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Bell Palsy

most common cause of unilateral facial weakness also termed as idiopathic facial paralysis (IFP) an acute unilateral facial nerve palsy that is not associated with other cranial neuropathies or brainstem dysfunction common disorder at all ages from infancy through adolescence a careful history and physical examination will usually lead to a correct diagnosis
Nelson Textbook of Pediatrics 19th edition

Epidemiology
approximately 60-75% of cases of acute unilateral facial paralysis recurrent, with a reported recurrence range of 4-14% USA: annual incidence of Bell palsy is approximately 23 cases per 100,000 persons. occurs more commonly in adults, in people with diabetes, and in pregnant women
http://emedicine.medscape.com/article/1146903-overview

Epidemiology
affect both sexes equally young women aged 10-19 years are more likely to be affected than men in the same age group Peak ages are 20-40 years Slightly higher predominance is observed in patients older than 65 years (59 cases per 100,000 people) ; lowest incidence is in children younger than 10 years
http://emedicine.medscape.com/article/1146903-overview

Pathogenesis
usually develops abruptly about 2 weeks after a systemic viral infection preceding infection is due to the Epstein-Barr virus(20%); Lyme disease, herpes simplex virus, and mumps virus believed to be a postinfectious allergic or immune demyelinating facial neuritis rather than an active viral invasion of the nerve or of its motor neurons of origin. at times associated with hypertension
Nelson Textbook of Pediatrics 19th edition

History
is a diagnosis of exclusion sudden onset of unilateral facial paralysis which peak in less than 48 hours patients first notice paresis in the morning because symptoms require several hours to become evident likely begin during sleep may follow recent upper respiratory infection

http://emedicine.medscape.com/article/1146903-clinical

History
Acute onset of unilateral upper and lower facial paralysis over a 48-hr period Posterior auricular pain Otalgia Hyperacusis Poor eyelid closure Epiphora Ocular pain Blurred vision Taste disturbances Tingling or numbness of the cheek/mouth
http://emedicine.medscape.com/article/1146903-clinical

Physical Examination
flattening of the forehead and nasolabial fold on the affected side not able to close the eye completely on the affected side On attempted eye closure, the eye rolls upward and inward on the affected (Bell phenomenon) decreased tearing and susceptibility to corneal abrasion and dryness of the eye unilateral drooping of an eyebrow and the corner of the mouth taste on the anterior two thirds of the tongue is lost on the involved side (50%)
Nelson Textbook of Pediatrics 19th edition

Grading House and Brackmann


Grade I - Normal facial function Grade II - Mild dysfunction Grade III - Moderate dysfunction Grade IV - Moderately severe dysfunction Grade V - Severe dysfunction Grade VI- Total paralysis

http://emedicine.medscape.com/article/1146903-clinical

Treatment
Protection of the cornea with methylcellulose eye drops or an ocular lubricant Studies do not support the efficacy of steroids to induce remission, and they are not recommended. Surgical decompression of the facial canal, theoretically to provide more space for the swollen facial nerve, is not of value.
Nelson Textbook of Pediatrics 19th edition

Prognosis
Excellent More than 85% of cases recover spontaneously with no residual facial weakness; 10% have mild facial weakness as a sequela; only 5% are left with permanent severe facial weakness.

Nelson Textbook of Pediatrics 19th edition