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 DEFINITION
The facial palsy of Bell: it is a question of an injury of the facial nerve generally produced by a virus or by an autoimmune illness.
CLINIC
It can happen at any age, in any sex and in persons previously healthy. The individual can notice in the previous days a pain behind the ear pavilions, sometimes with light affectation of the general state. It can notice, usually without previous symptoms, that it cannot close well the eye and that it does a rare "grimace" with the mouth. Sometimes it the others notice earlier that the proper patient. Generally the facial palsy is restored during hours to three days. Sometimes it is possible to notice an increase of the sounds in an ear or decrease of the flavor. The eye can cry on not having been able to blink of effective form.
I DIAGNOSE
Whenever a facial palsy fond of the eyelid, so that it cannot close it completely and to the mouth, which is twisted, and there are no other symptoms in the rest of head and members, it is necessary to think that it is a question of a palsy in the peripheral trajectory of the facial nerve. These palsies almost always are essential (of unknown origin).
EXPLORATION
- Look if it closes the eye. In the essential facial palsy (Bell) the eye does not close or stays with incomplete closing
- Try to close the teeth strongly. In case of palsy it will see like a commissure it contracts and other one not. It contracts just that of the side that does not close the eye.
- Indicate the elevation of the eyebrows up. The muscle of the forehead does not contract or not long ago.
- Look at the auditory conduit. If there are vesicles there talks each other of a facial palsy herpética (syndrome of Ramsay-Hunt). It has a completely different treatment with Aciclovir.
TREATMENT
70 % of the essential facial palsies recovers acceptably.
With treatment with cortisone from the first days the palsies improve up to 90 %.
Do not forget the eye. The eyelid has a protective function and extends the tears. During the day it must protect the eye with sunglasses and replace the blinking with the hand. In the night there must put itself ointment that dampens the eye and a patch so that I avoided the drying and the risk of corneal ulcer.
WHAT DOCTOR CAN TREAT ME?
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