2. • DEFINITION
Acute onset of non suppurative inflammation
of the facial nerve above the
stylomastoidforamen,producing a unilateral
LMN FACIAL PALSY
3. • Incidence is 23/1,00,000
Affects men and women equally , all ages ,all
times of the year.
Increased occurrence in the elderly diabetics,
hypertensives than in the common people.
Increased incidence in women during the third
trimester of pregnancy 2 weeks preceding
delivery ,first two weeks postpartum.
4. Etiology of Acute peripheral facial
palsy
• Common-HSV type 1,varicella zoster virus
• Less common infection-Otitis media,Lymes
disease,EBV,CMV,Mumps,HHV 6,Intranasal
influenza vaccine,Mycoplasma
• Other less common conditions-
Trauma,Tumor,Hypertension,Guillain-Barre
syndrome,Sarcoidosis,Melkerson rosenthal
syndrome,Ribavirin,Interferone
5. • Patho physiology
HSV I DNA in the endoneural fluid
• due to reactivation of the virus in the
geniuclate ganglion.
6. • Onset of bell’s palsy is acute.
½ of the cases attain maximum paralysis in 48
hours.
All cases are clinically prominent by 5 days
7. • Pain behind the ear may precede the paralysis
by a day or two .
Impairement of taste is present to some
degree in all cases –.(chorda tympani)
Hyperacusis or distortion of sound in
ipsilateral ear ---paralysis of stapedius muscle
8. • Paralysis is partial in 30%,complete in
70%cases.
Jaw jerk is normal
Corneal reflex is absent
These differentiate it from UMN palsy
9. • UMN TYPE LMN TYPE
• Upper face escapes total face involved
• Bells phenomenon-A Present
• Taste sensation presreved may be lost
• Corneal reflex-N Lost
• Plantar response-extnsr Flexor
10. • BELL’S PHENOMENON
Normally on closing the eye ,the eyeball
moves upwards and inwards.
This is obvious on the affected side due to
ineffective closure of the eyelids
11. • Clinically
• Corner of mouth droops
• Forehead is unfurrowed
• Eyelids will not close
• Eye on the paralysed side rolls upward –BELL’S PHENOMENON
• Wide palpebral fissure
12. • Watering from the eye or epiphora
• Food collects between the teeth and lips
• Saliva may dribble from the corner of the
mouth
• Heaviness or numbeness of the face
• Sensory loss rarely demonstratble
• Loss of nasolabial fold
13. Investigations
• Enhancement of the facial nerve on gadolinium
enhanced MRI
• Increased lymphocytes ,mononuclear cells in CSF.
Shirmer test
• ESR
• Blood glucose levels
14. • Prognosis
85% patients recover within a few weeks.2-12
weeks.
10%-mild facial weakness as a sequele.
5%-are left with permanent severe facial
weakness
Best clinical guide to progress is the severity of
the palsy during the first few days after
presentation.
Recovery of taste precedes motor function
15. • If recovery of taste occurs in first week –good
prognostic sign.
Early recovery of motor function in the first 5-
7 days— most favourable prognosis.
Recurrence is due to reactivation of
virus,pregnancy.
Interval between periods is not predictable
16. • Treatment
Controversial
Symptomatic
1.Protection of eye during the sleep patch
2.Massage of the weakened muscles
3.Lubricating eye drops
4.Prednisolone 1mg/kg/day for 1 wk,followed by
a 1wk taper.
Decreases the possibility of permanent paralysis
From swelling of facial nerve in facial canal.
Decreases the severe pain
17. • 5.NSAIDS may be given for releif of pain and
inflammation
• 6.Proper mouth wash is advised after each
meal
• 7.Facial exercise is advised or consult
physiotherapist
• 8.Galvanic current stimulation of paralysed
muscle may be of some help
• 9.If not improved at all within 6 wks-surgical
decompression may be done at the
stylomastiod foramen
18. • 10.Parenteral vitamin B1,B6 and B12 may be
given; oral or parenteral methylcobalamine
may be of some help
• 11.Recently acyclovir or valanciclovir is tried,
although the evidence for giving antivirals is
poor.
20. Bad Prognostic Factors
1.Complete palsy at the beginning
2.Associated comorbidities
3.Hyperacusis or loss of taste sensation
4.Severe axonal degeneration on
elecrophysiological study(EMG) after 10 days
21. • MELKERSSEN ROSENTHAL SYNDROME
1.RECURRENT FACIAL PARLAYSIS
2.LABIAL EDEMA
3.FURROWING OF TONGUE
• Ramsay Hunt syndrome- Reactivation of
dormant herpes zoster in the geniculate
ganglion
1.c/f –vesicles around the external ear
canal,pinna,soft palate-sensorineural
HL,Vertigo due to involvement of VIII th nerve
along with facial palsy
