FACIAL NERVE

Cortical control of VII nerve

Supranuclear control (UMN) of the facial

nerve is by the contra lateral precentral
gyrus, cross over to the facial nerve ucleus
in the pons.

BELLS PALSY
Definition
Bells palsy is idiopathic unilateral lower
motor type of facial nerve palsy.
Pathophysiology
Reactivation of herpes simplex type 1 in the
geniculate ganglion causing swelling of facial
nerve resulting in facial nerve palsy.
The lesion is believed to be at the stylomastoid
foramen

Clinical features
It affects men and women equally and is
seen at all ages.

Onset is abrupt and is unilateral and worsens

quickly

Maximal weakness usually is attained by 48

hours.

Features of LMN facial palsy will be there

The corner of the mouth droops, the creases and

skin folds are effaced, the forehead is unfurrowed,
and the eyelids will not close.

Upon attempted closure of the lids, the eye on the

paralyzed side rolls upward (Bell's phenomenon).

The lower lid sags also, and the punctum falls

away from the conjunctiva, permitting tears to
spill over the cheek.

Food collects between the teeth and lips, and

saliva may dribble from the corner of the mouth.

Taste is lost over the anterior two-thirds of the tongue on the

same side due to damage to chorda tympani nerve

There may be hyperacusis and rarely tearing from the eye

Loss of corneal reflex on side of facial palsy

May have subjective numbness on side of facial weakness,

but no true sensory deficit on testing (fifth cranial nerve
spared)

Rest of neurological examination is normal.

LMN lesion

Differential Diagnosis

Ramsay Hunt syndrome

Facial palsy associated with a vesicular eruption of
the pharynx, external auditory canal,
Often the eighth cranial nerve is affected as well.

Acoustic neuroma

Tumors that invade the temporal bone

lesion in the brain (upper motor neuron)

Investigations

Diagnosis can usually be made clinically

Investigations like MRI, ESR, HIV testing are

required only if presentation is atypical like
bilateral, involvement of other cranial nerve
and pyramidal tract.

Electromyography (EMG) has only

prognostic value

Treatment
1) Symptom management
Paper tape or patch to depress the upper eyelid
during sleep and prevent corneal drying and
abrasions
2) Medical treatment
a) Prednisolone
Oral prednisolone60 to 80 mg daily during the
first 5 days then tapered over the next 5 days
To be initiated in first 4872 hours of
symptoms.

Treatment (cont.)
b) Acyclovir

Combined with prednisone should be started

within 3 days of symptom onset

Dose - 400 mg 5 times daily for 10 days .

Complications
Corneal drying and injury (abrasion, ulceration)
Incomplete recovery with partial or permanent
nerve impairment

Prognosis
Approximately 8090% of patients recover
fully within a few weeks or months
Evidence of denervation by EMG after 10
days indicates bad prognostic sign.

DONT FORGET
UMN

lesions cause opp. side lower

half facial nerve palsy.

LMN

lesions cause same side one half

facial palsy.

Dont forget
Bells palsy
Onset

is LMN facial palsy.

is acute and is unilateral.

Diagnosis

is clinical

Treatment

steroids + acyclovir