Bell's Palsy

 

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Introduction

Bell's Palsy is facial paralysis which is caused by dysfunction of Cranial Nerve VII, the Facial Nerve.

It is sometimes known as Idiopathic Facial Palsy.

It results in inability or reduced ability, to move the muscles on the affected side of the face ie. Facial Palsy.

Mechanism of Injury / Pathological Process

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Clinical Presentation

Loss of control of the muscles on one side of the face is the main physical presentation.

Some patients also report general malaise in the first few days on onset, as well as some pain in the region of the ipsilateral mastoid (known as otalgia), but many of patients have no otalgia or malaise.

At onset the paralysis may be complete, or partial (paresis) and although it frequently affects all branches of the facial nerve on the affected side, resulting in loss of control of that side of the mouth and the ipsilateral eye, in a few cases only one or two branches of the facial nerve are affected.

For a more detailed description of the clinical presentation, please see the Facial Palsy page.

Diagnostic Procedures

Bell's Palsy is essentially a diagnosis of exclusion, so once other causes of facial palsy have been eliminated, we call an isolated facial palsy Bell's Palsy, or Idiopathic Facial Palsy.

Medical Management

Corticosteroids and antiviral medication are the 1st line treatment for Bell's Palsy, providing the best results when treatment starts within 72 hours of onset of symptoms.

Physiotherapy Interventions

Physiotherapy management of the facial paralysis or weakness is as detailed in the section on Facial Palsy.

It is also important to provide information on care of the eye in order to prevent formation of corneal ulcer: see advice page on Dry Eye. Referral to an opthalmologist should be considered.

RHS patients with long term facial palsy may also start to experience dental problems: see advice page on Dental Issues in Facial Palsy.

Differential Diagnosis

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Key Evidence

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Resources

The charity Facial Palsy UK have a page on RHS

The website RamsayHunt.org offers information and support

Case Studies

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References

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