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Infectious Disease – Bell’s Palsy
BASICS DESCRIPTION
• Bell’s palsy is characterized by acute, idiopathic, unilateral paralysis of the facial nerve. • Approximately fifty percent of facial nerve palsy cases are classified as “Bell’s palsy.”
Bilateral illness constitutes a rare subtype, accounting for 0.3%.
ETIOLOGY
• Herpes simplex virus • Herpes zoster virus, including herpes zoster oticus • Negative occurrence after to vaccination
Epidemiology
Incidence • Rates range from 13 to 34 instances per 100,000 in the United States. • Incidence peaks among individuals aged 20–35 years and those over 70 years.
• The distribution of boys and females is equal. • Bell's palsy is the predominant etiology of VII nerve palsy in pediatric patients.
RISK FACTORS
• Gestation • Diabetes mellitus • Hypertension in individuals over 40 years
GENERAL PREVENTION
Currently, there is no method to avert Bell's palsy.
DIAGNOSIS
• Sudden onset within one to two days, fast advancement of partial or complete unilateral facial nerve paralysis • Reduced tear and saliva secretion on the affected side • Hyperacusis • Dysgeusia • Retroauricular pain
DIFFERENTIAL DIAGNOSIS
The differential diagnoses list is extensive and includes, among others:
• Echovirus and enterovirus infections • Lyme disease • HIV infection, onset during seroconversion • Otitis media and mastoiditis • Mycobacterium tuberculosis • Syphilis • Infectious meningitis • Rubella • Tetanus • Mycoplasma • Cholesteatoma • Sarcoidosis
• Sjögren’s syndrome • Systemic lupus erythematosus • Melkersson–Rosenthal syndrome • Cerebral aneurysm • Tumor of the parotid gland • Melanoma of the head and neck • Meningioma • Carcinomatous meningitis • Granulomatous meningitis of unknown cause • Guillain-Barré syndrome • Pseudobulbar palsy • Birth trauma • Petrous bone fractures • Iatrogenic/surgical complications
• Paget's disease
• Consider bilateral facial nerve paralysis in the context of:
– Lyme disease – Sarcoidosis
DIAGNOSTIC TESTS & INTERPRETATION
Laboratory
• Electrodiagnostic examinations:
Patients with an incomplete, typical lesion who recover do not require additional investigation. - Electromyography (EMG)
Electroneurography (also known as evoked electromyography)
Imaging
Imaging is required if the clinical presentation is abnormal, development is gradual, or there is no improvement after six months. A CT or MRI scan may be necessary to exclude intracerebral pathology or middle ear disease in complex cases. Recent studies indicate that the ultrasonography diameter of the distal VII nerve is a reliable prognostic indicator for Bell's palsy at three months post-onset.
THERAPY
Early administration of prednisolone markedly enhances the likelihood of full recovery at 3 and 9 months (Recommendation Grade 1A).
Treatment must commence within three days.
The advised dosage is 60–80 mg each day for one week.
• Antivirals are designated for severe facial palsy (Recommendation Grade 2C).
• Safeguarding the ipsilateral eye with artificial tears and lubricating ointments throughout nocturnal hours.
The topic of surgical decompression remains contentious.
CONTINUOUS CARE
• Crucial for ocular health and mental well-being.
COMPLICATIONS
• Incomplete healing in one-third of patients • Keratitis and corneal abrasions
Recurrence has been noted in 7–15% of instances.
BASICS DESCRIPTION
• Bell’s palsy is characterized by acute, idiopathic, unilateral paralysis of the facial nerve. • Approximately fifty percent of facial nerve palsy cases are classified as “Bell’s palsy.”
Bilateral illness constitutes a rare subtype, accounting for 0.3%.
ETIOLOGY
• Herpes simplex virus • Herpes zoster virus, including herpes zoster oticus • Negative occurrence after to vaccination
Epidemiology
Incidence • Rates range from 13 to 34 instances per 100,000 in the United States. • Incidence peaks among individuals aged 20–35 years and those over 70 years.
• The distribution of boys and females is equal. • Bell's palsy is the predominant etiology of VII nerve palsy in pediatric patients.
RISK FACTORS
• Gestation • Diabetes mellitus • Hypertension in individuals over 40 years
GENERAL PREVENTION
Currently, there is no method to avert Bell's palsy.
DIAGNOSIS
• Sudden onset within one to two days, fast advancement of partial or complete unilateral facial nerve paralysis • Reduced tear and saliva secretion on the affected side • Hyperacusis • Dysgeusia • Retroauricular pain
DIFFERENTIAL DIAGNOSIS
The differential diagnoses list is extensive and includes, among others:
• Echovirus and enterovirus infections • Lyme disease • HIV infection, onset during seroconversion • Otitis media and mastoiditis • Mycobacterium tuberculosis • Syphilis • Infectious meningitis • Rubella • Tetanus • Mycoplasma • Cholesteatoma • Sarcoidosis
• Sjögren’s syndrome • Systemic lupus erythematosus • Melkersson–Rosenthal syndrome • Cerebral aneurysm • Tumor of the parotid gland • Melanoma of the head and neck • Meningioma • Carcinomatous meningitis • Granulomatous meningitis of unknown cause • Guillain-Barré syndrome • Pseudobulbar palsy • Birth trauma • Petrous bone fractures • Iatrogenic/surgical complications
• Paget's disease
• Consider bilateral facial nerve paralysis in the context of:
– Lyme disease – Sarcoidosis
DIAGNOSTIC TESTS & INTERPRETATION
Laboratory
• Electrodiagnostic examinations:
Patients with an incomplete, typical lesion who recover do not require additional investigation. - Electromyography (EMG)
Electroneurography (also known as evoked electromyography)
Imaging
Imaging is required if the clinical presentation is abnormal, development is gradual, or there is no improvement after six months. A CT or MRI scan may be necessary to exclude intracerebral pathology or middle ear disease in complex cases. Recent studies indicate that the ultrasonography diameter of the distal VII nerve is a reliable prognostic indicator for Bell's palsy at three months post-onset.
THERAPY
Early administration of prednisolone markedly enhances the likelihood of full recovery at 3 and 9 months (Recommendation Grade 1A).
Treatment must commence within three days.
The advised dosage is 60–80 mg each day for one week.
• Antivirals are designated for severe facial palsy (Recommendation Grade 2C).
• Safeguarding the ipsilateral eye with artificial tears and lubricating ointments throughout nocturnal hours.
The topic of surgical decompression remains contentious.
CONTINUOUS CARE
• Crucial for ocular health and mental well-being.
COMPLICATIONS
• Incomplete healing in one-third of patients • Keratitis and corneal abrasions
Recurrence has been noted in 7–15% of instances.
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