Bell palsy
See also in: External and Internal EyeSynopsis

Although the etiology for Bell palsy is idiopathic, autoimmune and/or viral-induced inflammation of the peripheral nerve is believed to play a role. Herpes zoster sometimes causes Bell palsy and is associated with vesicles by the ear (Ramsay-Hunt syndrome). Herpes simplex, cytomegalovirus, Epstein-Barr virus, and Borrelia infections including Lyme disease have also been associated. The use of some medications has rarely been associated with Bell palsy.
Severe hypertension has been associated with facial palsy, particularly in children but also in adults. In children, there may be a substantial delay to diagnosis of hypertension; one study notes a median time of 45 days between the first symptoms of peripheral facial palsy and a diagnosis of arterial hypertension. Another study reports that adults with uncontrolled hypertension due to poor medication compliance have a higher incidence of Bell palsy.
Patients may complain of difficulty with their speech and eating because of mouth droop. Due to the paralytic eyelid muscles, patients may have incomplete eye closure, causing their eyes to feel dry and leading to excessive corneal exposure and sometimes ulceration. Patients may have difficulty blinking, altered taste and tear production, and hyperacusis. The palsy is usually sudden in onset, with maximal facial weakness developing within 2 days. Facial or retroauricular pain may also be associated, but severe pain is highly suggestive of herpes zoster infection.
Eighty-four percent of patients with Bell palsy have spontaneous recovery within 2-3 months. Although most patients recover, up to 30% have residual pain and facial asymmetry. Aberrant regeneration (synkinesis) may occur after an acute episode.
Codes
G51.0 – Bell's palsy
SNOMEDCT:
193093009 – Bell Palsy
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
Subscription Required
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required