"Clinical presentation "
"It is named after Sir Charles Bell (1774-1842), a Scottish anatomist, surgeon, and physiologist, who described it in 1821 3."
"Bell palsy, also known as idiopathic peripheral facial paralysis, is characterised by rapid onset facial nerve paralysis, often with resolution in 6-8 weeks, without an identifiable aetiology. As there are numerous causes of facial nerve palsy, many acute in onset, it is a diagnosis of exclusion supported by a typical presentation."
"The peak age of presentation is between 15-50 years with ~25 cases per 100,000 per year. There is no gender predominance 10."
"In Bell palsy, long segments of the facial nerve enhance in a uniformly linear fashion, more intensely than the contralateral non-affected side. However, enhancement of the nerve is not seen in all patients, reported variably between 57-100%. It is also essential to appreciate the normal pattern of facial nerve enhancement, that include the geniculate ganglion and mastoid segments."
"The aetiology of Bell palsy is yet to be elucidated; thus, the diagnosis remains one of exclusion after other aetiologies for facial palsy have been considered 12,13. Prominent theories include reactivation of a virus, with herpes simplex virus type 1 (HSV-1) being the strongest pathogenic candidate, an immune-mediated phenomenon, or a microvascular issue 12,13. Anatomical predisposing factors, such as narrowing of the facial nerve pathway through the internal auditory canal, have also been suggested as contributory 13."
Expected headings
"Clinical presentation "
"Associations"
"Complications"
"The peak age of presentation is between 15-50 years with ~25 cases per 100,000 per year. There is no gender predominance 10."
"There is a limited role for imaging of patients with Bell palsy. MRI should be considered for the following patients:"
"Corticosteroids are the mainstay of treatment, to be started within 72 hours of symptom onset 12. Additionally, eye care should be sought, with use of eye drops (artificial tears) and ointments, and taping the eyes shut to protect the cornea 12. There is no role for empiric antiviral treatment 12. For facial synkinesis, therapies such as botulinum toxin A injections can be administered 16."
"The aetiology of Bell palsy is yet to be elucidated; thus, the diagnosis remains one of exclusion after other aetiologies for facial palsy have been considered 12,13. Prominent theories include reactivation of a virus, with herpes simplex virus type 1 (HSV-1) being the strongest pathogenic candidate, an immune-mediated phenomenon, or a microvascular issue 12,13. Anatomical predisposing factors, such as narrowing of the facial nerve pathway through the internal auditory canal, have also been suggested as contributory 13."