SPOTTERS MEDICINE
BELL’S PALSY
🔹 Definition:
Bell’s palsy
is an acute, unilateral lower motor neuron facial nerve paralysis of
unknown cause, resulting in sudden facial muscle weakness or paralysis
on one side of the face.
🔹 Etiology / Causes:
- Idiopathic (most common)
- Possible viral triggers:
- Herpes Simplex Virus (HSV-1)
- Varicella-Zoster Virus (VZV)
- Cold exposure
- Autoimmune inflammation of the
facial nerve
🔹 Pathophysiology:
- Inflammation and edema of the
facial nerve (CN VII) in the facial canal
- Leads to compression and
demyelination, causing temporary paralysis
🔹 Risk Factors:
- Pregnancy (especially third
trimester)
- Diabetes mellitus
- Hypertension
- Upper respiratory tract
infection
- Family history
🔹 Clinical Features:
- Sudden onset unilateral facial weakness
- Inability to close eye, raise
eyebrow, smile on affected side
- Drooping of mouth corner
- Loss of nasolabial fold
- Hyperacusis (due to stapedius muscle
paralysis)
- Loss of taste on anterior 2/3 of tongue
- Dry eye or excessive tearing
🔹 Diagnosis:
- Clinical diagnosis (no specific test)
- Rule out:
- Stroke (UMN lesion spares
forehead)
- Ramsay Hunt Syndrome (vesicles
in ear)
- Tumors, Lyme disease
- MRI/CT if atypical or not improving
- Electromyography (EMG) if
persistent >3 weeks
🔹 Treatment:
- Corticosteroids (Prednisolone) – started within
72 hours
- Antivirals (Acyclovir) – if HSV suspected
- Eye care – lubricating drops, eye patch
to prevent corneal damage
- Physiotherapy – facial muscle exercises
- Analgesics if pain is present
🔹 Prognosis:
- 85% recover completely within 3–6 months
- Better prognosis if:
- Partial paralysis
- Early treatment
- Poor prognosis if:
- Complete paralysis
- No improvement after 3 weeks
- Age >60 years
🔹 Complications:
- Synkinesis (involuntary facial movements)
- Corneal ulcers due to exposure
- Persistent facial weakness or
contracture
DR.C.GANESAN M.D.
PROFESSOR OF MEDICINE
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