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Bell's Palsy, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Acute, idiopathic peripheral CN VII (facial nerve) palsy

  • Complete recovery in 85% of cases without treatment

  • Degree of deficit correlates with prognosis:

    • Complete lesions have poorest p...

Diagnosis

Signs and Symptoms

History

Sudden onset of unilateral facial droop, incomplete eyelid closure, and loss of forehead muscle tone: 
  • Maximal deficit by 5 days in almost all cases (2 days in 50%)

  • Te...

Treatment

Pre-Hospital

None 

Initial Stabilization/Therapy

Patients with an isolated peripheral CN VII palsy are stable. 

Ed Treatment/Procedures

  • Corneal damage may result from incomplete eyelid closure:

    • Lu...

Follow-Up

Disposition

Admission Criteria

Isolated peripheral CN VII palsy does not require admission. 

Discharge Criteria

Isolated peripheral CN VII palsy may be treated on outpatient basis. 

Followup Recommendations

Pearls and Pitfalls

  • Motor weakness isolated to 7th nerve distribution:

    • Involves both upper and lower face

    • If tone is NOT lost on the forehead, it is not Bell's palsy.

  • Otherwise normal neurologic exam inc...

Additional Reading

  • de Almeida  JR, Al Khabori  M, Guyatt  GH, et al. Combined corticosteroid and antiviral treatment for Bell's palsy: A systematic review and meta-analysis. JAMA.  2009;302:985–9...

Codes

ICD9

351.0 Bell's palsy 

ICD10

G51.0 Bell's palsy 

SNOMED

  • 193093009 Bell's palsy (disorder)

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