Bilateral Facial Palsy
Original Editor - Wendy Walker
Top Contributors - Wendy Walker, WikiSysop, Kim Jackson and Rishika Babburu
Introduction[edit | edit source]
Bilateral facial palsy, AKA Facial Diplegia, is defined as facial paralysis or paresis affection both sides of the face, with onset being either completely simultaneous or the second side being affected within 30 days of the first side.
Bilateral facial palsy is a rare condition, with an incidence of between 0.2% and 2%[1][2][3].
Clinically Relevant Anatomy[edit | edit source]
For details of anatomy of the Facial Nerve, the seventh Cranial Nerve, please see the Facial Nerve page.
Causes of Bilateral Facial Palsy[edit | edit source]
Idiopathic Bell's Palsy can be the cause of bilateral facial palsy[4], but other causes such as Lyme Disease[5], neurosarcoidosis, Guillain-Barre Syndrome[6], Melkerssohn-Rosenthal Syndrome (a rare syndrome consisting of changes within the lip tissues known as granulomatous cheilitis, fissured tongue and facial palsy), systemic lupus erythematosus (SLE)[7], meningitis, leukaemia, HIV, tumours and basilar skull fractures must be considered and excluded as causes before a diagnosis of Bilateral Bell's Palsy is given[1][8]. In babies, bilateral facial palsy present from birth may be caused by Moebius Syndrome, a congenital condition in which several cranial nerves fail to develop.
Although unilateral facial palsy most commonly idiopathic or a result of viral infection, bilateral facial palsy presents more of a diagnostic challenge as some of the causes can be potentially fatal[9].
All patients presenting with bilateral facial palsy should undergo thorough investigations as a matter of urgency[8][9]. It is noteworthy that the most common causes of bilateral facial palsy reported among several case series were: Lyme Disease, Guillain-Barre Syndrome, sarcoidosis, trauma and Bell's Palsy[1][2][9][10].
Lyme Disease is the most common infectious cause of Bilateral Facial Palsy[1][edit | edit source]
This is caused by Borrelia Burgdorferi, which is carried by the common tick. In up to 11% of cases facial palsy occurs, some of which are bilateral presentations[11].
Clinical Presentation[edit | edit source]
Bilateral facial palsy is characterised by paralysis or weakness of the muscles in both sides of the face. In many cases the onset of paralysis is not completely simultaneous, and one side of the face may be affected several days before the other.
This frequently results in an inability to close the eyes fully, and reduced ability or even complete inability to move the mouth/lips.
Functional Issues[edit | edit source]
Eye Problems[edit | edit source]
Both eyes are generally unable to close, or unable to close fully, and also likely to have a significant reduction in tear production, which means that both eyes are at risk of develping a corneal ulcer.
Mouth Problems[edit | edit source]
Inability to move the lips eg. into smile, pucker, cause severe difficulties with non-verbal communication, and patients often report social problems as they are unable to convey their emotions through facial expression.
Eating and drinking are both affected, as lack of lip seal makes it difficult to keep fluids and food in the oral cavity.
There is also reduced clarity of speech as the "labial consonents" (ie. b, p, m, v, f) all require lip seal.
Diagnostic Procedures[edit | edit source]
- MRI or CT to brain: to involve the internal auditory meatus, cerebrobellopontine angle and mastoid with the aim primarily to exclude tumours
- Blood testing for Borrelia (for Lyme Disease), syphilis antibody, Epstein-Barr virus, antinuclear antibody, HIV, serum angiotensin converting enzyme levels (to exclude sarcoidosis)
- Lumbar puncture, with CSF testing
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions[edit | edit source]
Initial management will depend upon the cause of the palsy. If indicated, steroids and/or antiviral medications may be prescribed.
Long term management will be the same as for unilateral facial palsy: see the Facial Palsy page for more details.
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 Yang A, Dalal V. Bilateral Facial Palsy: A Clinical Approach. Cureus. 2021 Apr 25;13(4):e14671. doi: 10.7759/cureus.14671. PMID: 34079670; PMCID: PMC8159336.
- ↑ 2.0 2.1 Keane JR, Bilateral seventh nerve palsy: analysis of 43 cases and review of the literature. Neurology. 1994 Jul;44(7):1198-202
- ↑ Teller DC1, Murphy TP, Bilateral facial paralysis: a case presentation and literature review. J Otolaryngol. 1992 Feb;21(1):44-7
- ↑ Kilic R, Ozdek A, Felek S, Safak MA, Samim E: A case presentation of Bilateral Simultaneous Bell's Palsy. Americal Journal of Otolaryngology. 2003, 24 (4): 271-273
- ↑ Clark JR, Carlson RD, Sasaki CT, et al. Facial paralysis in Lyme disease. Laryngoscope. Nov 1985;95(11):1341-5
- ↑ Narayanan, R.P., James, N., Ramachandran, K. et al. Guillain-Barré Syndrome presenting with bilateral facial nerve paralysis: a case report. Cases Journal 1, 379 (2008). https://doi.org/10.1186/1757-1626-1-379
- ↑ Blaustein DA, Blaustein SA. Antinuclear antibody negative systemic lupus erythematosus presenting as bilateral facial paralysis. J Rheumatol. 1998 Apr;25(4):798-800.
- ↑ 8.0 8.1 8.2 Oosterveer DM1, Bénit CP, de Schryver EL. Differential diagnosis of recurrent or bilateral peripheral facial palsy. J Laryngol Otol. 2012 Aug;126(8):833-6
- ↑ 9.0 9.1 9.2 9.3 Gaudin RA1, Jowett N, Banks CA, Knox CJ, Hadlock TA. Bilateral Facial Paralysis: A 13-Year Experience. Plast Reconstr Surg. 2016 Oct;138(4):879-87
- ↑ Pothiawala S, Lateef F. Bilateral facial nerve palsy: a diagnostic dilemma. Case Rep Emerg Med. 2012;2012:458371.
- ↑ Clark JR, Carlson RD, Sasaki CT, Pachner AR, Steere AC Facial Paralysis in Lyme Disease. Laryngoscope. 1985 Nov; 95(11):1341-5.
