recovery
 85% show improvement in the first 3/52
 15% show some improvement in 3-6/12
 Refer all cases to ENT after initiating Rx
 Consider referral to eye specialist for
tarsorrhaphy for those patients who have
failed to make a complete recovery