Bell Palsy

Background
• Bell's palsy is a unilateral, peripheral facial
paresis or paralysis that has an abrupt onset
& no detectable cause.
• One of the most common neurologic
disorders affecting the cranial nerves
• First described in 1821, by the Scottish
anatomist & surgeon Sir Charles Bell, much
controversy still surrounds its etiology &
management.
 Pathophysiology
• Actual pathophysiology is unknown; this is
an area of interminable debate. A popular
theory champions inflammation of the facial
nerve. During this process, the nerve
increases in diameter and becomes
compressed as it courses through the
temporal bone.
 Anatomy

• The facial nerve (seventh cranial nerve) has

2 components. The larger portion comprises
efferent fibers that stimulate the muscles of
facial expression. The smaller afferent
portion contains taste fibers to the anterior
two thirds of the tongue, secretomotor fibers
to the lacrimal and salivary glands, and
some pain fibers.
Anatomy
Anatomy
Anatomy
 Causes
• Remains unclear, although vascular,
infectious, genetic, & immunologic causes
have all been proposed. Patients with other
diseases or conditions sometimes develop a
peripheral facial nerve palsy, but these are
not classified as Bell palsy.
 Causes
• Viral infections: Herpes simplex :HSV-1;
HSV-2; Human herpes virus (HHV);
varicella zoster virus (VZV); Mycoplasma
pneumoniae; Borrelia burgdorferi; influenza
B; adenovirus; coxsackievirus; Ebstein-Barr
virus; hepatitis A, B, and C; cytomegalovirus
(CMV); and rubella virus.
 Causes
• Pregnancy: Bell palsy is uncommon in
pregnancy; however, the prognosis is
significantly worse in pregnant women with
Bell palsy than among nonpregnant women
with palsy.
• Genetics: Recurrence rates (4.5-15%) and
familial incidence (4.1%) have been
addressed in various studies. Genetics may
have a role in Bell palsy, but which factors
are inherited is unclear.
 Lab Studies
• No specific laboratory tests exist.
• Complete blood count, Erythrocyte
sedimentation rate, Thyroid function, glucose
level, Rapid plasma reagin (RPR) or
Venereal Disease Research Laboratory
(VDRL) test, Human immunodeficiency
virus (HIV), CSF analysis, IgM, IgG, IgA
titers for CMV, rubella, HSV, hepatitis A,
hepatitis B, hepatitis C, Dll
 Imaging Studies
• Bell palsy remains a clinical diagnosis.
• Imaging studies are not indicated in the ED.
Excluding other causes of facial palsy may
require one of the following imaging studies
depending on clinical setting.
 Other Tests
• Electrodiagnosis of the facial nerve: These
studies assess the function of the facial nerve.
These tests are rarely performed on an
emergent basis.
• Electromyography (EMG)
• Electroneurography (ENoG) compares
evoked potentials on the paretic side versus
the healthy side.
 Treatment
• Steroids : remains controversial. Numerous
research articles have been written on the
benefit or uselessness of steroids to treat
patients with Bell palsy.
• Antiviral agents: Although there is
insufficient research evaluating the efficacy
of antiviral medicines in Bell palsy, most
experts believe in a viral etiology.
• Eye care
Treatment
Treatment
 Prognosis
• Group 1 regains complete recovery of facial
motor function without sequelae.
• Group 2 experiences incomplete recovery of
facial motor function, but no cosmetic defects
are apparent to the untrained eye.
• Group 3 experiences permanent neurologic
sequelae that are cosmetically and clinically
apparent.
 Prognosis
• Most patients develop an incomplete facial
paralysis during the acute phase. This group
has an excellent prognosis for full recovery.
Patients demonstrating complete paralysis are
at higher risk for severe sequelae.
• Of patients with Bell palsy, 85% achieve
complete recovery. Ten percent are bothered
by some asymmetry of facial muscles, while
5% experience severe sequelae.