Bells Palsy

Dwi Kusumaningsih

Definisi dan Epidemologi

Peripheral facial palsy of unknown origin Insiden: 20 30/100.000 / th

=
Umur median : 40, insidens tertinggi usia tua > 70 th, jarang anak < 10 th 60 75% unilateral

Diagnosis
Bedakan sentral atau perifer Pertimbangkan apakah suatu Hemifacial spasm Some diagnostic work up:
MRI
Contrast enhanced in:
intercanalicular

Labirinth
Geniculate Mastoid segmen of facial nerve

EMG
Dilakukan 3 hari setelah paresis komplit Outcome :
< 90% axonal degeneration in first 3 weeks good recovery 90% > 90% axonal degeneration in first 3 weeks poor outcome 50% recovery > 90% in 5 days worse than > 90% in 14 days

Where is The Lession ?

A: central type B. Peripheral C. Hemifacial spasm

Terapi
Corticosteroids
Prednison (40 60 mg selama 5 hr tapper off 5 mg/day)

Antiviral
Acyclovir 5 dd 800 mg
Famcyclovir 3 dd 750 mg

Surgical Decompression
Masih kontroversial Reseved for proximal geniculate, > 90% axonal deg Tidak dilakukan setelah 14 hr onset Gangguan pendengaran 1 -15% Px

Prognosis
Bad if
Complete facial palsy No recovery by three weeks Age over 60 years Severe pain Ramsay Hunt syndrome (herpes zoster virus Associated conditions : hypertension, diabetes pregnancy Severe degeneration of the facial nerve shown by electrophysiological testing