Symptoms
The most obvious visible symptom is usually a unilateral paralysis of the facial nerve manifested by a one-sided collapse of the musculature of the face. It may be difficult to open (or close) one eye. There may be tears or drooling accompanied by a loss of taste and loss of sensory perception around the mouth. Patients commonly report a feeling of sunburn around the scalp and face. There may be significant pain.
A common consequence is emotional disturbance because of anxiety or self-consciousness about the disfigurement that the condition may cause.
Causes
- The cause is unknown but some animal studies suggest a reactivation of herpes viruses.
- Lyme borreliosis can present with a lower motor neurone facial nerve palsy. Consider it in children; if any history of tick bites (particularly, but not exclusively, within the last 30 days); if any suggestion of erythema migrans particularly of head and neck area; or if history of the progression of palsy is unusual. If that is a possibility, discuss with infectious diseases.
Prevalence
The condition affects 25 – 35 people per 100,000 per year, which is to say roughly one person in 60 during their lifetime (or about 100 people per month in Scotland). There is no significant difference in rates between men and women, though the preferred age range seems to be 30 – 45 years old.
Please see Primary Care Management Tab.
- If not improvement at 1 month refer to ENT to arrange scan
- Plastics referral if ongoing cosmetic issues
BELL’S PALSY
Idiopathic lower motor neurone CN VII palsy
May or may not be associated with pain
LMN palsy is suggested by absence of forehead wrinkles.
Examination
Neurology CN VII palsy
Ears – Middle Ear infection – Any abnormality, discuss with on call n ENT via St John’s switchboard on 01506523000
Neck + Parotid gland for masses – Any abnormality doscuss with on call ENT via St John’s switchboard on 01506523000
Look for vesicles on TM/Soft palate = Ramsay Hunt
- Herpes Zoster infection
- Treat with Acyclovir +/- Steroids (discuss)
If all other Examination is normal, treatment:
- Should be ideally commenced within 72hours
- Prednisolone 50mg OD 10 days (NB NO Acyclovir if Bell’s)
- Eye protection – due to lack of eye closure consider:
- Tape eye shut at night
- Lacrilube/viscotears
- Patching when outside (protection from grit)
- Ophthalmology review if painful / red eye
Bells is confirmed if all other examinations are normal and is managed in primary care with referral only if there is abnormalities as above.
