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DIAGNOSTICS

BELL’S PALSY. DIAGNOSTICS. CLINICAL: Typical presentation No risk factors or presenting symptoms for other causes of facial paralysis Absence of neurocutaneous lesions of herpes zoster in the external ear canal Normal neurologic examination with the exception of the facial nerve.

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DIAGNOSTICS

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  1. BELL’S PALSY DIAGNOSTICS

  2. CLINICAL: • Typical presentation • No risk factors or presenting symptoms for other causes of facial paralysis • Absence of neurocutaneous lesions of herpes zoster in the external ear canal • Normal neurologic examination with the exception of the facial nerve

  3. Complete blood count • Erythrocyte sedimentation rate • Thyroid function studies • Lyme titer • Serum glucose level • Rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test • Human immunodeficiency virus (HIV) antibodies • Cerebral spinal fluid analysis • Immunoglobulin M (IgM), immunoglobulin G (IgG), and immunoglobulin A (IgA) titers for CMV; rubella; HSV; hepatitis A virus; hepatitis B virus; hepatitis C virus; VZV; M pneumoniae; and Borreliaburgdorferi

  4. MAGNETIC RESONANCE IMAGING • Swelling and uniform enhancement of the geniculate ganglion and facial nerve • Entrapment of the swollen nerve in the temporal bone • Secondary etiology of facial palsy

  5. CHEST X-RAY • Possible evidence of Sarcoidosis • ELECTROMYOGRAPHY • Prognostic value • LUMBAR PUNCTURE • Performed to rule-out other etiologies • Low-grade lymphocytic pleomorphic pleocytosis with normal glucose and protein may be present

  6. BELL’S PALSY TREATMENT

  7. SYMPTOMATIC • Use of paper tape to depress the upper eyelid during sleep and prevent corneal drying and abrasions • Lubricating drops for eyes as needed • Massage of the weakened muscles

  8. GLUCOCORTICOIDS • Prednisone • 60-80 mg daily during the first 5 days and then tapered over the next 5 days • Shorten recovery period • Modestly improve functional outcome when initiated in the 1st 48-72 hours of symptoms

  9. SURGERY • Facial nerve decompression for proximal, complete deficits • No clear evidence in clinical trials for its benefit over standard care

  10. MONITORING AND PATIENT EDUCATION • Periodic outpatient follow-up • Monitor for resolution of symptoms • Monitor for complications • Possible corneal abrasions or ulcerations • Eye care • Protect the eye from foreign objects and sunlight. • Keep the eye well lubricated. • Educate the patient to report new ocular findings such as pain, discharge, or visual changes.

  11. BELL’S PALSY COMPLICATIONS

  12. CORNEAL DRYING AND INJURY • Abrasion • Ulceration • INCOMPLETE RECOVERY WITH PARTIAL OR PERMANENT NERVE IMPAIRMENT • Incomplete motor regeneration • Incomplete sensory regeneration

  13. PROGNOSIS • Group 1 - Complete recovery of facial motor function without sequelae • Group 2 - Incomplete recovery of facial motor function, but no cosmetic defects are apparent to the untrained eye • Group 3 - Permanent neurologic sequelae that are cosmetically and clinically apparent

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