Bell’s Palsy

Dwi Kusumaningsih
Definisi dan Epidemologi
• Peripheral facial palsy of “unknown” origin
• Insiden: 20 – 30/100.000 / th
• ♂=♀
• Umur median : 40, insidens tertinggi usia tua >
70 th, jarang anak < 10 th
• 60 – 75% unilateral
Diagnosis
• Bedakan sentral atau perifer
• Pertimbangkan apakah suatu Hemifacial spasm
• Some diagnostic work up:
▫ MRI
 Contrast enhanced in:
 intercanalicular
 Labirinth
 Geniculate
 Mastoid segmen of facial nerve
EMG
 Dilakukan 3 hari setelah paresis komplit
 Outcome :
 < 90% axonal degeneration in first 3 weeks → good
recovery 90%
 > 90% axonal degeneration in first 3 weeks → poor
outcome 50% recovery
 > 90% in 5 days worse than > 90% in 14 days
Where is The Lession ?
A: central type B. Peripheral C. Hemifacial spasm
Terapi
• Corticosteroids
▫ Prednison (40 – 60 mg selama 5 hr tapper off 5 mg/day)
• Antiviral
▫ Acyclovir 5 dd 800 mg
▫ Famcyclovir 3 dd 750 mg
• Surgical Decompression
▫ Masih kontroversial
▫ Reseved for proximal geniculate, > 90% axonal deg
▫ Tidak dilakukan setelah 14 hr onset
▫ Gangguan pendengaran 1 -15% Px
Prognosis
• Bad if
▫ Complete facial palsy
▫ No recovery by three weeks
▫ Age over 60 years
▫ Severe pain
▫ Ramsay Hunt syndrome (herpes zoster virus
▫ Associated conditions : hypertension, diabetes
pregnancy
▫ Severe degeneration of the facial nerve shown by
electrophysiological testing